Background: Internationally, elder abuse is underreported. Health professionals have statutory responsibilities to intervene when action is required to safeguard older people living in the community. The GP is often the first health professional that an older person will turn to, when they want to report abuse perpetrated by a family carer. Currently, there is little research available in Ireland, the UK and internationally on GPs’ experiences of managing elder abuse of this nature.Aim: To explore GPs’ experiences of management of elder abuse perpetrated by a family carer.Design and Setting: Two focus groups were conducted, involving nine GPs in primary care in Northern Ireland. Method: Purposive sampling was used to recruit the GPs. The focus group discussions were audio-recorded and transcribed. Date were analysed using a process of thematic analysis.Results: The overarching theme of GPs feeling under-prepared for management of elder abuse perpetrated by a family carer permeated through all the data. Three subthemes were identified. These are ‘intervening to minimise potential for abuse’, ‘confronting challenge and isolation’, and ‘taking ownership of the responsibility to report abuse’. GPs highlighted learning needs relating to the practical application of safeguarding legislation. A number of important issues were raised that have implications for nursing practice. These include a sense of frustration that nurses distance themselves from GPs when elder abuse is suspected, a perception that some victims of elder abuse will encounter challenge in being believed, and the rising prevalence of medication misuse for financial gain in the community. Conclusions: Our findings demonstrate a need for greater collaboration between GPs, nurses and social workers in the management of elder abuse. An inter-professional elder abuse training programme may have value in enhancing knowledge and clarifying the role and responsibilities of GPs, nurses, social workers, and pharmacists in the prevention, identification and management of abuse.
|Journal||Journal of the All Ireland Gerontological Nursing Association|
|Publication status||Accepted/In press - 12 Mar 2018|
Bibliographical noteReference text: Abolfathi Momtaz Y., Hamid T.A. & Ibrahim R. (2013). Theories and measures of elder abuse. Psychogeriatrics, 13, 182-188.
Acierno R., Hernandez M.A., Amstadter A.B., Resnick H.S., Steve K., Muzzy W. & Kilpatrick D.G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the national elder mistreatment study. American Journal of Public Health, 100, 292-297.
Adult Support and Protection (Scotland) Act (2007). Available at: http://www.legislation.gov.uk/asp/2007/10/contents. Accessed 5 September 2017.
Almogue A., Weiss A., Marcus E.L. & Beloosesky Y. (2009). Attitudes and knowledge of medical and nursing staff toward elder abuse. Archives of Gerontology and Geriatrics, 51, 86–91.
Assisted Decision-Making (Capacity) Act 2015. Available at: http://www.irishstatutebook.ie/eli/2015/act/64/enacted/en/html Accessed 26 February 2018.
Bensadon B.A., Teasdale T.A. & Odenheimer G.L. (2013). Attitudinal adjustment: Shaping medical students’ perceptions of older patients with a geriatrics curriculum. Academic Medicine, 88 (11), 1630-1634.
Brandl B. & Raymond J.A. (2012). Policy implications of recognizing that caregiver stress is not the primary cause of elder abuse. Generations, 36 (3), 32-39.
British Association of Social Workers (2012). The Code of Ethics for Social Work. Available at: http://cdn.basw.co.uk/upload/basw_112315-7.pdf. Accessed 12 October 2017.
Care Act (England) (2014). Available at: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted/data.htm. Accessed 7 April 2017.
Colaizzi P.F. (1978). Psychological Research as the phenomologist views it. In Valle, RS. and King, M.(eds), Existential phenomenological alternatives for psychology. Oxford University Press, Oxford.
Cooper C., Selwood A. & Livingston G. (2009). Knowledge, Detection, and Reporting of Abuse by Health and Social Care Professionals: A Systematic Review. American Journal of Geriatric Psychiatry, 17, 826-38.
Davis L.L, Burgio L, Buckwalter K.C. & Weaver M.T. (2004) A comparison of in-home and telephone-based skill training interventions with caregivers of persons with dementia. Journal of Mental Health & Aging, 10, 31–44.
Department of Health, Social Services & Public Safety (2010). Adult safeguarding in Northern Ireland: regional and local partnership arrangements. DHSSPS, Belfast.
Dong X.Q. (2015). Elder Abuse: Systematic Review and Implications for Practice. Journal of the American Geriatric Society, 63, 1214-1238.
Dong X.Q. & Simon M.A. (2014). Vulnerability risk index profile for elder abuse in a community-dwelling population. Journal of the American Geriatric Society, 62, 10-15.
Elder Justice Coalition (2014). Elder Justice Act Summary. Available at: http://elderjusticecoalition.com/sites/default/files/documents/Elder%20Justice%20Act%20Facts%20Funding%20Resources.pdf. Accessed 3 December 2017.
Elliott, R.A., Lee, C.Y., Beanland, C., Vakil, K., Goeman, D. (2016). Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study. Drugs - Real World Outcomes, 3 (1), 13–24.
Feinberg LF, Wolkwitz K, Goldstein C. (2006) Ahead of the curve: Emerging trends in family caregiver support. AARP, Washington.
Fisher J.M. & Walker R.W. (2013). A new age approach to an age old problem: using simulation to teach geriatric medicine to medical students. Age and Ageing, 43, 424-428.
Friedman LS., Avila S., Shah M., Tanouye K. & Joseph K. (2014). A description of cases of severe physical abuse in the elderly and 1-year mortality. Journal of Elder Abuse & Neglect, 26, 1-11.
General Medical Council (2009). Confidentiality. GMC, London.
Harbinson J., Coughlan S., Beaulieu M., Karabanow J., VanderPlatt M., Wildeman S & Wexler E. (2012). Understanding elder abuse and neglect: A critique of assumptions underpinning responses to the treatment and neglect of older people. Journal of Elder Abuse and Neglect, 24, 88-103.
Health Service Executive (2014). Safeguarding Vulnerable Persons at Risk of Abuse National Policies and Procedures, Social Care Division, HSE, Kildare.
Helmes E. & Cuevas E. (2007). Perceptions of elder abuse among Australian older adults and general practitioners. Australasian Journal on Ageing, 26, 120-124.
Hempton C., Dow B., Cortes-Simonet E.N., Ellis K., Koch S., LoGiudice D., Mastwyk M., Livingston G., Cooper C. & Ames D. (2010). Contrasting perceptions of health professionals and older people in Australia: what constitutes elder abuse? International Journal of Geriatric Psychiatry, 26, 466–472.
Irish Medical Council (2016) Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edn. Available at: https://www.medicalcouncil.ie/News-and-Publications/Reports/Guide-to-Professional-Conduct-and-Ethics-8th-Edition-2016-.pdf. Accessed 26 February 2018.
Johannesen M. & LoGiudice D. (2013). Elder abuse: a systematic review of risk factors in community-dwelling elders. Age and Ageing, 42 (3), 292-298.
Manthorpe J., Samsi K. & Rapaport J. (2012). Responding to the financial abuse of people with dementia: A qualitative study of safeguarding experiences in England. International Psychogeriatrics, 24 (9), 1454–64.
Melchiorre M.G., Penhale B. & Lamura G. (2014). Understanding Elder Abuse in Italy: Perception and Prevalence, Types and Risk Factors from a review of the literature. Educational Gerontology, 40, 909-931.
Mental Capacity Act (Northern Ireland) (2016). Available at: http://www.legislation.gov.uk/nia/2016/18/contents/enacted Accessed 4 April 2017.
Moyer V.A. (2013). Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 158, 478-486.
National Center on Elder Abuse (2014). Types of Abuse. Available online at: http://www.ncea.aoa.gov/FAQ/Type_Abuse/index.aspx, Accessed 29 October 2017.
Nursing and Midwifery Board of Ireland (2014). Code of Professional Conduct and Ethics. Available at: https://www.nmbi.ie/nmbi/media/NMBI/Publications/Code-of-professional-Conduct-and-Ethics.pdf?ext=.pdf. Accessed 10 December 2017.
Nursing and Midwifery Council (2015). The Code Professional standards of practice and behaviour for nurses and midwives. NMC, London.
O'Brien J., ni Riain A. Collins C., Long V. & O'Neill D. (2014). Elder Abuse and Neglect – a Survey of Irish General Practitioners. Journal of Elder Abuse & Neglect, 26, (3), 291-299.
O’Keefe M., Hills A., Doyle M., McCreadie C., Scholes S., Constantine R., Tinker A., Manthorpe J., Biggs S. & Erens B. (2007). UK Study of Abuse and Neglect of Older People: prevalence survey report. National Centre for Social Research, London.
Rinker A.G. (2009). Recognition and perception of elder abuse by prehospital and hospital-based care providers. Archives of Gerontology and Geriatrics. 48, 110–115.
Roth D.L, Mittleman M.S., Clay O.J., Madan A., Haley W.E. (2005). Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer’s disease. Psychology & Aging, 20, 634–44.
Schmeidel A. N., Daly, J. M., Rosenbaum M. E., Schmuch G. A. & Jogerst J. (2012). Health care professionals’ perspectives on barriers to elder abuse detection and reporting in primary care settings. Journal of Elder Abuse & Neglect, 24, 17-36.
Social Services and Well-being Act (Wales) (2014). Available at: http://www.legislation.gov.uk/anaw/2014/4/pdfs/anaw_20140004_en.pdf Accessed 22 November 2017.
Visser-Meily A, van Heugten C, Post M, Schepers V & Lindeman E. (2005). Intervention studies for caregivers of stroke survivors: A critical review. Patient Education & Counselling, 56, 257–67.
Walden G. (2012) Focus Group Research. Sage, London.
Wiglesworth A., Mosqueda L., Mulnard R., Liao S., Gibbs L. & Fitzgerald W. (2010). Screening for abuse and neglect of people with dementia. Journal of American Geriatric Society, 58, 493-500.
World Health Organisation / International Network for the Prevention of Elder Abuse (2002). Missing Voices: Views of Older Persons on Elder Abuse. WHO, Geneva.
Yan E. (2014) Abuse of older persons with dementia by family caregivers: results of a 6-month prospective study in Hong Kong. International Journal of Geriatric Psychiatry, 29, 1018-1027.
Yaffe M.J., Weiss D. & Lithwick M. (2012) Seniors’ self-administration of the elder abuse suspicion index (EASI): A feasibility Study. Journal of Elder Abuse & Neglect, 24, 277-292.
- Elder abuse
- family caregiving
- general practice
- primary health care
- qualitative research.