Maltreatment of older people: challenges for patient-centred care in general practice.

Lieve Peremans, Naomi Aerts, Kristof Van Assche, Maxime Castermans, Paul Van Royen, Hilde Bastiaens

Keywords: Maltreatment, older people, patient-centred care

Background:

Older people are vulnerable for maltreatment, but also reluctant to ask support from healthcare providers. Interprofessional collaboration between health care and justice has deontological obstacles. Limited research has been done on models taking in account the patient’s perspective.

Research questions:

What are the different stakeholder’s perspectives and concrete obstacles in the prevention, detection and policy for maltreatment?

Method:

The first step involves a descriptive qualitative interview study with a purposive sample of patients and experienced professionals including nurses, GPs, social workers, notaries, lawyers and judges. Data-collection by two skilled interviewers (NA and MC) started in October 2022.Respondents were identified by organisations familiar with the problem and by snowballing. Second, we are starting a multiple case study of abused older persons, to identify and interview the parties involved and examine the obstacles they encountered during the intervention process.

Results:

Until now 24 patients and 39 professionals were interviewed. Three main themes were highlighted: (1) need for sensitization of older people and professionals, (2) difficulties raised by deontological obligation and (3) need for, and obstacles hampering interprofessional collaboration.
Multi-level sensitization is needed because of the complexity of elder abuse; the victim’s vulnerability, their reluctance to request help; and potential abuse of powers of attorney.
Healthcare professionals, focused on a patient-centred approach, identified a tension between a trust-based relationship and upholding professional secrecy. No adequate model for interprofessional collaboration currently exists, but only goodwill of the individual actors.

Conclusions:

These results highlight the complexity of situations of elder abuse, and the challenges in developing and valorizing an interprofessional collaboration model which can overcome the obstacles for collaboration between healthcare, welfare and legal experts and which takes into account the patient’s perspective.

Points for discussion:

Who has experience with valorisation study of this kind of models for interprofessional collaboration?

What is your experience with the problem of elderly abuse in your practice?