The many guises of elder abuse

There is still no standard definition of elder abuse in the UK.
Although agreement is needed on how to establish more precise
figures on its prevalence, the difficulties the public and staff
face in deciding whether to report such abuse compound the problems
in determining its scale. In the same way, gaps remain in
practitioners’ knowledge as to what constitutes abuse (1) and so
statistics gathered through monitoring are likely to be
estimates.

One year ago, community care minister Stephen Ladyman announced
funding of £280,000 to Action on Elder Abuse to collect
information about social services data on adult protection
referrals in England. This study is set to make recommendations on
what data can be routinely and accurately collected. Ladyman also
raised the possibility of introducing performance measures relating
to adult protection.

This is welcome news for adult protection more generally. Our
recent review in response to the health select committee’s report
on elder abuse made recommendations in the areas of research
development and policy. (2) These confirm the need for better
evidence to underpin policy development and practice
initiatives.
But to be able to gather better evidence, training across the
social care sector in identifying elder abuse needs to be expanded
so that staff are more confident about reporting abusive
situations. However, there needs to be an evaluation of what type
of training is needed, for whom, and how it is to be delivered and
so on.

While monitoring of adult protection and interventions is still
in its early stages, social services departments recognise the need
for robust data collection and analysis to measure abuse and
performance targets. (3) The Commission for Social Care Inspection
and the Healthcare Commission may be helpful in devising methods of
data collection on local issues and be valuable sources of evidence
about statutory agencies’ responses to abuse and in identifying
best practice.

Callers to the UK Elder Abuse Response Helpline cited financial
abuse as the third most common form of abuse; psychological abuse
was the most prevalent and physical abuse ranked second.(4) Yet
there is little UK research on financial abuse and how to combat
this in the social care sector or in the financial sector, social
security, legal or criminology arenas. The select committee report
indicated its surprise at this lack of research.

The report also confirmed general views that those who have been
abused need more access to advocacy services. However, the capacity
of existing advocacy services to respond to this role is uncertain.
Again there is little research on the nature of support for abused
older people, and what works and why.

Recent research in adult protection did not find any cases of
formal advocacy schemes being used to represent victims’ views. (5)
There is little evidence to guide practitioners as to what support
is most effective to meet the needs of those who have been
abused.

The health select committee report also recommended that more
advocates be drawn from ethnic minorities, and that training given
to social care workers about ethnicity should be assessed to ensure
it takes account of elder abuse. But it is not known what the best
model of such training should be and we could not find any
evaluations in this area. Understanding of abuse within ethnic
minority communities has been described as “patchy” and inadequate,
but so far few specific population or practice studies have been
undertaken.

Although the select committee report highlighted links between
abuse and domestic violence, understanding of these is
under-developed. A recent report commissioned by Help the Aged and
the Housing Associations’ Charitable Trust (6) reports that lack of
training for housing practitioners and health care workers often
results in the assumption that domestic violence is not an issue
for older women and that staff are consequently unlikely to
accurately identify signs. Marks of physical injury are often
attributed to falls, and if an older person reveals they are
frightened or are being hurt this may be put down to either
confusion or dementia.

Additionally, and not surprisingly, in light of the lack of
research in the area of sexual abuse and older adults, there is
little attention given to this area in the report. But the ageist
assumption that older people cannot be sexually abused is clearly
outdated.(7)

The health select committee report is a landmark document. It
sums up much of what is known and unknown about elder abuse in the
UK. It shows that much of the knowledge base rests on attempts to
raise awareness about the subject and to attract political and
professional attention.

However, there is a dearth of research and a surfeit of
overviews. Effectively, we know little about what works and how to
prevent abuse. New initiatives to count numbers must not remain a
paper exercise; they need to be matched by investment in and
evaluation of interventions and responses to abuse.

Lisa Pinkney is research associate at the University of
Sheffield’s community, ageing, rehabilitation, education and
research department. Her interests include older people and
neglect, community support for people with challenging behaviour,
and personality disorder. Pinkney, Jill Manthorpe, Neil Perkins,
Bridget Penhale, and Paul Kingston are all members of the research
team Partnerships and Regulation in Adult Protection, a project
funded by the Department of Health’s Modernising Adult Social Care
Research Programme (2003-6). The views expressed in this article
are the authors’ and are not necessarily those of the Department of
Health.

Abstract

This article summarises recent developments arising from the
health select committee’s elder abuse report. It highlights the
report’s proposals on research.

References

1. K Taylor, K Dodd, “Knowledge and attitudes of staff towards
   adult protection,” Journal of Adult Protection, 5, (4) p26-32,
   2003, from www.pavpub.com
2. J Manthorpe et al, A Systematic Literature Review in Response
   to Key Themes Identified in the Report of the House of Commons
   Select Committee on Elder Abuse, 2004, (forthcoming) from: www.masc.bham.ac.uk
3. K Sumner, “Social Services’ Progress in Implementing No
   Secrets,” Journal of Adult Protection, 6, (1) p4-11, 2004, from www.pavpub.com
4. G Bennett, G Jenkins, Z Asif, “Listening is not enough: an
   analysis of calls to the Elder Abuse Response Helpline,” Journal of
   Adult Protection, 2, (1) p6-20, 2000, from www.pavpub.com
5. K Jeary, “The Victim’s Voice; How is it Heard?,” Journal of
   Adult Protection, 6, (1) p12-19, 2004, from www.pavpub.com
6. I Blood, Older Women and Domestic Violence, Help the Aged,
   2004, from: www.hact.org.uk
7. K Jeary, “Sexual abuse of elderly people: would we rather not
   know the details?” Journal of Adult Protection, 6, (2) p21-30,
   2004, from www.pavpub.com

Further information

• The Government’s Response to the Recommendations and
  Conclusions of the Health Select Committee’s Inquiry into Elder
  Abuse, The Stationery Office, at www.dh.gov.uk
• www.elderabuse.org.uk
• House of Commons health select committee, Elder Abuse, Second
  Report of Session 2003-4 Vol 1, The Stationery Office, 2004

Contact the Authors

l.pinkney@sheffield.ac.uk;

tel: 0114 222 8314