What this article is about
In brief
In a mixed methods study of 37 interdisciplinary geriatric care providers in Ontario, most could correctly identify risk factors for older adult maltreatment, yet described real barriers — fear, apprehension, insufficient training, and institutional obstacles — that kept them from reporting suspected cases...
For nursing students
Study summary
Older adult maltreatment — abuse or neglect of an older person, often by someone they trust — is a serious but under-recognized problem in health and social care settings. This mixed methods study, published in the Canadian Journal of Nursing Research, looked at how interdisciplinary geriatric care providers in Ontario, Canada actually experience this issue in their daily work, and what stands in the way of them reporting it.
The researchers recruited 37 geriatric care providers from across disciplines. Each participant completed two things: a qualitative interview and a set of quantitative questionnaires. In the interview, providers described what they had personally observed or suspected in their workplaces, talked about their training background, and offered ideas for how professional development in this area could be improved. The questionnaires measured something different: how accurately providers could identify known risk factors for older adult maltreatment, and how willing they said they were to assess for signs of it.
The qualitative interviews were analyzed using inductive thematic coding, meaning the researchers let patterns emerge from what providers actually said rather than starting with a fixed checklist of themes. Two big patterns stood out. First, providers reported that they frequently observe maltreatment in their work settings — and importantly, the people most often identified as responsible were not strangers but family members and, notably, other geriatric care providers within the same care environments. Second, providers described a cluster of real barriers that kept them from reporting what they saw: fear of what might happen to them or their working relationships as a result of reporting, worry that the older adult themselves would be apprehensive or resistant to a report being made, gaps in their own knowledge of how and when to report, insufficient training and a sense of not being prepared, and broader professional and institutional obstacles built into how their workplaces operate.
Here is the part that makes this study especially useful for nursing education: on the quantitative measures, most providers actually did quite well. They could correctly identify the common, evidence-based risk factors for older adult maltreatment when asked directly. In other words, this was not primarily a knowledge problem in the narrow sense of "do you know the risk factors." Yet in the same breath, during the qualitative interviews, these same providers described clear personal, institutional, and professional barriers that kept that knowledge from turning into action. Knowing the risk factors and feeling safe, supported, and prepared enough to act on that knowledge are two different things — and this study found a gap between them.
The authors conclude that closing this gap requires more than adding a lecture on risk factors to a curriculum. They call for a genuine culture change around reporting processes: stronger professional and institutional support for staff who raise concerns, better and more specific training, and — perhaps most importantly — psychological safety, meaning providers need to trust that reporting maltreatment will not backfire on them professionally or personally. Without that combination of support, training, and safety, providers may continue to accurately recognize risk on paper while still hesitating to act in real workplace situations.
For nursing students and new graduates, this study is a useful reminder that recognizing abuse or neglect is only the first step in protecting older adults. Nurses also need clear institutional pathways for reporting, confidence that raising a concern will be taken seriously and handled fairly, and workplace cultures that do not punish or isolate staff who speak up — especially when the person of concern may be a colleague. As you build your own practice, it is worth asking not just "would I recognize maltreatment?" but "would I feel safe enough, and know exactly how, to act on what I recognized?"
Original publication
Source abstract and study details
Read the source abstract
In the current mixed methods study, 37 interdisciplinary geriatric care providers in Ontario, Canada, completed a qualitative interview and a series of quantitative questionnaires. The qualitative interview explored their experiences observing, identifying and reporting older adult maltreatment in their work settings, along with their training background and recommendations for professional development. The quantitative measures assessed their abilities to identify risk factors for older adult maltreatment, and their attitudes and willingness to assess for potential indicators of maltreatment. Inductive thematic coding of the qualitative interviews revealed that these providers frequently observe older adult maltreatment in their workplaces, which is most often perpetrated by family members and geriatric care providers. Several barriers to reporting older adult maltreatment were identified, including fear of consequences, older adult apprehension, insufficient reporting knowledge, training and preparedness, and professional and institutional barriers. Although most providers accurately identified the common risk factors for older adult maltreatment on the quantitative measures, they nevertheless expressed clear individual, institutional and professional barriers to maltreatment reporting during the qualitative interviews. These findings underscore the essential need for a culture change in reporting processes, professional and institutional support, training and psychological safety to ensure that all interdisciplinary geriatric care providers have the confidence and preparation to effectively assist older adults who are at-risk for abuse and neglect.
Reviewed findings
Main findings
- In interviews with 37 interdisciplinary geriatric care providers in Ontario, inductive thematic coding showed that providers frequently observe older adult maltreatment in their work settings.
- Maltreatment observed by providers was most often attributed to family members and to other geriatric care providers within the same care settings.
- Providers described several distinct barriers to reporting maltreatment: fear of consequences, concern about the older adult's own apprehension, insufficient reporting knowledge, inadequate training and preparedness, and professional or institutional obstacles.
- On the quantitative measures, most providers accurately identified the common, established risk factors for older adult maltreatment.
- Despite this accurate risk-factor knowledge, providers still expressed clear individual, institutional, and professional barriers to actually reporting maltreatment during the qualitative interviews, revealing a gap between knowledge and action.
For teaching and learning
Education implications
- Nurses and other geriatric care providers should not assume that being able to name risk factors for maltreatment is the same as being prepared or willing to report suspected cases in practice; both need to be addressed.
- Because co-workers were identified as a possible source of maltreatment, workplaces need clear, protected reporting pathways that function even when the concern involves a colleague, not only a family member.
- Reducing fear of consequences and building psychological safety around reporting should be treated as a patient-safety priority alongside knowledge-based training, not as a secondary concern.
- Training programs for geriatric care providers should go beyond teaching risk factors and include explicit guidance on how, when, and to whom to report suspected maltreatment within their specific institution.
- Providers should anticipate that older adults themselves may be apprehensive about a report being made, and should be prepared to address this apprehension sensitively as part of the reporting process rather than treating it as a reason not to report.
For educators
Teaching and appraisal notes
This mixed methods study, published in the Canadian Journal of Nursing Research (Wyman, Dion Larivière, Tayem, & Malloy), examined the experiences and training needs of 37 interdisciplinary geriatric care providers in Ontario, Canada around observing, identifying, and reporting older adult maltreatment. The design combines a qualitative interview strand with a quantitative questionnaire strand within the same sample, allowing the authors to compare providers' stated knowledge against their described real-world behaviour and barriers — a useful pairing for an applied practice topic like this one.
The qualitative interviews explored providers' direct observations of maltreatment in their work settings, their training backgrounds, and their recommendations for professional development. These interviews were analyzed using inductive thematic coding, an approach well suited to surfacing categories that the researchers did not necessarily anticipate going in, rather than testing a predetermined framework. The quantitative questionnaires assessed two related but distinct constructs: providers' ability to identify established risk factors for older adult maltreatment, and their self-reported attitudes and willingness to assess for potential indicators of maltreatment.
The central finding worth foregrounding in class discussion is the disconnect between the two data strands. On the quantitative measures, most providers accurately identified common risk factors — suggesting that basic content knowledge about maltreatment risk is reasonably well distributed in this workforce. Yet the qualitative interviews told a more complicated story: providers frequently observe maltreatment (most often attributed to family members and other geriatric care providers within the care setting itself), and they describe substantive barriers to reporting it, including fear of consequences, concern about the older adult's own apprehension toward a report, insufficient reporting knowledge, inadequate training and preparedness, and professional or institutional obstacles. This is a strong illustration for students of why knowledge-based competency and practice-based competency are not interchangeable — a provider can pass a risk-factor quiz and still not act in the moment.
For curriculum purposes, the finding that co-workers (other geriatric care providers) were identified as a source of maltreatment alongside family members is worth flagging explicitly, since it complicates the reporting calculus in ways that external-perpetrator scenarios do not: reporting a colleague carries interpersonal and workplace risk that reporting a family member typically does not. This has direct relevance to discussions of just-culture reporting environments, whistleblower protection, and psychological safety in nursing teams.
The authors' recommendation is not simply "more training," but a combination of culture change in reporting processes, professional and institutional support, targeted training, and psychological safety — framing the problem as organizational and cultural as much as educational. This gives instructors a natural bridge to broader organizational-behaviour and patient-safety-culture content, and to comparing this study against parallel Canadian literature on service-provider underreporting of elder abuse (e.g., work from Alberta) and on law-enforcement perceptions of older adult maltreatment, which the same research group has also examined.
Limitations for appraisal include the modest, single-province sample (n = 37), the self-report nature of both interview and questionnaire data, and the fact that reported maltreatment was not independently verified — findings describe providers' perceptions and disclosures rather than confirmed maltreatment incidence.
Critical appraisal
Limitations
- The sample of 37 interdisciplinary geriatric care providers was drawn from a single province (Ontario), limiting generalizability to other provinces, health systems, or countries.
- Both the qualitative interview data and the quantitative questionnaire data relied on provider self-report, which is subject to social desirability and recall bias.
- Observed and suspected maltreatment described by providers was not independently verified, so the findings reflect provider perception and disclosure rather than confirmed maltreatment incidence.
Classroom use
Discussion Questions
- Why might a geriatric care provider correctly identify the risk factors for older adult maltreatment on a questionnaire but still hesitate to report a suspected case in real practice?
- What does it mean for a reporting system that other geriatric care providers, not only family members, were identified as a source of maltreatment in this study?
- How would you design a reporting pathway in your own care setting that protects a staff member who reports a concern about a colleague?
- What specific institutional supports could reduce a provider's fear of consequences when reporting suspected maltreatment?
- How might an older adult's own apprehension about a report affect a nurse's decision-making, and how should a nurse respond to that apprehension?
- What would 'psychological safety' around reporting look like concretely on your unit or in your placement setting?
Knowledge check
Quiz
1. How many interdisciplinary geriatric care providers participated in this mixed methods study?
- 15
- 37
- 50
- 100
Show answer and rationale
Rationale: The abstract states that '37 interdisciplinary geriatric care providers in Ontario, Canada, completed a qualitative interview and a series of quantitative questionnaires.'
2. In which Canadian province were the study's participants located?
- Ontario
- British Columbia
- Quebec
- Nova Scotia
Show answer and rationale
Rationale: The abstract specifies '37 interdisciplinary geriatric care providers in Ontario, Canada.'
3. What research design did this study use?
- A randomized controlled trial
- A mixed methods study
- A systematic review
- A retrospective cohort study
Show answer and rationale
Rationale: The abstract opens: 'In the current mixed methods study, 37 interdisciplinary geriatric care providers... completed a qualitative interview and a series of quantitative questionnaires.'
4. According to the qualitative interviews, who were most often identified as perpetrators of the older adult maltreatment providers observed?
- Strangers in the community
- Family members and geriatric care providers
- Law enforcement officers
- Only unlicensed care aides
Show answer and rationale
Rationale: The abstract states maltreatment observed by providers 'is most often perpetrated by family members and geriatric care providers.'
5. Which of the following was NOT listed in the abstract as a barrier to reporting older adult maltreatment?
- Fear of consequences
- Older adult apprehension
- Lack of interest in older adult care as a career
- Insufficient reporting knowledge, training and preparedness
Show answer and rationale
Rationale: The abstract lists barriers as 'fear of consequences, older adult apprehension, insufficient reporting knowledge, training and preparedness, and professional and institutional barriers' — career disinterest is not among them.