New light cast on extent of elder abuse

Campaigners hope that the Comic Relief and Department of Health report into the mistreatment of older people in their own homes will imprint the issue of elder abuse onto the public consciousness in much the same way as child abuse hit the headlines in the 1980s.

Former athlete Dame Kelly Holmes and actress Sarah Lancashire addressed the media at last week’s launch presumably to give the report the level of star quality needed to propel it into the national press.

But the figures in the research, written by the National Centre for Social Research and King’s College London and the first ever UK-wide elder abuse prevalence study, speak for themselves.

Based on a survey of around 2,000 older people, the researchers calculated that in the past year 2.6% of over-65s, or 227,000 people, had been neglected or abused by people who they should be able to trust, such as family members, close friends or care workers.

And when the scope of mistreatment was widened to include abuse or neglect by neighbours or acquaintances the figure rose to 4% of over-65s or 342,400 people. The report suggests that the figure is probably an underestimate as older people with dementia or serious health problems would not have been able to take part in the survey. The figure does not include older people in residential care either.

Campaign group Action on Elder Abuse quite rightly points out that even the 342,400 figure equates to more than the whole population of Leicester and significantly more than Cardiff, Belfast or Aberdeen. Along with a wide range of other campaign groups and charities, it has now called for urgent action.

In response to the report, the DH has promised a review of its No Secrets adult protection guidance, now seven years old. It will also require local authorities to collect data on elder abuse from next year. But whatever further action the government and other agencies take they would do well to look beyond the headline figures to the study’s complexities.

While it does not diminish the scale of the abuse, the research points out that the prevalence rate for mistreatment in the UK is broadly in line with other international research, suggesting the issues to be tackled are not unique to this country.

The headline figures relate to what the researchers defined as “mistreatment” which includes neglect as well as financial, psychological, physical and sexual abuse. The most common type of mistreatment recorded was neglect, which stood at 105,00 cases, followed by 86,500 cases of financial abuse, about 62,000 cases of physical abuse and 58,000 cases of psychological abuse. The report says the prevalence of neglect and financial abuse goes against the “still common perception of abuse as physical violence”.

There were about 42,000 cases of sexual abuse, but the researchers suggest that most of these cases would be more properly classified as “harassment”.

Partners emerge as the main perpetrators of neglect, with a sharp rise in the likelihood of neglect for over-85s. The report proposes a hypothesis whereby a partner has a positive impact until the mid-80s after which time mental or physical disability sets in and neglect increases. “Thus, what is being reported is not necessarily at all deliberate neglect, but rather the kind of neglect that comes about as a consequence of two people with increasing disabilities trying to support each other – and increasingly failing.”

But Action on Elder Abuse policy development manager Daniel Blake says he has concerns about that analysis. While agencies must be better at spotting where things are going wrong and offering support he says that neglect of another person is a pattern of behaviour and as much a matter of choice as physically striking someone.

He suggests much of the mistreatment uncovered in these cases is more akin to domestic violence and needs a similar response. So the review of No Secrets must involve the Home Office and its crime and disorder and domestic violence functions, he argues. The charity also calls for the “false barriers” between elder abuse, vulnerable adults and domestic violence to be removed.

While a third of abuse victims were using social care services, such as home help or meals on wheels, the report estimates that just 3% of abuse cases come to the attention of adult protection teams. Blake says most people are simply not aware of where to go to report elder abuse and clearer pathways need to be created for them to do so. “Abuse is a crime, that’s what we need to call it. There’s an awful lot to do to get people to recognise what it is and respond accordingly.”

Action on Elder Abuse also believes the current system for adult protection “is at best a second class approach” and is leading the call for it to be put on the same statutory footing as child protection, a possibility the government says it will consider as part of its review.

The Association of Directors of Adult Social Services’ lead on adult protection Dwayne Johnson says the Every Child Matters child protection framework and new adult protection legislation in Scotland should be assessed before a decision is made on introducing new legislation.

And Johnson says the responsibility for tackling elder abuse must be spread much more widely than social services. “Individuals themselves who know that abuse is occurring, either because of family circumstances or because they are a friend or neighbour, have a responsibility to report that.”

What they said…

● Care services minister Ivan Lewis: “Legislation has its place but there are also massive long-term cultural and attitude issues.”

● Action on Elder Abuse chief executive Gary FitzGerald: “The truth is that we’ve stopped seeing our older people as a positive resource and instead view them as a burden or as a ‘demographic time bomb’ waiting to explode in our faces. And this is the consequence.”

● UK Homecare Association chair, Mike Padgham: “We need to see providers’ commitment to professionalise the workforce matched by a commitment from councils to meet the full costs of pre-employment screening, supervision and training.”

Sound familiar?

The government’s pledge to review No Secrets and introduce national data collection for elder abuse may sound familiar. In March 2006, the then care services minister Liam Byrne told an Action on Elder Abuse conference he would ask officials to examine how adult protection could be given the same legislative status as protecting children. He also accepted a further two recommendations made in an Action on Elder Abuse report to introduce a national data collection system and bring in a performance indicator for social care and health to improve outcomes for victims.

The charity’s policy development manager Daniel Blake said he was delighted that last week’s report had created the necessary impetus to make the pledges a reality.

* Better justice and protection for vulnerable adults came top in a reader’s vote for Community Care’s mission statement.

* Find out more about the research and an accompanying qualitative study at the Community Care conference The Realities of Elder Abuse: research into practice on Thursday, 12 July in London.

Further information
UK Study into the Abuse and Neglect of Older People

Contact the author
 Simeon Brody