Screening for Elder Mistreatment Risk in Caregivers: Clinician Perspectives on Barriers, Feasibility, & Response

TL;DR

This study explores how primary care clinicians view the feasibility and challenges of screening for elder mistreatment risk among caregivers of dementia patients.

Contribution

The paper provides new insights into clinician perspectives on implementing EM screening for dementia caregivers in primary care settings.

Findings

Clinicians see EM screening as feasible but highlight time and identification challenges.

Cultural and linguistic barriers and fear of alienating caregivers were major concerns.

Successful implementation requires support strategies and clinician readiness for sensitive discussions.

Abstract

Elder mistreatment (EM) risk screening in primary care presents challenges, particularly when aimed at assessing caregivers of people living with dementia. This secondary qualitative analysis examines how primary care clinicians conceptualize elder mistreatment, the feasibility of screening caregivers, and the perceived barriers and facilitators to screening implementation. Data were drawn from five focus groups (N = 38) conducted with multidisciplinary personnel at general and geriatric primary care clinics. Using Braun and Clarke’s reflexive thematic analysis, we analyzed focus group discussions to explore attitudes toward elder mistreatment screening among caregivers of patients with dementia, its practicality in primary care workflows, and related concerns. Participants viewed EM screening as feasible under certain conditions but raised concerns about time constraints, difficulty in dementia caregiver identification, and cultural and linguistic barriers. Some worried that screening might feel accusatory rather than supportive, emphasizing the need for careful framing. Respondents struggled with defining who qualifies as a caregiver, particularly when caregivers were not included in medical records or were absent during visits. While many saw screening as a potential opportunity to assess caregiver needs and connect them with resources, they noted that without clear implementation strategies and resources, feasibility remained uncertain. Effective implementation of dementia caregiver-focused EM risk screening requires clinician and site buy-in, cultural responsiveness, and framing that reassures rather than alienates caregivers. Findings highlight the importance of embedding screening within broader caregiver support efforts and ensuring clinicians feel equipped to navigate sensitive conversations.