Doctors’ competences in caring for older people in situations of violence: scope review

Rathke, Cesar Augusto de Freitas e; Costa, Gabriela Maria Cavalcanti; Souto, Rafaella Queiroga

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Geriatria e Gerontologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Articles • Rev. bras. geriatr. gerontol. 24 (6) • 2021 • https://doi.org/10.1590/1981-22562020024.210037 copy

Doctors’ competences in caring for older people in situations of violence: scope review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

describing by means of the evidence in the literature, the competences of doctors in hospital services in situations of violence against older people (VAOP).

Method

scope review with search in databases/platforms/searchers and grey literature covering Medline; VHL; Embase; CINAHL; Web of Science; BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal and Theses Canada Portal (Aurora and Voilà catalogs). The descriptors and keywords used, combined with the Boolean operators OR, AND, NOT were: “Physicians”, “Doctors”, “Attitude”, “Attitude”, “Knowledge”, “Knowledge”, “Behavior”, “Medical Care”, “Medical Care”, “Medical Care”, “Hospital Services”, “Hospital Services”, “Hospital”, “Hospitalists”, “Hospital Doctors”, “Older People Abuse”, “Older People Abuse”, “Physical Abuse”, “Older People Neglect ”, “Aged Abuse”, “Older People Mistreatment”.

Results

six papers were selected. There was a lack of knowledge on the topic and the approach, and of specific training. As for skills, the findings that most led doctors to suspect abuse were physical findings linked to appearance, hygiene and injuries - communication and relationship problems were little mentioned. In the attitude, there was a research of abuse in only 44% of the suspicions and low or null percentages on case reporting. Only one study explored the attitude towards negligence, where 24.8% reported to social services and 21.3% informed the police.

Conclusion

most cases of VAOP remain unnoticed and therefore unreported or unhandled. There are multiple problems regarding the competences of hospital doctors when dealing with such situations, a scenario that exposes the demand for measures to raise awareness, training, and encouragement to adequately deal with VAOP.

Keywords
Health Services for the Aged; Elder Abuse; Clinical Competence

Database/ Grey Literature	Search Strategies
BVS (BIREME)	(tw:(older people mistreatment)) AND (tw:(doctors)) AND (tw:(hospital)) AND (tw:(knowledge OR attitudes OR skills OR medical conduct))
PubMed Central: PMC	((elder abuse[Title/Abstract] OR elder neglect[Title/Abstract] OR aged abuse[Title/Abstract]) AND (physicians[Title/Abstract] OR doctors[Title/Abstract] OR hospitalists[Title/Abstract] OR medical staff, hospital[Title/Abstract])) AND (attitude[Title/Abstract] OR knowledge[Title/Abstract] OR behavior[Title/Abstract] OR practice[Title/Abstract] OR management[Title/Abstract] OR approach[Title/Abstract] OR treatment[Title/Abstract])
Web Of Science Main Collection	AB=(“elder abuse”) AND AB=(Knowledge OR Attitude OR Hability) AND AB=(Hospital OR "Medical Staff, Hospital" OR Hospitalist) AND AB=(Physicians OR Doctors)
Scopus (Elsevier)	TITLE-ABS-KEY (( "elder abuse" ) AND (knowledge OR attitude OR ability) AND (hospital OR "Medical Staff, Hospital" OR hospitalist) AND (physicians OR doctors))
EMBASE (Elsevier)	(('elder abuse':ti,ab,kw OR 'elder neglect':ti,ab,kw OR 'aged abuse':ti,ab,kw) AND physician:ti,ab,kw AND 'medical staff':ti,ab,kw OR hospital:ti,ab,kw) AND attitude:ti,ab,kw AND (elder:ti OR older:ti OR aged:ti) AND [2004-2020]/py
CINAHL (EBSCO)	(elder abuse or elder mistreatment or elder neglect) AND (physicians or doctors or clinicians) AND hospital AND (attitudes or perceptions or behavior or knowledge)
BDTD	(Summary Portuguese:older people abuse And Summary Portuguese:doctors And Summary Portuguese:hospital)
OpenGrey	(elder abuse OR aged abuse OR elder neglect) AND (physicians OR doctors) AND hospital
OpenThesis	text((physicians OR doctors OR "medical care") AND hospital AND ("elder abuse" OR "elder neglect" OR "aged abuse")
RCAAP	physicians AND (attitudes OR knowledges OR skills) hospital AND older people abuse
Portal de Teses e Dissertações da CAPES	("medical care" OR "medical care" OR doctors) AND hospital AND ("older people abuse" OR "older people neglect" OR violence against older people")
DART	(physicians OR doctors OR "medical care") AND hospital AND ("elder abuse" OR "elder neglect" OR "aged abuse")
Library and Archives Canada (Theses Canada Portal)	"physicians" AND hospital AND ("elder abuse" OR "aged abuse" OR "elder neglect" OR "physical abuse")

Authors, year of publication, type of study	Education of the main author, country	Professional category(ies) addressed	Study Objective(s)
Corbi et al., 2019¹⁵15 Corbi G, Grattagliano I, Sabbà C, Fiore G, Spina S, Ferrara N, et al. Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals. Intern Emerg Med. 2019;14(4):549-55., descriptive comparative study	Doctor, Italy	Doctors, nurses and nursing technicians	Establish the level of awareness and perception of abuse to older people by health workers, and understand whether they were able to properly identify and report abuse, also to identify physical signs of abuse and negligence
Eraslan et al., 2018¹⁶16 Eraslan BS, Çaki İE, Karadayi B, Özaslan A. A study on physicians’ perspectives on elder abuse and neglect. Turk J Geriatr. 2018;21(2):157-65., descriptive quantitative study	Doctor, Turkey	Clinical doctors, specialists and resident doctors	To assess doctors' perspectives on abuse and neglect of older people and to understand their knowledge and approaches, to raise awareness of the subject, and to identify abuse and offer possible solutions
Caines et al., 2017¹⁷17 Caines J, Ward MJ. Identifying Elder Abuse in the Emergency Department: Results from a Structured Physician Survey in Canada. J Fam Med Community Health. 2017;4(8):1134-41., descriptive study	Doctor, Canada	Doctors	Examine the depth of knowledge and approach of Canada's emergency doctors on older people abuse
Almogue et al., 2010¹⁸18 Almogue A, Weiss A, Marcus EL, Beloosesky Y. Attitudes and knowledge of medical and nursing staff toward elder abuse. Arch Gerontol Geriatr. 2010;51(1):86-91., descriptive comparative study	Doctor, Israel	Nurses and doctors	To assess the level of knowledge and attitudes of doctors and nurses regarding older people abuse in Israel, comparing doctors and nurses and analyzing the results according to workplace, specialization and professional and geriatric experience
Kennelly et al., 2007¹⁹19 Kennelly S, Sweeney N, O’Neill D. Elder abuse: knowledge, skills, and attitudes of healthcare workers. Ir Med J. 2007;100(1):1-9., descriptive comparative study	Doctor, Ireland	Doctors and Medicine social workers	To assess the awareness of health professionals about older people abuse
Mandiracioglu et al., 2006²⁰20 Mandiracioglu A, Govsa F, Celikli S, Yildirim GO. Emergency health care personnel’s knowledge and experience of elder abuse in Izmir. Arch Gerontol Geriatr. 2006;43(2):267-76., descriptive comparative study	Doctor, Turkey	Doctors, nurses and other specialties	To assess the definition of older people abuse, level of knowledge, attitudes and practices of emergency medical service personnel

Studies	Knowledge of hospital doctors in the face of older people in situation of violence
Corbi et al., 2019¹⁵15 Corbi G, Grattagliano I, Sabbà C, Fiore G, Spina S, Ferrara N, et al. Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals. Intern Emerg Med. 2019;14(4):549-55., Italy	All aware that many older people are victims of abuse, and 93.8% of the sample put the abuse of older people as a violation of human rights. Of the total, 44.7% knew the standard procedures for reporting and approaching, and 40% of the doctors did not believe that negligence is a form of abuse.
Eraslan et al., 2018¹⁶16 Eraslan BS, Çaki İE, Karadayi B, Özaslan A. A study on physicians’ perspectives on elder abuse and neglect. Turk J Geriatr. 2018;21(2):157-65., Turkey	Specific training was received by 14.9% of the doctors. The trained group reported more than the untrained group (p<0.001) and revealed a higher rate of abuse cases realization (p=0.04), more often felt able on the subject (p<0.001), and defined older people as older than 65 years (p=0.02). They also defined old age as a period of dependence/need less frequently than the untrained group (p=0.02). Doctors from public institutions had higher training on the subject (p=0.004) and higher rates of case communication (p=0.005) than those in the private sector.
Caines et al., 2017¹⁷17 Caines J, Ward MJ. Identifying Elder Abuse in the Emergency Department: Results from a Structured Physician Survey in Canada. J Fam Med Community Health. 2017;4(8):1134-41., Canada	Sixty-eight percent of the doctors felt able to report suspected cases of domestic abuse, and 63% in institutional cases. Regarding specific training, 35% did not complete it and 83% felt that the training was insufficient, in addition to 77% not being aware of all community services available to victims of abuse and their families. Half reported that their services did not have a written protocol to address cases of abuse, and 39% were uncertain whether there was protocol in their services.
Almogue et al., 2010¹⁸18 Almogue A, Weiss A, Marcus EL, Beloosesky Y. Attitudes and knowledge of medical and nursing staff toward elder abuse. Arch Gerontol Geriatr. 2010;51(1):86-91., Israel	Doctors had no differences by service type (general or geriatric hospital). A total of 43% of the professionals knew that older people could receive state assistance if necessary, and 14% knew that there was no possible penalty if the case was not reported. There was a correlation between knowledge on the subject and that related to important laws and protocols (p=0.006).
Kennelly et al., 2007¹⁹19 Kennelly S, Sweeney N, O’Neill D. Elder abuse: knowledge, skills, and attitudes of healthcare workers. Ir Med J. 2007;100(1):1-9., Ireland	A total of 45% of the doctors never heard the term older people abuse, and 30% read some technical material about it, while 85% felt that abuse was common and underreported. No doctor received formal training, and only one knew guidelines for this management.
Mandiracioglu et al., 2006²⁰20 Mandiracioglu A, Govsa F, Celikli S, Yildirim GO. Emergency health care personnel’s knowledge and experience of elder abuse in Izmir. Arch Gerontol Geriatr. 2006;43(2):267-76., Turkey	75% of the doctors believed that older people abuse was not common in Turkey. The scores obtained were high in understanding risk factors, intermediaries in knowledge and attitude towards cases and in diagnosis, and low in knowing their legal obligations in relation to cases. Twenty-four percent never received training.

Studies	Hospital doctors' skills faced with older people in situation of violence
Corbi et al., 2019¹⁵15 Corbi G, Grattagliano I, Sabbà C, Fiore G, Spina S, Ferrara N, et al. Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals. Intern Emerg Med. 2019;14(4):549-55., Italy	As potential signs of abuse, doctors often indicated physical findings such as burns, bruises, abrasions, and varied stages of healing bruises and fractures. All personal negligence was a form of abuse for 60% of the doctors, and 48.7% suspected abuse less than 3 times in their careers.
Eraslan et al., 2018¹⁶16 Eraslan BS, Çaki İE, Karadayi B, Özaslan A. A study on physicians’ perspectives on elder abuse and neglect. Turk J Geriatr. 2018;21(2):157-65., Turkey	45% of the doctors witnessed cases in their practices. They were able to suspect abuse more frequently in the face of physical findings related to the appearance of the older people (91.4%), such as inadequate care in hair, nails, mouth and body hygiene; communication between older people and family members/caregivers was the least pointed out, with only 56.8%. The most frequently found types of abuse were negligence (37.4%), emotional (25.1%), financial (22.2%), physical (15.7%), and sexual (1.1%).
Caines et al., 2017¹⁷17 Caines J, Ward MJ. Identifying Elder Abuse in the Emergency Department: Results from a Structured Physician Survey in Canada. J Fam Med Community Health. 2017;4(8):1134-41., Canada	Regarding the perception of cases, 85% considered that abuse occurred sometimes, and 78% suspected cases in their careers (73% in the last 5 years, and 45% in the last 12 months). The type of abuse considered most common was negligence, followed by financial.
Kennelly et al., 2007¹⁹19 Kennelly S, Sweeney N, O’Neill D. Elder abuse: knowledge, skills, and attitudes of healthcare workers. Ir Med J. 2007;100(1):1-9., Ireland	As for the experience, 65% had come across at least one suspected case in the last year.
Mandiracioglu et al., 2006²⁰20 Mandiracioglu A, Govsa F, Celikli S, Yildirim GO. Emergency health care personnel’s knowledge and experience of elder abuse in Izmir. Arch Gerontol Geriatr. 2006;43(2):267-76., Turkey	Half of the sample would not know what to do faced with a case. Doctors had low scores in performing anamnesis and physical examination focused on the diagnosis of abuse, and on knowing their legal obligations in facing cases. The least identified risk factors were linked to sexual and financial abuse.

Studies	Hospital doctors' Knowledge faced with older people in situation of violence
Corbi et al., 2019¹⁵15 Corbi G, Grattagliano I, Sabbà C, Fiore G, Spina S, Ferrara N, et al. Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals. Intern Emerg Med. 2019;14(4):549-55., Italy	In both suspected and witnessed cases, doctors neither reported it to the authorities nor notified the protection agencies - 22.4% of the doctors witnessed abuse 1-3 times during their careers, but never reported it to the authorities, although 88.2% considered it a duty to report abuse.
Eraslan et al., 2018¹⁶16 Eraslan BS, Çaki İE, Karadayi B, Özaslan A. A study on physicians’ perspectives on elder abuse and neglect. Turk J Geriatr. 2018;21(2):157-65., Turkey	90.6% of the doctors said they had an obligation to notify the authorities. 24.3% of the doctors who found abuse and neglect reported it to the authorities. The main reason for not reporting (62.3%) was the concern that older people could suffer even more damage after the complaint, while 49% considered as insufficient the resources offered by the government to address the issue, and 35.2% thought that the legal process would be stressful for them. Faced with confirmed cases, 55.1% claimed having reported cases to the police without informing the family, 23.1% met the older person's wishes, and 17.5% spoke to the family, warning about the subsequent complaint to the police in the case of recurrence. When the same question was repeated for negligence to older people, 24.8% reported to social services, 21.3% reported to police agencies and 19.5% consulted the multidisciplinary team.
Caines et al., 2017¹⁷17 Caines J, Ward MJ. Identifying Elder Abuse in the Emergency Department: Results from a Structured Physician Survey in Canada. J Fam Med Community Health. 2017;4(8):1134-41., Canada	Regarding the performance of VAOP research, doctors "always" or "often" asked directly about abuse in 44% of the suspects, and 64% did not report suspected cases, but 83% considered as a medical responsibility to report.
Almogue et al., 2010¹⁸18 Almogue A, Weiss A, Marcus EL, Beloosesky Y. Attitudes and knowledge of medical and nursing staff toward elder abuse. Arch Gerontol Geriatr. 2010;51(1):86-91., Israel	Of the total, 79% indicated that it was their responsibility reporting cases of abuse; and 88.5% agreed that all health professionals have a legal responsibility of reporting it. There was a general tendency towards neutrality in relation to older people abuse: given the allegation that only the interventions of legal authority will prevent older people abuse, the opinions were neutral. There was disagreement about the statement that placing the victim of abuse in a nursing home against their will is an effective intervention. Forty-one percent 41% considered that reporting abuse would make the aggressor angrier. Twenty-eight percent agreed that family members would assume that the whistleblower was a member of the team and 59% of respondents were sure that if they reported, their relationship with the patient would not be impaired. Now, 30% were certain that victims would generally deny abuse. The main reasons pointed out for not reporting the cases were the desire of not being legally involved, the denial of abuse by the victim, the non-recognition of abuse in consultation, lack of clarity in the definition of case of abuse or negligence and uncertainty about how to proceed with the complaint.
Kennelly et al., 2007¹⁹19 Kennelly S, Sweeney N, O’Neill D. Elder abuse: knowledge, skills, and attitudes of healthcare workers. Ir Med J. 2007;100(1):1-9., Ireland	The usual conduct pointed out was to seek advice from senior colleagues when managing suspected cases of abuse, and 46% would feel uncomfortable using the label of "older people abuse."
Mandiracioglu et al., 2006²⁰20 Mandiracioglu A, Govsa F, Celikli S, Yildirim GO. Emergency health care personnel’s knowledge and experience of elder abuse in Izmir. Arch Gerontol Geriatr. 2006;43(2):267-76., Turkey	They had low scores in disposition to report. Most considered it an unacceptable invasion asking about abuse and that it would affect the professional-patient relationship.

Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence Rafaella Queiroga Souto rqs@academico.ufpb.br

Brasil

Brasil

Doctors’ competences in caring for older people in situations of violence: scope review

Abstract

﻿Objective

Method

Results

Conclusion

Objective