Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place

Michael A. Rodríguez; Steven P. Wallace; Nicholas H. Woolf; Carol M. Mangione

doi:10.1370/afm.575

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Table 1.

Open-Ended Interview Questions

We are interested in understanding physician’s thoughts on addressing elder abuse in the outpatient clinical setting.

Please tell me about the kinds of elder abuse that a primary care physician might encounter in the outpatient setting?
Please tell me about any patients who, for whatever reason, made you think that they may be at risk for or may be experiencing elder abuse?
What might make you suspicious that a patient of yours was experiencing elder abuse?
What would you do if you become suspicious?
Is there anything else that a primary care physician might consider doing once there is a suspicion of elder abuse?
Under what conditions if any would you report abuse?
Under what circumstances if any would you consider only monitoring?
Why do you think that patients who have been victims of elder abuse might be reluctant to bring this up with their primary care physicians at regularly scheduled visits?
Why do you think doctors may not address the topic of elder .abuse, even if suspected during regularly scheduled visits?
How do you feel about the law that requires physicians to report suspected elder abuse?
What do you think could be done in your practice to help improve the effectiveness of physician efforts to address elder abuse?
What changes can be made to the clinic setting or environment that will help improve the effectiveness of physician efforts to address elder abuse?
Is there anything else that we haven’t talked about that you would like to say about improving physician effectiveness in addressing elder abuse?

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The Article in Brief

Background Although doctors are required by law to report elder abuse, they do so at low rates. In this study, researchers interviewed primary care doctors about their experiences and perspectives on required reporting of elder abuse. The goal of the study was to gain insights to help train medical professionals and students on elder abuse issues.

What This Study Found Doctors identified paradoxes, or contradictions, in the required reporting of elder abuse, including the following: (1) A strong bond between patient and doctor can create the trust needed for a patient to disclose abuse, which increases the likelihood that the abuse will be reported. Doctors who have a strong bond with a patient, however, may be hesitant to report abuse for fear that the patient will feel deceived and their relationship will be damaged. (2) A doctor may report abuse because of a desire to improve the patient�s quality of life by removing the elder from the abusive situation. But a doctor may be less likely to report elder abuse out of concern that it will decrease the patient�s quality of life in other ways (such as revenge or another negative response by the abuser). (3) Required reporting is a way to potentially help the patient and therefore increases the doctor�s control over the patient�s well-being . Because reporting is required, however, it also decreases the doctor�s ability to decide how to best help the patient.

Implications

Although these paradoxes may be hidden or unconscious, they appear to influence doctors� decisions about whether report elder abuse.
There is a need to increase primary care doctors� awareness about elder abuse and its reporting.
There has been progress in training health care professionals about child abuse and intimate partner violence, but it is unclear to what extent the topic of elder abuse has been included in such tra
There are mismatches between required reporting laws and the realities of primary care practice. Reducing these mismatches, as well as the paradoxes they create, could help increase reporting of elder