Makaroun Lena K, Shin Naomi, Hruska Kristina L, Rosen Tony, Dichter Melissa E, Thorpe Carolyn T, Rodriguez Keri L, O'Hare Ann, Rosland Ann-Marie
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Innov Aging. 2025 Feb 10;9(5):igaf012. doi: 10.1093/geroni/igaf012. eCollection 2025.
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.
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.
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).
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.
虐待老年人（EA）情况普遍，且对健康有重大影响。新举措试图利用医疗系统内部应对EA的机会，但对于临床医生在这些努力中取得成功可能需要什么却知之甚少。我们的目标是从一系列不同学科的一线临床医生的角度，了解在综合医疗系统中管理EA各个阶段所感知到的障碍和促进因素。
来自2个大型退伍军人健康管理局（VHA）医疗中心不同临床地点的37名临床医生（10名社会工作者、9名医生、7名心理学家、6名护士和5名高级执业提供者）参与了半结构化访谈。访谈指南旨在引出在应对EA过程中各个离散阶段的促进因素和障碍，包括检测、报告、干预和监测。使用演绎法（基于预先指定的概念模型）和归纳法对访谈记录进行编码，并采用主题分析法进行分析。
大多数（78%）参与者为女性，年龄在33岁至64岁之间，在各种环境（如初级保健和急诊科）工作，有4至25年的VHA工作经验。我们确定了5个相互关联的主题，贯穿于EA护理的不同阶段：情境背景（主题1）、对家庭和医疗关系的信任程度（主题2）、教育和技能水平（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获得授权并激发行动动力（主题5）。
加强技能培训、建立信任关系以及改善系统基础设施的努力，有助于使临床医生有能力参与医疗系统干预，以减少EA造成的伤害。
