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Recognising and preventing the abuse of older people

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VOL: 103, ISSUE: 27, PAGE NO: 21

Comic Relief and the Department of Health have published research revealing the extent of abuse experienced by older people in the UK (O’Keefe et al, 2007). Based on a survey of around 2,100 people aged 66 and over who live in their own homes, including sheltered housing, the report is aimed at all health and social care professionals. It gives evidence of mistreatment of older people and advice to help professionals recognise those at risk and prevent further abuse.

 

Comic Relief and the Department of Health have published research revealing the extent of abuse experienced by older people in the UK (O’Keefe et al, 2007). Based on a survey of around 2,100 people aged 66 and over who live in their own homes, including sheltered housing, the report is aimed at all health and social care professionals. It gives evidence of mistreatment of older people and advice to help professionals recognise those at risk and prevent further abuse.

 

 

Increasing longevity among the population has led to a related growth in the numbers of older people with disabilities, mobility and cognitive problems. As the number of older people increases, it is likely that the number at risk of abuse will also increase.

 

 

There have been significant changes in the way social care is provided in recent years, involving the growth of independent provision of services, increased importance of regulation, service commissioning and assessment. There has also been growth in the private funding of domestic help and personal care in people’s own homes.

 

 

Elder abuse and neglect (elder mistreatment) are increasingly acknowledged as a social problem in the UK and internationally. Precise knowledge of the extent of mistreatment has improved over the past 25 years and this study was the first of its kind in the UK with the aim of providing nationally representative prevalence estimates.

 

 

Standards and guidance
Several safeguards already exist to protect older people. The National Service Framework for Older People (Department of Health, 2001) sets out standards for providers of care and support to older people in England in 2001. Key standards relevant to the prevention of abuse are: rooting out age discrimination (standard 1); providing person-centred care (standard 2); and focusing on mental health in older people (standard 7).

 

 

A range of professional guidance governs the protection of older people and other vulnerable adults. No Secrets (DH and Home Office, 2000) aims to ensure health, social services and the police work together to protect vulnerable adults from abuse.

 

 

The DH is to review this guidance in consultation with other government departments, with the intention of publishing new guidance to reflect the evidence in the Comic Relief/DH report. The DH will also consider the case for legislation as part of the review process.

 

 

Safeguarding Adults (Association of Directors of Social Services, 2005) is a framework of national standards for good practice and outcomes in adult protection work. It sets out 11 good practice standards covering partnership, access to help and response to need. It was drawn up in consultation and partnership with key organisations including the Association of Chief Police Officers, the Commission for Social Care Inspection, the DH and the Public Guardianship Office.

 

 

Another safeguard is the Protection of Vulnerable Adults (POVA) scheme (DH, 2006), which aims to ensure that people with a track record of poor practice or who are intent on harming vulnerable adults are banned from working in health and social care. However, a project undertaken by the DH and the charity Action on Elder Abuse investigating how authorities record abuse revealed limitations with the POVA scheme.

 

 

The DH is exploring alternative models for the regulatory system from 2008 as part of the wider review of health and social care regulation. This may help tackle the abuse of older people.

 

 

Scotland is ahead of the rest of the UK in addressing abuse and neglect. It has adopted a legislative framework to protect adults at risk of abuse or neglect, including self-neglect, under the Adult Support and Protection (Scotland) Act 2007.

 

 

The extent of elder abuse
The Comic Relief/DH study used the definition of abuse developed by Action on Elder Abuse and adopted by the World Health Organization: ‘A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.’

 

 

It identified five types of mistreatment (see box), and listed signs to help professionals recognise abuse, since people who are being abused are often afraid or unable to disclose it themselves.

 

 

Of the 2,100 people included in the study, 2.6% of those aged 66 and over who were living in private households reported that they had experienced mistreatment involving a family member, close friend or care worker during the past year. Extrapolated to the whole of the UK, this equates to about 227,000 people.

 

 

However, when the authors broadened their calculations to include incidents involving neighbours and acquaintances, the overall prevalence increased from 2.6% to 4%, equating to approximately 342,400 older people being subject to some form of mistreatment.

 

 

The most common type of mistreatment reported was neglect, followed by financial abuse. The risk factors for neglect included being female, being aged 85 and over, suffering from bad or very bad health or depression, and likely to be receiving services from or being in touch with health or social services.

 

 

The risk of financial abuse increased for people who were living alone, who were in receipt of services or were in bad or very bad health, as well as for older men, women who were divorced or separated, and people who were lonely.

 

 

Most often, the perpetrator of mistreatment was a partner or spouse (51% of cases), closely followed by another family member (49%), then by a care worker (13%) and by a close friend (5%). Some people reported abuse from more than one person.

 

 

Around three-quarters of the people questioned said that the effect on them was either serious (43%) or very serious (33%).

 

 

The majority of people who experienced mistreatment (70%) in the previous year reported the incident or sought help, mostly from a family member or friend (31%), or a health professional or social worker (30%).

 

 

The report concludes that older people are often seen as dependent, frail and needing to be rescued. However, in many cases, they are struggling with complex interpersonal or social circumstances where there may not be a simple solution. For example, carers may be perpetrating abuse because they are overwhelmed by their responsibilities and are themselves in need of support.

 

 

How should services respond?
Better prevention procedures are required. These must involve earlier intervention, offer more choice for older people and give them a stronger voice. They must also tackle inequalities, improve access to community services and offer more support for people with long-term needs.

 

 

The authors say that, for many years, health and social services have used the lack of evidence about the extent of elder abuse as a reason for their failure to set up services to deal with elder abuse. They point out that there is now evidence about mistreatment of older people, as well as guidance on how to recognise it. Health and social care professionals must increase their understanding of factors contributing to mistreatment, and more should be done to tackle the problem.

 

 

The DH has said that national and local records on the abuse of older people will now be systematically collected. This will enable councils to monitor and act on abuse by targeting help where it is most needed.

 

 

Five types of elder abuse/neglect
- Financial abuse -unauthorised and improper use of funds, property or any other resource of an older person.

 

 

- Psychological abuse - persistent use of threats, humiliation, bullying, swearing and other verbal conduct and/or of any other form of mental cruelty.

 

 

- Physical abuse - non-accidental infliction of physical force that results in a bodily injury, pain or impairment.

 

 

- Sexual abuse - direct or indirect involvement in any form of sexual activity without consent.

 

 

- Neglect - repeated deprivation of assistance needed by an older person for important activities of daily living.

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