Healthcare Clinicians' Perspectives on Managing Suspected Elder Abuse: "We Don't Want to Just Swoop in and Do What We Think Is Best".

IF 4.9 3区医学 Q1 GERIATRICS & GERONTOLOGY

Innovation in Aging Pub Date : 2025-02-10 eCollection Date: 2025-01-01 DOI:10.1093/geroni/igaf012

Lena K Makaroun, Naomi Shin, Kristina L Hruska, Tony Rosen, Melissa E Dichter, Carolyn T Thorpe, Keri L Rodriguez, Ann O'Hare, Ann-Marie Rosland

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引用次数: 0

Abstract

Background and objectives: Elder abuse (EA) is common and has significant health impacts. New initiatives seek to capitalize on opportunities to respond to EA from within the healthcare system, but little is known about what clinicians may need to be successful in these efforts. Our objective was to understand perceived barriers and facilitators to managing all phases of EA within an integrated healthcare system from the perspectives of frontline clinicians from a range of different disciplines.

Research design and methods: Thirty-seven clinicians (10 social workers, 9 physicians, 7 psychologists, 6 nurses, and 5 advanced practice providers) from different clinical sites within 2 large Veterans Health Administration (VHA) medical centers participated in semistructured interviews. The interview guide was designed to elicit facilitators and barriers to discrete stages in the process of addressing EA, including detection, reporting, intervention, and monitoring. Transcripts were coded using deductive (based on a prespecified conceptual model) and inductive approaches and analyzed using thematic analysis.

Results: Most (78%) participants were women, ranging in age from 33 to 64 years, and practicing in a variety of settings (e.g., primary care and emergency department) with between 4 and 25 years of VHA experience. We identified 5 interrelated themes that cut across the different stages of EA care: situational context (theme 1), degree of trust in familial and healthcare relationships (theme 2), extent of education and skills (theme 3), and existing system infrastructure (theme 4) all contributed to clinician empowerment and motivation toward action (theme 5).

Discussion and implications: Efforts to enhance skills training, build trusting relationships, and improve system infrastructure could help to equip clinicians to engage in healthcare system interventions to reduce harm from EA.

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医疗保健临床医生对管理疑似虐待老人的观点：“我们不想只是突然进入并做我们认为最好的事情”。

背景和目标：虐待老年人很常见，对健康有重大影响。新的计划寻求利用机会从医疗保健系统内部响应EA，但是很少知道临床医生在这些努力中可能需要什么才能成功。我们的目标是从不同学科的一线临床医生的角度，了解在综合医疗保健系统中管理EA所有阶段的感知障碍和促进因素。研究设计与方法：来自2个大型退伍军人健康管理局（VHA）医疗中心不同临床站点的37名临床医生（10名社会工作者、9名内科医生、7名心理学家、6名护士和5名高级执业医师）参加了半结构化访谈。访谈指南的设计是为了引出解决EA过程中离散阶段的促进因素和障碍，包括检测、报告、干预和监控。使用演绎（基于预先指定的概念模型）和归纳方法对转录本进行编码，并使用主题分析进行分析。结果：大多数（78%）参与者为女性，年龄从33岁到64岁不等，在各种环境（例如，初级保健和急诊科）执业，具有4至25年的VHA经验。我们确定了跨越EA护理不同阶段的5个相互关联的主题：情景背景（主题1），对家庭和医疗保健关系的信任程度（主题2），教育和技能程度（主题3）以及现有系统基础设施（主题4），所有这些都有助于临床医生的授权和行动动机（主题5）。讨论和影响：努力加强技能培训，建立信任关系，改善系统基础设施可以帮助临床医生参与医疗保健系统干预，以减少EA的伤害。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Innovation in Aging GERIATRICS & GERONTOLOGY-

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

15 weeks

期刊介绍： Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.