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  1. Mohd Mydin FH, Othman S
    J Interpers Violence, 2020 11;35(23-24):6041-6066.
    PMID: 29294874 DOI: 10.1177/0886260517726411
    This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.
  2. Othman S, Kong SZ, Mohd Mydin FH, Ng CJ
    Malays Fam Physician, 2019;14(1):10-17.
    PMID: 31289626
    Early sexual debut, partner violence, pregnancy and sexually transmitted infections contribute to negative health outcomes among adolescents. While the primary care clinics offer accessible sexual and reproductive health (SRH) services to adolescents, it is uncertain whether adolescents are aware of and utilize these services. This study aimed to examine Malaysian adolescents' knowledge, utilization and barriers to primary care services for SRH. A cross-sectional survey was conducted from August to November 2011 among adolescent from five randomly selected schools in Selangor, Malaysia. A self-administered questionnaire was used to assess their knowledge, attitudes, sexual behaviors and utilization of SRH services. A total of 680 adolescents participated in the study. One in ten of the adolescents were aware of the availability of SRH services, and only 6.9% of them had ever visited a primary care clinic for SRH. About 75% of them felt uncomfortable going to a primary care clinic for SRH services. Knowledge and utilization of primary care clinics for SRH among adolescents in Malaysia is poor.
  3. Abdul Khalil NM, Mohd Mydin FH, Moy FM
    PLoS One, 2023;18(11):e0292390.
    PMID: 37972052 DOI: 10.1371/journal.pone.0292390
    Mobile diet apps assist in tracking nutritional intake and managing healthy eating diets. Effective diet apps incorporate specific population-tailored behavior change strategies (BCS) for user engagement and adherence to healthy diets. Malaysians have their unique behaviors and customs surrounding food and diet. This study aims to explore the perceptions, views, and experiences of healthy Malaysian adults with diet monitoring apps, by focusing on the BCS that engages users to use diet mobile apps and adhere to a healthy diet. A qualitative approach utilizing semi-structured in-depth interviews was conducted using a topic guide based on the Theory of Planned Behavior and trigger materials. Twenty interviews were audio-recorded and transcribed verbatim. Five themes emerged from the data, which are; instilling self-awareness, closed online group support, shaping knowledge, personalization, and user-friendly design. Influence by one's social circle and attractiveness of app features may initiate users' interest and help them engage with mobile diet apps, but the app's ability to raise awareness of progress and impart useful knowledge help them adhere and comply to a healthier diet in the long run. The results from this study may help improve the behavior change strategy features of mobile diet apps for Malaysian adults.
  4. Ahmed A, Choo WY, Othman S, Hairi NN, Hairi FM, Mohd Mydin FH, et al.
    J Elder Abuse Negl, 2016 Jun-Jul;28(3):163-77.
    PMID: 27149412 DOI: 10.1080/08946566.2016.1185985
    Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.
  5. Mohd Mydin FH, Othman S, Choo WY, Mohd Hairi NN, Mohd Hairi F, Ali Z, et al.
    Public Health Nurs, 2021 Aug 12.
    PMID: 34386986 DOI: 10.1111/phn.12961
    OBJECTIVES: To explore the views of nurses on challenges, perceived roles and improvement strategies concerning elder abuse intervention in Malaysia.

    DESIGN AND SAMPLE: Eleven focus group discussions were conducted using a semi-structured interview based on the socio-ecological framework. The data were analyzed using a multistep process of thematic analysis.

    RESULTS: Three themes emerged from the data analysis: (1) The predicament: being unwilling or not able to intervene (2) Bridging the older people and health system gap (3) Getting to grips with the barriers. There are multifactorial contributors identified at the individual, interpersonal, organizational, community and policy levels in each theme. These factors interact across the levels to influence nurses' capability to intervene in elder abuse.

    CONCLUSION: A framework is needed to articulate Malaysian nurses' role in elder abuse intervention in terms of personal and professional development through culturally sensitive education and the establishment of clinical guidelines in the primary care setting. Strengthening organizational support and the institution of national policy and permissive reporting laws of elder abuse will empower the primary care nurses to address elder abuse in primary care settings and communities.

  6. Lim MK, Wong PS, Othman S, Mohd Mydin FH, Lim PS, Lai PSM
    J Am Med Dir Assoc, 2023 Dec;24(12):1831-1842.
    PMID: 37844872 DOI: 10.1016/j.jamda.2023.09.008
    OBJECTIVES: To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP.

    DESIGN: Mixed-methods systematic review (PROSPERO: CRD42018091033).

    SETTING AND PARTICIPANTS: Asian adults (≥18 years old) living in the community globally.

    METHODS: Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review.

    RESULTS: Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population.

    CONCLUSIONS AND IMPLICATIONS: A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.

  7. Mohd Mydin FH, Wan Yuen C, Othman S, Mohd Hairi NN, Mohd Hairi F, Ali Z, et al.
    J Interpers Violence, 2022 01;37(1-2):NP719-NP741.
    PMID: 32394780 DOI: 10.1177/0886260520918580
    Elder abuse and neglect (EAN) goes largely unrecognized and underreported globally by health care professionals. Despite acknowledging their role to intervene elder abuse, health care professionals lacked knowledge and skills in this issue. This is a single-blinded, three-armed, cluster randomized controlled trials aimed to evaluate the effectiveness of the face-to-face Improving Nurses' dEtection and managEment of elDer abuse and neglect (I-NEED) intensive training program and I-NEED educational video in improving primary care nurses' knowledge, attitude, and confidence to intervene EAN; 390 primary care nurses were randomized equally into two intervention groups-ITP group (intensive training program) and ITP+ group (intensive training program and educational video)-and a control group. The knowledge, attitudes, and confidence to intervene EAN were measured using questionnaires at four intervals during 6-month follow-up. A total of 269 primary care nurses participated in this study. There was a significant increase in knowledge, attitude, and confidence to intervene EAN immediately post intervention observed in both intervention groups compared to the control group (p < .001). At the end of sixth month, there was an increase of knowledge favoring ITP group than the ITP+ group (p < .001). There is, however, no significant difference in attitude score between ITP and ITP+ group. There is a significant difference of confidence to intervene among the participants between both intervention groups with ITP+ participants reporting higher scores post intervention (p < .05). An intensive training module improved the knowledge, attitude, and confidence to intervene EAN. Other co-existing barriers for abuse victims getting help, resources, policy, and law of EAN need further highlights.
  8. Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.
    J Elder Abuse Negl, 2021 04 25;33(2):151-167.
    PMID: 33899705 DOI: 10.1080/08946566.2021.1919272
    This quasi-experimental study examined the effect of Supporting Family Doctors to Address Elder Abuse (SAFE) educational intervention among family doctors practicing at public primary care clinics in Malaysia. SAFE is an intensive, multimodal, locally tailored, and culturally sensitive face-to-face educational intervention on elder abuse. A significant mean score improvement of knowledge [Baseline: 5.33 (SD:1.33) to 6-month post-intervention: 6.45 (SD: 1.35); p<0.001] and perceived behavioral control [Baseline: 50.83 (SD: 8.87) to six-month post-intervention: 56.16 (SD: 9.56); p<0.001] observed in the intervention group compared to the control group. No significant difference in attitude, subjective norm, and practice scores between the two groups over time. SAFE educational intervention for family doctors was effective to improve but not sustainable knowledge and perceived behavioral control toward elder abuse identification and management. We recommend SAFE educational intervention as part of the continuous medical education for family doctors supplemented with a change in organization and national policy.
  9. Jackson AA, Lai PSM, Alias AM, Atiya N, Ramdzan SN, Abdul Malik TF, et al.
    J Infect Dev Ctries, 2019 03 31;13(3):219-226.
    PMID: 32040451 DOI: 10.3855/jidc.11089
    INTRODUCTION: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting.

    METHODOLOGY: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist.

    RESULTS: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available.

    CONCLUSION: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

  10. Mohd Mydin FH, Mikton C, Choo WY, Shunmugam RH, Murray A, Yon Y, et al.
    Campbell Syst Rev, 2024 Sep;20(3):e1419.
    PMID: 39211334 DOI: 10.1002/cl2.1419
    BACKGROUND: The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels.

    OBJECTIVES: This review rigorously employed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings.

    SEARCH METHODS: A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT.

    SELECTION CRITERIA: All quantitative, qualitative (addressing face and content validity), and mixed-method empirical studies published in peer-reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings.

    DATA COLLECTION AND ANALYSIS: Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta-analysis was performed.

    MAIN RESULTS: We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty-seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high-income countries (69 studies). Ninety-five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one-quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS-EAST (assessed in 11 studies), VASS-12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL-31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS-EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS-12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality.

    AUTHORS' CONCLUSIONS: This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.

  11. Mohd Mydin FH, Mikton C, Choo WY, Shanmugam RH, Murray A, Yon Y, et al.
    Campbell Syst Rev, 2023 Sep;19(3):e1342.
    PMID: 37383829 DOI: 10.1002/cl2.1342
    BACKGROUND: The psychometric properties of elder abuse measurement instruments have not been well-studied. Poor psychometric properties of elder abuse measurement instruments may contribute to the inconsistency of elder abuse prevalence estimates and uncertainty about the magnitude of the problem at the national, regional, and global levels.

    OBJECTIVES: The present review will utilise the COSMIN taxonomy on the quality of outcome measures to identify and review the instruments used in measuring elder abuse, assess the instrument's measurement properties, and identify the definitions of elder abuse and abuse subtypes measured by the instrument.

    SEARCH METHODS: Searches will be conducted in the following online databases: Ageline, ASSIA, CINAHL, CNKI, EMBASE, Google Scholar, LILACS, Proquest Dissertation & Theses Global, PsycINFO, PubMed, SciELO, Scopus, Sociological Abstract and WHO Index Medicus. Relevant studies will also be identified by searching the grey literature from several resources such as OpenAIRE, BASE, OISter and Age Concern NZPotential studies by searching the references of related reviews. We will contact experts who have conducted similar work or are currently conducting ongoing studies. Enquiries will also be sent to the relevant authors if any important data is missing, incomplete or unclear.

    SELECTION CRITERIA: All quantitative, qualitative (that address face and content validity), and mixed-method empirical studies published in peer-reviewed journals or the grey literature will be included in this review. Studies will be included if they are primary studies that (1) evaluate one or more psychometric properties; (2) contain information on instrument development, or (3) perform content validity of the instruments designed to measure elder abuse in the community or institutional settings. Studies should describe at least one of the psychometric properties, such as reliability, validity and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings (i.e., nursing homes, long-term care facilities, assisted living, residential care institutions, and residential facilities).

    DATA COLLECTION AND ANALYSIS: Screening of titles, abstracts, and full texts of the selected studies will be evaluated based on the preset inclusion criteria by two reviewers. Two reviewers will be assessing the quality appraisal of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence of each psychometric property of the instrument against the updated criteria of good measurement properties. Any dispute between the two reviewers will be resolved through discussions or consensus with a third reviewer. The overall quality of the measurement instrument will be graded using a modified GRADE approach. Data extraction will be performed using the data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The information includes the characteristic of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, psychometric properties listed in the COSMIN criteria, including details on the instrument development, content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness and interoperability. We will perform a meta-analysis to pool psychometric properties parameters (where possible) or summarise qualitatively.

  12. Choo WY, Hairi NN, Sooryanarayana R, Yunus RM, Hairi FM, Ismail N, et al.
    BMJ Open, 2016 05 25;6(5):e011057.
    PMID: 27225651 DOI: 10.1136/bmjopen-2016-011057
    INTRODUCTION: Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

    METHODS AND ANALYSIS: This is a community-based prospective cohort study using randomly selected households from the national census. A multistage sampling method was employed to obtain a total of 2496 older adults living in the rural Kuala Pilah district. The study is divided into two phases: cross-sectional study (baseline), and a longitudinal follow-up study at the third and fifth years. Elder mistreatment was measured using instrument derived from the previous literature and modified Conflict Tactic Scales. Outcomes of elder mistreatment include mortality, physical function, mental health, quality of life and health utilisation. Logistic regression models are used to examine the relationship between risk factors and abuse estimates. Cox proportional hazard regression will be used to estimate risk of mortality associated with abuse. Associated annual rate of hospitalisation and health visit frequency, and reporting of abuse, will be estimated using Poisson regression.

    ETHICS AND DISSEMINATION: The study has been approved by the Medical Ethics Committee of the University of Malaya Medical Center (MEC Ref 902.2) and the Malaysian National Medical Research Register (NMRR-12-1444-11726). Written consent was obtained from all respondents prior to baseline assessment and subsequent follow-up. Findings will be disseminated to local stakeholders via forums with community leaders, and health and social welfare departments, and published in appropriate scientific journals and presented at conferences.

  13. Loh DA, Choo WY, Hairi NN, Othman S, Mohd Hairi F, Mohd Mydin FH, et al.
    J Adv Nurs, 2015 Nov;71(11):2661-72.
    PMID: 26031344 DOI: 10.1111/jan.12699
    The aim of this study was to describe a trial protocol of an educational intervention for nurses to improve their awareness and practice in detecting and managing elder abuse and neglect.
  14. Yunus RM, Hairi NN, Choo WY, Tan MP, Hairi F, Sooryanarayana R, et al.
    J Am Geriatr Soc, 2018 07;66(6):1165-1171.
    PMID: 29601084 DOI: 10.1111/jgs.15370
    OBJECTIVES: To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians.

    DESIGN: Two-year prospective cohort study.

    SETTING: Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur.

    PARTICIPANTS: Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later.

    MEASURES: EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions.

    RESULTS: The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain-age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03-2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81-1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data.

    CONCLUSION: Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes.

  15. Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.
    J Elder Abuse Negl, 2020 02 21;32(1):72-83.
    PMID: 32085693 DOI: 10.1080/08946566.2020.1731640
    This study aimed to determine the primary care doctors' ability to recognize elder maltreatment and their intentions to report on such conditions. About 358 primary care doctors participated in this study. Outcomes were assessed using a validated five context-relevant clinical vignettes. Primary care doctor's recognition of sexual abuse was highest (91.0%); while the lowest (70.2%) in case signifying physical abuse. Despite being able to ascertain elder maltreatment, the intention to report the event is generally low even for cases exemplifying physical abuse, emotional abuse and neglect. However, intentions to report cases of sexual and financial abuse are 86.9% and 73.5% respectively. Findings highlighted the uncertainties of primary care doctors in distinguishing the clinical findings of non-accidental injuries and injuries due to acts of maltreatment. This provides support for educational intervention and guidelines or policies to improve the knowledge and skills of primary care doctors to intervene in elder maltreatment.
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