Primary care physicians and elder abuse: current attitudes and practices.

CONTEXT: while estimates suggest that between 1.4% and 5.4% of older adults experience abuse, only 1 of 14 cases of elder abuse or neglect is ever reported to authorities. It is critical for clinicians to be aware of elder abuse in order to improve primary care. OBJECTIVE: to understand Michigan primary care physicians' knowledge of and reporting practices for elder abuse, including the type of elder abuse education they received, the nature of their clinical practice, and the barriers that prevent them from reporting elder abuse. METHODS: a 17-item survey was mailed to 855 primary care physicians in Michigan in 2 waves between October 2007 and December 2007. RESULTS: Of the 855 surveys mailed, 222 were returned for a response rate of 26%. The majority of physicians (131 [67%] of 197 physicians) believed that their training about elder abuse was not very adequate or not adequate at all. Physicians with fewer than 10 hours of training were more likely to rate their training as not adequate when compared to those who had more than 10 hours of clinical training (χ(2)=64.340, P<.001). Whether abuse was reported was highly correlated with whether it was suspected (χ(2)=26.195, P<.001). Those physicians who reported receiving formal training on the topic of elder abuse in residency programs and those who reported participating in CME activities while in practice were less likely to identify not recognizing abuse at time of patient visits as a barrier to reporting. CONCLUSION: recognizing the subtle signs of elder abuse continues to be a barrier for physicians who treat older adult patients. However, education may improve primary care physicians' ability to detect and recognize elder abuse.

Elder abuse education in residency programs: how well are we doing?

PURPOSE: To understand whether education is at the heart of underreporting elder abuse by surveying Michigan residency program directors to learn about their elder abuse curricula. METHOD: In 2006, a questionnaire was mailed to 71 residency program directors in Michigan. Participants responded to closed-ended or Likert-type items about program demographics, elder abuse curricula, desire for additional related program materials, and related clinical experience. RESULTS: Results are based on 41 usable responses, for a response rate of 58%. Elder abuse education played a major role in residency curricula in more than a third of all programs (15/41). Of the 31 programs that had elder abuse lectures, 77% (24/31) required attendance at lectures. Sixty-one percent (25/41) expressed a need to learn more about screening tools, and more than half (23/41) did not use a screening assessment tool in their clinical care. Of desired additional materials, respondents most frequently requested screening tools at 63.4% (26/41). With elder abuse reporting, 61% (25/41) rated their experience with Adult Protective Services (APS) as "poor." Those curricula with the most elder abuse content topics experienced a more positive relationship with APS than those with fewer. CONCLUSIONS: Elder abuse education is not a consistent or highly prioritized topic in many primary care residency programs. Standardized educational goals and clinical experiences would help educate residents. Many participants voiced a need for additional educational materials, especially around screening, suggesting that future research should focus on the development of valid reliable elder abuse screening tools or protocols specific to medical settings.

Elder abuse education in primary care residency programs: a cluster group analysis.

BACKGROUND AND OBJECTIVES: Elder abuse is a serious issue, affecting up to 10% of community-dwelling older adults. This project sought to understand if elder abuse under-reporting was related to physician specialty and residency training. METHODS: A 17-item survey focusing on program demographics, current curriculum, priority of elder abuse education, clinical and didactic experiences, and triage resources was mailed to directors of all Michigan primary care residencies approved by the Accreditation Council for Graduate Medical Education. RESULTS: Clustering by program type, family medicine programs were primarily represented in the high-intensity group (standard residual -1.6), while internal medicine programs were primarily represented in the low-intensity group (standard residual 2.5, X2=14.80, df=6). Emergency medicine comprised the mid-intensity groups. The high- intensity group scored very high or high on areas including knowledge of elder abuse facts, elder abuse curriculum and training, and awareness of community resources related to elder abuse. CONCLUSIONS: Family medicine residency programs appear to address elder abuse more comprehensively than do emergency medicine and internal medicine programs. These programs may need to consider additional curriculum and clinical experience in elder abuse.

An administrator's perspective on mental health in assisted living.

Administrators of 94 assisted living facilities in Michigan completed a 19-item survey about the extent of mental health problems of residents and how such problems were addressed. In 45 facilities more than half of the residents were reported to be cognitively impaired. The two most common problems were dementia and depression. The most common problematic behaviors were resistance to care and wandering. Two-thirds of the facilities conducted some type of mental health evaluation at admission, and two-thirds conducted evaluations as needed. The most common treatment barriers were patient refusal and family refusal. Results of the study suggest that there may be a significant need for mental health services in assisted living facilities.

Comparing clinical practice with guideline recommendations for the treatment of depression in geriatric patients: findings from the APA practice research network.

OBJECTIVE: The authors describe treatments provided for depressed geriatric patients (age 65+) treated by psychiatrists in the American Psychiatric Association's (APA) Practice Research Network (PRN) and compare treatments with recommended guidelines for treating late-life depression. METHODS: Detailed demographics, diagnoses, service utilization, and treatment information were collected on relevant patients treated by psychiatrists participating in the APA's PRN during 1997, sample-weighted to produce nationally representative estimates. Treatment data were qualitatively compared with existing depression treatment guidelines from the APA and the Expert Consensus Guideline Series on pharmacotherapy of depressive disorders in older patients. RESULTS: Of patients treated by psychiatrists in the PRN (N=152), just over 41% had a diagnosable depressive disorder, and, of those with depression, nearly 84% had major depression. Over 90% received a psychotropic medication, and over 75% received an antidepressant. Treatment intensity, as measured by visit frequency and duration of treatment, were more intense than typically found in primary care. Most patients received a combination of medication management and psychotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressant, although they were less frequently prescribed than in primary care and other national surveys. Just over 11% received a tertiary amine antidepressant, and nearly 43% received benzodiazepines, this frequency being inconsistent with existing guidelines. CONCLUSION: Depressed geriatric patients treated by psychiatrists in APA's PRN receive active treatments largely consistent with existing guidelines, which generally resulted in favorable patient outcomes.