Article Figures & Data
Figures
- Figure 1.
Variation in providers’ level of identification and management of older patients with IPV. The horizontal axis/continuum corresponds to the degree to which providers actively attempted to identify IPV among their older female patients (ie, suboptimal identification, limited identification, and thorough identification). The vertical axis/continuum corresponds to the extent to which providers manage the patients who have been diagnosed as victims of IPV (ie, suboptimal, limited, and thorough management). The intersection of suboptimal or limited identification and thorough management and thorough identification and suboptimal management are unlikely and were not found among our participants, so these intersections are not explored. (n = 42; office/nurse managers were not assigned a position in the model because they did not see patients.)
Tables
Type of Practitioner (n = 44) n % Family Medicine Physician 29 65.9 Physician Extenders 2 4.5 Internal Medicine Physician 9 20.5 Gynecologist 2 4.5 Nurse Manager 2 4.5 Race White 38 86.4 African American 5 11.4 Asian 1 2.2 Gender Male 28 63.6 Female 16 36.4 Mean SD Age(years) 46.0 9.0 Years in Practice 15.6 9.9 1. Do you screen for intimate partner violence (IPV)? If yes, ′Have you seen older women who are victims of intimate partner violence in your practice?′ If no, ′Do you have older female patients with chronic physical/somatic complaints?′ Tell me about those patients. Do you have female patients with chronic mental issues such as depression or anxiety? Tell me about those patients. 2. How do you manage those patients? 3. Do you know who your local domestic violence crisis agency is? What has been your experience with these agency/agencies? 4. What is you experience with Adult Protective Services? What about other agencies for seniors? 5. What do you need to do a better job with IPV? Barriers Illustrative Quotes from the Focus Groups Victims Accept as inevitable ′Older women are more likely to expect their husbands to yell and abuse them, but you stay married because that is what you do and then you celebrate that 50th wedding anniversary.′ Reluctant to seek help ′She is 72,says her husband is an SOB, he’s chased away all her friends, but she won’t do anything...it is generational. I suggested counseling, she’s not interested.′ Intertwined lives, lots to lose ′The more privilege, the harder to confront what is not working in the marriage. They are wedded to the husband and what he brings to the marriage.′ Providers Attitude barriers ′It does not have medical solutions and so it’s not my job to try to find it.′ Lack of knowledge about IPV ′My suspicions include: bruises,dementia, forgetful, unkempt, dressed inappropriately....′ Time constraints ′This is not something that can be solved in a 10-minute office visit.′ Lack knowledge about appropriate resources for older IPV victims ′We are not aware of IPV resources′ Community Agencies Agencies serving seniors ′There is an absence of IPV information in the senior centers. They do not deal with IPV.′ IPV agencies ′The local shelter operates from a perspective that is usually not helpful to older women. These women are not going to leave the relationship. The shelter thinks they should. The agency needs to understand that the goal is to help women figure out how to make something better in the relationship. The more empowered women have already left the relationship.′ Other community agencies (eg, police, APS) ′Got a page last night from a patient’s son. The husband was beating up the wife. He called the police, but when the police came, they said she wasn’t beat up enough to take him to jail. She had some scratches on her arms. They [APS] are not really an agency to be used with IPV. They do well with people who are neglected and their families are not supportive.′ - Table 4.
Strategies to Enhance Awareness and Services for Older Women with IPV Suggested by Providers
Individual/Family Brochures about IPV and resources Programs that help seniors negotiate the health care system and facilitate their linkage with resources (transportation,meals on wheels, etc) On-site IPV advocates or social workers knowledgeable about IPV at senior centers or in doctors’ offices. Community Awareness Public service announcements on television, billboards, newspaper ads to reduce the stigma. More awareness that IPV occurs for all ages. Pamphlets about IPV in beauty shops, churches, women’s clubs, doctor’s offices, senior centers, Adult Day Care Cross training for IPV and Aging Agencies Educate intake workers who are the first line with older people at the Council on Aging about IPV. Train home health and meals on wheels workers about IPV. Educate APS staff to screen for IPV. Train IPV agencies about issues of seniors and the need to ′think outside the box′ to create safety. Leaving may not be realistic.
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