Free
Original Contribution  |   December 2010
Primary Care Physicians and Elder Abuse: Current Attitudes and Practices
Author Notes
  • From the Department of Psychiatry (Dr Wagenaar), the Department of Statistics and Probability (Dr Page), and the Center for Statistical Training and Consulting (Dr Herman) at Michigan State University and the Michigan State University College of Osteopathic Medicine (Dr Rosenbaum), both in East Lansing. 
  • Address correspondence to Deborah B. Wagenaar, DO, MS, Department of Psychiatry, A 231 E Fee Hall, Michigan State University, East Lansing, MI 48824-1020. E-mail: wagenaar@msu.edu 
Article Information
Geriatric Medicine
Original Contribution   |   December 2010
Primary Care Physicians and Elder Abuse: Current Attitudes and Practices
The Journal of the American Osteopathic Association, December 2010, Vol. 110, 703-711. doi:10.7556/jaoa.2010.110.12.703
The Journal of the American Osteopathic Association, December 2010, Vol. 110, 703-711. doi:10.7556/jaoa.2010.110.12.703
Abstract

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 (χ2=64.340, P<.001). Whether abuse was reported was highly correlated with whether it was suspected (χ2=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.

Estimates suggest that between 1.4% and 5.4% of older adults experience abuse, a problem that has worsened since it was first highlighted in the early 1970s.1,2 Because older adults are expected to account for 1 of every 5 US individuals by 2030,3 it is critical for clinicians to be aware of elder abuse in order to improve geriatric primary care.4 Between 1 million and 2 million adults in the United States experience abuse annually.5 In the National Elder Mistreatment Study,6 1-year prevalence rates for adults older than 65 years were 4.6% for emotional abuse, 1.6% for physical abuse, 5.1% for potential neglect, and 5.2% for financial abuse. Older adults who have been abused have poorer survival when compared with those who have not been abused.7 
The term elder abuse is comprehensive and may refer to abuse, neglect, exploitation, or abandonment of an older adult by someone who is not identified as a stranger.1 Abuse can be physical (ie, willful act with intent of pain or injury)8 or psychological (ie, verbal act resulting in mental anguish). Neglect is the failure to fulfill a caretaking obligation9 and may be described as intentional neglect (ie, willful failure to provide care), unintentional neglect (ie, nonwillful failure to provide care) or self-neglect (ie, conduct that threatens an individual's own safety).8 Financial exploitation is defined as theft or confiscation of property or assets. 
Although no federal statute exists specifically to prevent the mistreatment of older adults,8 individual states have enacted statutes to protect the elderly. Most states require mandatory reporting by professionals including physicians, psychologists, nurses, law enforcement officials, and clergy. Physicians are in an especially critical role with regard to the safety of elderly patients because physicians are likely to have frequent contact with older adults as they manage medical problems. In addition, physicians are often taken into confidence by older adults, who respect their authority and confidentiality. Given these facts, it is of concern that only 1 of 14 cases of elder abuse or neglect is ever reported to authorities.10 
Results of studies suggest that physician involvement in the reporting of elder abuse is lacking. In a survey10 of emergency room physicians, only 31% were aware of a written protocol for elder abuse and most were unfamiliar with the reporting mandates for elder abuse in their state. Surprisingly, only 2% of all elder abuse reports are generated by physicians, despite statewide mandates that are present in most states.11 In one survey, two-thirds of residency programs did not place a major emphasis on training about elder abuse.12 
Reasons for underreporting of elder abuse and for physicians' lack of knowledge about reporting statutes are not fully clear. Proposed barriers to reporting have included physicians' concerns about being wrong, disturbing the patient-physician relationship, confidentiality, and lack of ample proof to make a report.13 In addition, reporting elder abuse to local or state authorities may take additional time and resources from busy primary care physicians. Jones et al10 found that 92% of physicians surveyed did not believe that their states had sufficient resources to meet the needs of elderly victims; this belief could contribute to reporting apathy. 
How can clinicians more actively address elder abuse? Some efforts14 have used the Minimum Data Set for Home Care assessment to identify risk factors for abuse including brittle support (problems with the primary caregiver), loneliness, and conflict with family or friends. The presence of these risk factors might encourage primary care physicians to screen for elder abuse. In addition, efforts continue in the development of brief, rapid screening tools for detecting elder abuse in primary care.1 The US Preventive Services Task Force has also studied elder abuse, noting that trials demonstrating screening instrument use and validity are limited.15 
Given these facts, we sought 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
Survey Development
A focus group of experts in primary care, elder abuse, and survey development was convened to offer content expertise in the creation of this survey. Members of the focus group represented the fields of medicine, education, and statistics. We also used a focus group while conducting an earlier survey project that evaluated primary care training directors' recollection of the quantity and quality of elder abuse information in their residency curricula. The focus group used in the previous study helped us to review literature and generate survey questions for the present study.12,16 A thorough review of the literature on how primary care physicians handle the issue of elder abuse was presented to group members. The group reviewed these materials and commented on the draft survey, which was based on results of existing elder abuse literature and contained questions that focused on elder abuse education, elder abuse intervention and support, and barriers to reporting. 
Survey Participants
Inclusion criteria for the physicians in the present study consisted of active practice in internal medicine, family practice, or emergency medicine. Physicians in all other specialties were excluded, as were residents and retired physicians. All participants were physicians who resided in Michigan. 
Michigan currently has more than 3500 primary care physicians.17 We elected to sample one quarter of these individuals by using osteopathic and allopathic membership rosters from the Michigan Osteopathic Association and Michigan State Medical Society, respectively. Both osteopathic and allopathic physicians were randomly selected in equal numbers for survey participation. 
Survey Design and Implementation
The institutional review board of Michigan State University approved the present study and its methods. The 17-item survey instrument included a definition of elder abuse at the beginning of the survey (Appendix). Demographic items included specialty, age, years in practice, practice location, and practice setting. We also asked participants to identify the specialty and the location of the residency program they completed. Questions about completed hours and perceived adequacy of training about elder abuse during participants' residency followed. Participants were asked to identify the types of elder abuse education they received within the past 5 years, as well as types of elder abuse continuing medical education (CME) activities that they believed would be beneficial for the future. Subsequent items inquired about the prevalence of elder abuse in the participants' practices, the number of elderly abuse cases the participants had reported, and perceived barriers to reporting elder abuse. 
Data Analysis
Distributions for all variables were examined for errors in coding and distributional properties. Dichotomized variables were created for the following items: adequacy of residency training about elder abuse (not adequate/adequate); participation in CME on elder abuse (no/yes); presence of patients experiencing abuse in practice (no/yes); patient abuse reported to Adult Protective Services (APS) (no/yes); use of at least one category of support staff to report abuse (no/yes); and identification of at least one barrier to reporting (no/yes). 
Counts were created for questions with more than one answer, including the questions on past and future CME opportunities; types of support staff used to report abuse; and number of barriers identified. The 14 possible answers to the question about barriers to reporting elderly abuse were divided into 3 categories: victim, office, and external. The number cited for each type of barrier was computed. 
The χ2 analyses were used to assess the degree of association between categorical variables. One-way analyses of variance were used to assess mean difference on continuous dependent variables (number of types of CME opportunities, number of patients suspected of having been abused, number of patients reported as having been abused, and number of barriers identified) among groups based on the categorical independent variables (specialty, location, setting [eg, hospital, ambulatory care centers, nursing home], education in elder abuse, and adequacy of training). Correlational analyses were used to assess the degree of association between 2 continuous variables. 
Results
Demographics
Of the 855 surveys mailed, 222 were returned for a response rate of 26%. The largest number of respondents were physicians in family practice (100 [47%] of 214 physicians) (Table 1). Most physicians who responded were aged between 46 and 55 years (76 [36%] of 208 physicians) (Table 2). Years in practice were fairly evenly divided among all categories (Table 3). 
Table 1
Medical Specialty of Physicians Who Responded to Elder Abuse Survey (n=214) *

Specialty

No. (%)
Family medicine100 (47)
Internal medicine 70 (33)
Emergency medicine
44 (21)
 *Eight of the 222 physicians surveyed did not answer this survey question.
 Percentages do total 100 because of rounding.
Table 1
Medical Specialty of Physicians Who Responded to Elder Abuse Survey (n=214) *

Specialty

No. (%)
Family medicine100 (47)
Internal medicine 70 (33)
Emergency medicine
44 (21)
 *Eight of the 222 physicians surveyed did not answer this survey question.
 Percentages do total 100 because of rounding.
×
Table 2
Age of Physicians Who Responded to Elder Abuse Survey (n=208) *

Age, y

No. (%)
36-4555 (26)
46-55 76 (37)
56-6544 (21)
>65
33 (16)
 *Fourteen of the 222 physicians surveyed did not answer this survey question.
Table 2
Age of Physicians Who Responded to Elder Abuse Survey (n=208) *

Age, y

No. (%)
36-4555 (26)
46-55 76 (37)
56-6544 (21)
>65
33 (16)
 *Fourteen of the 222 physicians surveyed did not answer this survey question.
×
Table 3
Years in Practice for Physicians Who Responded to Elder Abuse Survey (n=213) *

Years in Practice

No. (%)
0-1047 (22)
11-20 60 (28)
21-3060 (28)
30
46 (22)
 *Nine of the 222 physicians surveyed did not answer this survey question.
Table 3
Years in Practice for Physicians Who Responded to Elder Abuse Survey (n=213) *

Years in Practice

No. (%)
0-1047 (22)
11-20 60 (28)
21-3060 (28)
30
46 (22)
 *Nine of the 222 physicians surveyed did not answer this survey question.
×
Almost half of the respondents practiced in suburban settings (97 [46%] of 211 physicians), with fewer practicing in urban settings (70 [33%] of 211 physicians) and rural settings (41 [19%] of 211 physicians). The majority of respondents practiced in ambulatory care settings (119 [56%] of 211 physicians). Sixty-one (29%) of 211 survey respondents reported working in hospital-based practices, and substantially fewer respondents (7 [3%]) reported working in nursing home practices. Twenty five (12%) of 211 survey respondents endorsed the nonspecific “other” category for practice location. 
Reported Training About Elder Abuse
More than half of the survey respondents (103 [51%] of 204 physicians) had no formal residency training in elder abuse detection. About one-third (77 [38%] of 204 physicians) reported undergoing 1 to 5 hours of training, while only 24 (12%) reported 6 or more hours of training in elder abuse (Table 4). 
Table 4
Reported Hours of Residency Training on Elder Abuse Topics: Physician Reponses to Elder Abuse Survey (n=204) *

Hours of Training

No. (%)
None103 (51)
1-5 77 (38)
6 or more
24 (12)
 *Eighteen of the 222 physicians surveyed did not answer this survey question.
 Percentages do not total 100 because of rounding.
Table 4
Reported Hours of Residency Training on Elder Abuse Topics: Physician Reponses to Elder Abuse Survey (n=204) *

Hours of Training

No. (%)
None103 (51)
1-5 77 (38)
6 or more
24 (12)
 *Eighteen of the 222 physicians surveyed did not answer this survey question.
 Percentages do not total 100 because of rounding.
×
Survey responses showed an association between medical specialty and hours of training about elder abuse topics (P<.001). Physicians in internal medicine were most likely to report no training, whereas physicians in emergency medicine were most likely to report some training (Figure 1). 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.” A small minority of respondents (13 [7%] of 197 physicians) thought that their elder abuse education was “very adequate.” 
Figure 1.
Hours of residency training on elder abuse topics by medical specialty as reported by physicians who completed a survey on elder abuse.
Figure 1.
Hours of residency training on elder abuse topics by medical specialty as reported by physicians who completed a survey on elder abuse.
Most physicians who reported completing training about elder abuse cited “elder abuse reading materials” (84 [40%] of 210 physicians), “formal in-person lectures” (58 [28%] of 210 physicians), and “audio tapes/CD” (25 [12%] of 210 physicians) as types of activities completed. Newer learning technologies such as “on-line lecture” and “video/DVD” were much less popular with respondents (15 [7%] of 210 physicians). When the respondents were asked about how they would best like to have elder abuse information presented to them in the future, they consistently endorsed similar strategies including elder abuse reading materials (84 [40%] of 210 physicians), formal in-person lectures (58 [28%] of 210 physicians), and audio tapes/CD (25 [12%] of 210 physicians) (Table 5). 
Table 5
Continuing Medical Education Activities on Elder Abuse: Physician Reponses to Elder Abuse Survey (n=201)


No. (%)
Type of Continuing Medical Education Activity
Completed in the Past 5 years
Would Be Beneficial in the Future
Online lecture101 (5)37 (18)
Formal in-person lecture 58 (28) 113 (54)
Video or DVD5 (2)25 (12)
Audio tapes or CD 25 (12) 44 (21)
Small group case reviews16 (18)41 (20)
Elder abuse reading materials 84 (40) 102 (48)
None
91 (43)
18 (8)
Table 5
Continuing Medical Education Activities on Elder Abuse: Physician Reponses to Elder Abuse Survey (n=201)


No. (%)
Type of Continuing Medical Education Activity
Completed in the Past 5 years
Would Be Beneficial in the Future
Online lecture101 (5)37 (18)
Formal in-person lecture 58 (28) 113 (54)
Video or DVD5 (2)25 (12)
Audio tapes or CD 25 (12) 44 (21)
Small group case reviews16 (18)41 (20)
Elder abuse reading materials 84 (40) 102 (48)
None
91 (43)
18 (8)
×
Physicians who reported up to 10 hours of training were more likely to rate their training as either not very adequate or not adequate at all, compared with physicians who reported more than 10 hours of training (χ2=64.340, P<.001). Hours of training and adequacy of training were positively related (r =0.582). However, physicians who reported 6 to 10 hours of training were most likely (193 [88.9%] of 217 physicians) to rate their training as “somewhat adequate” or “very adequate.” 
Reporting Elder Abuse
The mean (standard deviation [SD]) percentage of older adult patients who experience abuse, as perceived by the survey respondents, was 3% (4.5%). The mean (SD) number of cases of elder abuse reported to APS per physician was 1.2 (1.9). Whether abuse was reported was highly correlated with whether it was suspected (χ2=26.195, P<.001). Physicians who reported completing no CME on elder abuse were also likely to report “did not recognize abuse at time of visit” as a barrier to reporting. 
The use of ancillary health professionals to actually file an APS complaint could have an impact on whether elder abuse is reported. According to the responses, support staff in family practice offices was used substantially less often than was support staff in emergency medicine departments to report elder abuse (sum of squares=19.408, df=2, P<.002). Emergency room physicians may have a more extensive network of support staff as a function of their hospital setting. More than one-fourth of survey respondents (63 [29%] of 218 physicians) reported not using any support staff to report elder abuse. Physicians who did report using support staff most frequently cited nurses (n=49 [23%]) and social workers (n=38 [86%]) as types of support staff used. Practice location also appeared to influence the type of support staff used to deal with elder abuse. Physicians in suburban locations, compared with physicians in urban or rural settings, appeared to have the greatest number of staff resources (Figure 2). Survey respondents from rural settings were half as likely to use nurses, social workers, or mental health professionals to help with elder abuse issues. 
Figure 2.
Use of support staff in reporting elder abuse by specialty, practice location, and practice setting as reported by physicians who completed a survey on elder abuse.
Figure 2.
Use of support staff in reporting elder abuse by specialty, practice location, and practice setting as reported by physicians who completed a survey on elder abuse.
Family practitioners most frequently identified elder abuse as not being a significant problem for their patients (35 [57%] of 63 physicians) and poor cooperation from reporting agencies (21 [52%] of 41 physicians) as barriers to reporting. Internists were more likely to defer reporting to other specialties (eg, social work, nursing) (3 of 5 physicians). Thirteen [31%] of 44 emergency medicine physicians reported abuse involving subtle signs or minor injuries as a barrier. 
Comment
More than half of the survey respondents reported no formal training in elder abuse. Based on our survey results, education makes a difference in a primary care physicians' ability to detect and recognize signs and symptoms of elder abuse. Those physicians who reported undergoing formal training in elder abuse during their residency programs or who participated in CME activities within the past 5 years were less likely to check “yes” for “did not recognize abuse at time of visit” as a barrier to reporting. Additional efforts should be made at the state and federal level to provide elder abuse education in formats that physicians desire, such as journal articles, audiotapes, and formal lectures.18 Primary care disciplines should consider offering more education about elder abuse as part of member educational activities.19 As physicians become more adept at using online resources, additional consideration might be given to producing primary care–focused online CME materials that physicians could access as they desire.20 
The inability to recognize subtle signs of elder abuse continues to be a barrier for primary care physicians. It might be easier for physicians to develop alternate explanations for bruises or fractures than to entertain the notion that caregivers may have caused these injuries. Our survey results suggest that, for some groups of physicians, such as emergency room physicians, this is a compelling issue. 
According to our survey, physicians in suburban locations feel they have more ancillary help in reporting elder abuse cases. Of concern is that more than 25% of all physicians in rural settings reported that they did not use support staff in dealing with elder abuse. What help is then provided to an abused elder living in a rural setting? One answer may be that, in rural settings, elder abuse is more often addressed informally by the community and less frequently by physicians. For example, informal family networks may help with care-giving or dealing with abuse. In addition, it is unclear whether rural physicians do not report elder abuse at all or if they simply do not use support staff when reporting abuse. Further studies of elder abuse that take into account treatment location may further elucidate health service needs issues and regional differences in treatment approach. 
The findings from our survey suggest that, to reach primary care physicians with additional information and support about elder abuse, we may need to take a flexible, variable approach that is dependant on the needs of the primary care specialty.21 For example, family physicians most frequently endorsed inadequate community resources as a barrier to responding to identified cases, leading us to believe that perhaps a greater connection with APS and community resources to provide support may be most meaningful to these family practice physicians. On the other hand, internists more often cited deferring elder abuse reporting to other specialties. Providing ongoing, effective CME activities for internists that focus on screening and physician responsibility may be most effective for them. Finally, emergency department physicians might benefit most from seminars and educational materials that address subtle signs of elder abuse. Providing specialty-specific information about detection and treatment of elder abuse could more effectively impact clinical care. 
One element that is critical for the improvement of elder abuse detection and treatment is victim advocacy. Older adults without obvious physical evidence of abuse may be unwilling to talk about the abuse they have experienced at the hands of caregivers, because they are fearful of retaliation or abandonment. Educating primary care physicians on how to ask about elder abuse in an open-ended, nonthreatening manner is critical to providing an atmosphere of safety.13 Additional surveys should be performed or clinical observations made to clarify further if and how physicians ask about abuse if the abuse is not obvious to them. In addition, public information and advocacy campaigns on elder abuse would also be helpful to educate the community about the dangers of elder abuse and the importance of early detection. 
A number of limitations exist with this survey. We recognize that our physician response rate is low but not uncharacteristic for physician-based surveys.22 Low physician response rates may impact the generalizability of this study. However, these rates are not unusual for practicing primary care physicians.23-25 In addition, physicians' responses were subject to recall bias with respect to number of CME hours focused on elder abuse. This survey is limited to Michigan physicians; we had respondents from all settings (rural, urban, suburban) and hope that our results might generalize to other settings. National surveys on this topic are warranted in order to support the generalizabilty of these results. 
Our study points out the need for future research on elder abuse detection and reporting in primary care. Other studies may want to more fully explore the role of support staff and why physicians choose to use or not use them. In addition, future research calls for epidemiologic approach to studying detection rates and how physicians' attitudes impact their actual ability to detect and triage elder abuse cases. Little is known about the differences between suspected and actually reported elder abuse cases; information about these differences is also important for future research. 
Conclusion
As our older adult population increases, we must find ways to more effectively identify elder abuse.1 Physician education is one critical component of this task.26 Education in the form of clear, effective literature, as well as CME lectures that are accessible and interesting continue to be critical for primary care physicians. In addition, providing additional community resources and financial support to treatment programs and public education is necessary to improve the quality of life for our abused elders. A multifaceted approach is vitally important to correct the problem of elder abuse. 
 
Appendix
Survey mailed to 855 primary care physicians in Michigan to gauge their knowledge of and reporting practices for elder abuse. The survey has been altered for graphic enhancement only.
Appendix
Survey mailed to 855 primary care physicians in Michigan to gauge their knowledge of and reporting practices for elder abuse. The survey has been altered for graphic enhancement only.
 Financial Disclosure: Funding for this survey project was provided in full by a grant from the Blue Cross Blue Shield Foundation of Michigan.
 
Fulmer T, Guadagno L, Bitondo Dyer C, Connolley MT. Progress in elder abuse screening and assessment instruments. J Am Geriatr Soc. 2004;52(2):297-304.
The National Center on Elder Abuse at The American Public Human Services Association, in Collaboration with Westat Inc. The National Elder Abuse Incidence Study: Final Report. Washington, DC: American Public Human Services Association in collaboration with Westat, Inc;1998. http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf. Accessed January 15, 2009.
US Census Bureau. Statistical Abstract of the United States, 2006: The National Databook. 125th ed. Washington, DC: Commerce Department, Economics and Statistics Administration, US Census Bureau; 2006:14. http://www.census.gov/compendia/statab/2006/tables/06s0012.xls. Accessed November 1, 2010.
Lachs MS, Pillemer K. Elder abuse. Lancet. 2004;364(9441):1263-1272.
Shields LB, Hunsaker DM, Hunsaker JC 3rd. Abuse and neglect: a ten-year review of mortality and morbidity in our elders in a large metropolitan area. J Forensic Sci. 2004;49(1):122-127.
Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health.. (2010). ;100(2):292-297.
Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA. 1998;280(5):428-432.
Ahmed M, Lachs M. Elder abuse and neglect: what physicians can and should do. Cleve Clin J Med. 2002;69(10):801-808.
Koenig RJ 3rd, DeGuerre CR. The legal and governmental response to domestic elder abuse. Clin Geriatr Med. 2005;21(2):383-398.
Jones JS, Veenstra TR, Seamon JP. Elder mistreatment: national survey of emergency physicians. Ann Emerg Med. 1997;30(4):473-479.
Rosenblatt DE, Cho KH, Durance PW. Reporting mistreatment of older adults: the role of physicians. J Am Geriatr Soc.. (1996). ;44(1):65-70.
Wagenaar DB, Rosenbaum R, Page C, Herman S. Elder abuse education in residency programs: how well are we doing? Acad Med. 2009;84(5):611-618.
Dong X. Medical implications of elder abuse and neglect. Clin Geriatr Med.. (2005). ;21(2):293-313.
Shugarman LR, Fries BE, Wolf RS, Morris JN. Identifying older people at risk of abuse during routine screening practices. J Am Geriatr Soc. 2003;51 (1):24-31.
Nelson HD, Nygren P, McInerney Y, Klein J. Screening women and elderly adults for family and intimate partner violence: a review of the evidence for the U.S. Preventative Services Task Force. Ann Intern Med.. (2004). ;140(5):387-396.
Wagenaar DB, Rosenbaum R, Herman S, Page C. Elder abuse education in primary care residency programs: a cluster group analysis. Fam Med. 2009;41(7):481-486.
Michigan Department of Community Health. Survey of Physicians 2005. www.michigan.gov/.../mdch_survey_of_physicians2005_172770_7.pdf. Accessed November 29, 2010.
Taylor DK, Bachuwa G, Evans J, Jackson-Johnson V. Assessing barriers to the identification of elder abuse and neglect: a communitywide survey of primary care physicians. J Natl Med Assoc.. (2006). ;98(3):403-404.
U.S. Preventative Services Task Force. Screening for family and intimate partner violence: recommendation statement (review). Ann Fam Med.. (2004). ;2(2):156-160.
Hill JR. Teaching about family violence: a proposed model curriculum. Teach Learn Med.. (2005). ;17(2):169-178.
Kennedy RD. Elder abuse and neglect: the experience, knowledge, and attitudes of primary care physicians. Fam Med.. (2005). ;37(7):481-485.
Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol.. (1997). ;50(10):1129-1136.
Kaner EF, Haighton CA, McAvoy BR. `So much post, so busy with practice— so, no time!': a telephone survey for general practitioners' reasons for not participating in postal questionnaire surveys. Br J Gen Pract.. (1998). ;48(428):1067-1069.
McAvoy BR, Kaner EF. General practice postal surveys: a questionnaire too far? BMJ. 1996;313(7059):733-734.
Morris CJ, Cantrill JA, Weiss MC. GP survey response rates: a miscellany of influencing factors. Fam Pract. 2001;18(4):454-456.
Heath JM, Dyer CB, Kerzner LJ, Mosqueda L, Murphy C. Four models of medical education about elder mistreatment. Acad Med. 2002;77(11):1101-1106.
Figure 1.
Hours of residency training on elder abuse topics by medical specialty as reported by physicians who completed a survey on elder abuse.
Figure 1.
Hours of residency training on elder abuse topics by medical specialty as reported by physicians who completed a survey on elder abuse.
Figure 2.
Use of support staff in reporting elder abuse by specialty, practice location, and practice setting as reported by physicians who completed a survey on elder abuse.
Figure 2.
Use of support staff in reporting elder abuse by specialty, practice location, and practice setting as reported by physicians who completed a survey on elder abuse.
Appendix
Survey mailed to 855 primary care physicians in Michigan to gauge their knowledge of and reporting practices for elder abuse. The survey has been altered for graphic enhancement only.
Appendix
Survey mailed to 855 primary care physicians in Michigan to gauge their knowledge of and reporting practices for elder abuse. The survey has been altered for graphic enhancement only.
Table 1
Medical Specialty of Physicians Who Responded to Elder Abuse Survey (n=214) *

Specialty

No. (%)
Family medicine100 (47)
Internal medicine 70 (33)
Emergency medicine
44 (21)
 *Eight of the 222 physicians surveyed did not answer this survey question.
 Percentages do total 100 because of rounding.
Table 1
Medical Specialty of Physicians Who Responded to Elder Abuse Survey (n=214) *

Specialty

No. (%)
Family medicine100 (47)
Internal medicine 70 (33)
Emergency medicine
44 (21)
 *Eight of the 222 physicians surveyed did not answer this survey question.
 Percentages do total 100 because of rounding.
×
Table 2
Age of Physicians Who Responded to Elder Abuse Survey (n=208) *

Age, y

No. (%)
36-4555 (26)
46-55 76 (37)
56-6544 (21)
>65
33 (16)
 *Fourteen of the 222 physicians surveyed did not answer this survey question.
Table 2
Age of Physicians Who Responded to Elder Abuse Survey (n=208) *

Age, y

No. (%)
36-4555 (26)
46-55 76 (37)
56-6544 (21)
>65
33 (16)
 *Fourteen of the 222 physicians surveyed did not answer this survey question.
×
Table 3
Years in Practice for Physicians Who Responded to Elder Abuse Survey (n=213) *

Years in Practice

No. (%)
0-1047 (22)
11-20 60 (28)
21-3060 (28)
30
46 (22)
 *Nine of the 222 physicians surveyed did not answer this survey question.
Table 3
Years in Practice for Physicians Who Responded to Elder Abuse Survey (n=213) *

Years in Practice

No. (%)
0-1047 (22)
11-20 60 (28)
21-3060 (28)
30
46 (22)
 *Nine of the 222 physicians surveyed did not answer this survey question.
×
Table 4
Reported Hours of Residency Training on Elder Abuse Topics: Physician Reponses to Elder Abuse Survey (n=204) *

Hours of Training

No. (%)
None103 (51)
1-5 77 (38)
6 or more
24 (12)
 *Eighteen of the 222 physicians surveyed did not answer this survey question.
 Percentages do not total 100 because of rounding.
Table 4
Reported Hours of Residency Training on Elder Abuse Topics: Physician Reponses to Elder Abuse Survey (n=204) *

Hours of Training

No. (%)
None103 (51)
1-5 77 (38)
6 or more
24 (12)
 *Eighteen of the 222 physicians surveyed did not answer this survey question.
 Percentages do not total 100 because of rounding.
×
Table 5
Continuing Medical Education Activities on Elder Abuse: Physician Reponses to Elder Abuse Survey (n=201)


No. (%)
Type of Continuing Medical Education Activity
Completed in the Past 5 years
Would Be Beneficial in the Future
Online lecture101 (5)37 (18)
Formal in-person lecture 58 (28) 113 (54)
Video or DVD5 (2)25 (12)
Audio tapes or CD 25 (12) 44 (21)
Small group case reviews16 (18)41 (20)
Elder abuse reading materials 84 (40) 102 (48)
None
91 (43)
18 (8)
Table 5
Continuing Medical Education Activities on Elder Abuse: Physician Reponses to Elder Abuse Survey (n=201)


No. (%)
Type of Continuing Medical Education Activity
Completed in the Past 5 years
Would Be Beneficial in the Future
Online lecture101 (5)37 (18)
Formal in-person lecture 58 (28) 113 (54)
Video or DVD5 (2)25 (12)
Audio tapes or CD 25 (12) 44 (21)
Small group case reviews16 (18)41 (20)
Elder abuse reading materials 84 (40) 102 (48)
None
91 (43)
18 (8)
×