Family Physicians' Perceptions of Elder Abuse and Structural Changes in Mongolia

Introduction

Elder abuse (EA) is a globally-recognized social problem. The prevalence of EA in various countries ranges between 2% and 36%. EA is associated with increased helplessness, social isolation and death. Evidence suggests that crises generated by economic recession, changes in governments, housing policy, poverty level, and other structural factors increases risk for EA many of which apply to Mongolia. Studies show that family physicians (FPs) stay in close contact with older adults outside of their homes and are among their most trusted connections. Currently, however, there is no data on the influence of structural factors on EA in Mongolia, it is important to explore the ways in which older Mongolians may be mistreated as result of wider social change. The purpose of this study is to articulate the social outcomes of the structural changes in Mongolia during the 1990s by examining how the existing structure may be connected to abuse through experience of FPs. FPs in Mongolia have specific professional tasks that provide more frequent contact with older adults than any other professionals, making them uniquely positioned to witness EA in conjunction with the wider social context.

Research question

The overarching research question is “How do FPs in Mongolia perceive the influence of structural changes in EA?”. Study objectives are (1) to understand the experience of EA as witnessed by FPs, (2) to identify common conditions in which older adults are found vulnerable, and (3) to understand family physician’s understanding of the connections between EA and wider societal change in Mongolia.

Methodology

The research was carried out at a Distirct Health Center in Mongolia’s capital, Ulaanbaatar. We purposefully selected 21 FPs for in-depth interviews about their experiences with older patients who have experienced EA. All interviews were audiotaped and transcribed verbatim. For the data analysis, we used grounded theory methods consisting of systematic coding, theoretical memoing, and thematic sorting. Atlas.ti software was used to facilitate the analysis. Primary themes were used to develop a model that proposes structural and societal factors the participants associated with EA in Mongolia.

Results

FPs that we interviewed have witnessed increasing incidents of neglect, physical, verbal, financial and sexual abuse of older Mongolians, mostly perpetrated by the elders’ close family members. Many of our participants believe that social problems such as extreme poverty and chronic alcoholism have significantly influenced the emergence of elder abuse. Older Mongolians have experienced a loss of status and dignity in the current society and mistreatment in family relationships. Being pushed aside from the mainstream society, in turn, leads to tremendous loneliness and isolation in later life. Findings from this exploratory study have significant practice and policy implications for care for older patients at primary health care level.