Krueger P, Patterson C
Hamilton-Wentworth Regional Public Health Department, McMaster University, Hamilton, Ont.
CMAJ. 1997 Oct 15;157(8):1095-100.
To determine family physicians' perceptions of barriers and strategies in the effective detection and appropriate management of abused elderly people.
Questionnaire survey; the protocol included an advance notification letter and 3 follow-up mailings.
Regional Municipality of Hamilton-Wentworth, Ont.
All active nonspecialist physicians who reported seeing elderly patients in their practices were eligible for inclusion. Fifty health service organization (HSO) physicians were randomly selected from among those listed with the HSO Mental Health Program, and 200 fee-for-service physicians were randomly selected from the Canadian Medical Directory. Of the 189 eligible physicians 122 returned completed questionnaires, a response rate of 65%.
Physicians' ratings of the importance of potential barriers in assisting older people experiencing abuse and of the usefulness of strategies for dealing with elder abuse.
Physicians identified the following barriers as fairly or very important: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. Strategies deemed to be helpful included a single agency to call, a directory of services, a list of resource people, an educational package, guidelines for detection and management, reimbursement for time spent on legal matters, continuing education, revision of fee structure and a central library of resources on elder abuse.
Although the physicians perceived numerous barriers to their detection and management of elder abuse, they identified many strategies that could be implemented at a local level. Preparation of an algorithm to help physicians is the next phase of this work.
确定家庭医生对于有效发现并妥善处理受虐老年人过程中存在的障碍及策略的看法。
问卷调查；方案包括一封预先通知信和三次后续邮寄。
安大略省汉密尔顿 - 温特沃斯地区市政当局。
所有报告在其诊疗过程中看过老年患者的在职非专科医生均符合纳入条件。从心理健康项目列出的医生中随机选取50名卫生服务机构（HSO）医生，从加拿大医学名录中随机选取200名按服务收费的医生。189名符合条件的医生中有122名返回了完整问卷，回复率为65%。
医生对协助受虐老年人时潜在障碍的重要性以及处理虐待老年人问题策略的有用性的评分。
医生认为以下障碍相当重要或非常重要：否认虐待、抵制干预、不知向何处求助、缺乏评估和应对虐待的方案、缺乏保密指南、害怕报复以及对虐待老年人的患病率和定义缺乏了解。被认为有帮助的策略包括一个可拨打的单一机构、服务目录、资源人员名单、教育包、检测和管理指南、处理法律事务时间的报销、继续教育、费用结构调整以及一个关于虐待老年人的资源中央图书馆。
尽管医生们意识到在发现和处理虐待老年人问题上存在众多障碍，但他们也确定了许多可在地方层面实施的策略。编写帮助医生的算法是这项工作的下一阶段。
