Table 3.

Barriers to Diagnosing and Managing Older Women Patients

BarriersIllustrative Quotes from the Focus Groups
    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 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.′
    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.′