Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia

Abstract

This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.

Development and validation of REAGERA-P, a new questionnaire to evaluate health care provider preparedness to identify and manage elder abuse

“…Barriers to identifying and managing elder abuse in health care have been found on the personal level, on the organizational level, and on the system level [11,14,15,20]. Examples of barriers on the personal level are when health care professionals are unaware of elder abuse or unsure of what constitutes abuse, when they are concerned that asking about abuse would have a negative impact on their relationship with the patient, or when they lack confidence in their ability to manage abuse cases [11][12][13][14][15][16][20][21][22][23]. Some reported that barriers on the organizational or system levels include a lack of time to deal with such a complex issue or lack of clear referral pathways to effective support systems [11,14,20,[23][24][25].…”

Validation of REAGERA-S: a new self-administered instrument to identify elder abuse and lifetime experiences of abuse in hospitalized older adults

“…The health care system is considered an important institution for identifying and managing elder abuse (Cohen, Levin, Gagin, & Friedman, 2007;, X. Q. Dong, 2015Ministry of Health and Social Affairs, 2014). Despite elder abuse being a known and serious health problem, many health care professionals hesitate to ask about experiences of abuse (Mohd Mydin & Othman, 2017;Schmeidel, Daly, Rosenbaum, Schmuch, & Jogerst, 2012). Furthermore, older adults seldom self-report abuse and are often unaware of where to seek help (Eriksson, 2001;Erlingsson, Saveman, & Berg, 2005;Fulmer, Guadagno, Bitondo Dyer, & Connolly, 2004).…”

Hospitalization Due to Assault Injury Across Different Age Groups, 2010 to 2014: A Population-Based Study in New South Wales, Australia

“…8 Moreover, the fear of disclosure or difficulty understanding what constitutes “abuse” makes detection difficult. 9 Due to the natural health consequence of aging, recovery from physical injury may lead to slower recovery, leading to increased hospital length of stay (LOS), access to multiple health services, and higher mortality rates. 10…”