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

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.