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Who really knows about the mistreatment of older people?
Claudine McCreadie, Simon Biggs, Amy Hills, Jill Manthorpe, Anthea Tinker, Melanie Doyle, Madeleine O’Keeffe, Rebecca Constantine, Shaun Scholes and Bob Erens.
Institute of Gerontology and Social Care Workforce Research Unit, King’s College London and National Centre for Social Research
This article reports on findings from the UK survey of the prevalence of abuse and neglect about the use of services by those older people who had experienced mistreatment in the previous year. It demonstrates that a considerable proportion of people reporting mistreatment were users of services and poses questions about the implications of these findings for practitioners. In particular, it raises the question about the extent to which care workers are aware of mistreatment, and if aware, how adequate they feel about responding to it.
Our UK study of the abuse and neglect (mistreatment) of older people (O’Keeffe et al., 2007) has recently been published. This large, nationally representative survey was carried out by the National Centre for Social Research (NatCen) with colleagues from the Institute of Gerontology and Social Care Workforce Research Unit at King’s College London. The survey had over 2000 respondents aged 66 years and over. We adopted a rigorous and transparent approach in defining abuse and neglect, investigating four types of abuse (as well as neglect) – financial, physical, sexual and psychological, that could be carried out by groups of people defined as being in a ‘relationship of trust’ to the older person – family members, close friends and ‘care workers’ (from doctors to home care workers). 2.6% of people aged 66 and over reported that they had experienced mistreatment (abuse and neglect) during the past year. Neglect (1.1%) was the predominant type reported, followed by financial abuse (0.7%). The inclusion of harmful behaviour by neighbours and acquaintances as well increased the prevalence estimate to 4%.
Questions about mistreatment were asked in the context of people’s background and well-being, including their use of a range of care services. These covered: private or local authority provided home help, home care worker, meals on wheels, visits from a health care professional, social worker, care manager or helper from a voluntary organisation. Overall, 35% of people reporting mistreatment in the previous year were using one or more of these services. This finding poses a number of interesting questions, particularly in relation to the issue of how far practitioners are already aware of mistreatment occurring, particularly when this is in the form of neglect, and what they are doing about if they are aware.
Respondents were asked if they currently used a private or local authority provided home help, home care worker, or meals on wheels, or were currently visited by a health professional, social worker, care manager or helper from a voluntary organisation. As can be seen from Table 1, about a fifth of respondents were currently using one or more of these services (18% of men and 23% of women) and 6% of respondents were currently attending a lunch club or day centre. As would be expected, those who were reliant on help (whether paid or unpaid) were more likely to use these services than those not reliant on help. So, nearly half our respondents who were reliant on help, were using services, compared with 12% using services who were not so reliant. Similarly twice as many (10%) of those reliant on help visited a lunch club and/or a day centre, as did those not so reliant on help (5%).
We examined the relationship between the respondents who reported that they had been mistreated in the previous year, and their use of these services and lunch clubs. We found that, overall, those who used any services (as defined above) were twice as likely to have experienced mistreatment as those who did not (4.5% compared with 2.2%). This pattern, however, was only seen for women (6.2% mistreated who used services against 3.1% who did not) and not for men. Likewise, there were differences according to the type of mistreatment being reported by women. Women using services were four times more likely to have reported neglect than those who were not using services (3.6% against 0.9%). Similarly women using services were much more likely to have reported financial abuse – 1.9% of those reporting financial abuse were using services, compared with 0.4% of those who were not using services. This does not necessarily imply that most of the neglect and financial abuse were ‘service-related’. From the data we have on the perpetrators of mistreatment, we found that mistreatment was predominantly by partners and other family members, and only 13% of perpetrators were professionals or practitioners. .
From this arise a number of questions for practice: are practitioners, and, if so, which, aware of this ‘mistreatment’? Are they addressing it? Are they involving colleagues in their own or in other agencies, including Adult Protection? And if not, why not? Is it because they do not see Adult Protection as relevant? Or perhaps they do not label what they see as mistreatment, but as something else? Or perhaps it is because the service user will not consent to information sharing?
These questions may be particularly pertinent for staff running lunch clubs and day centres and those who help in those services. Table 2 shows the proportions of women reporting mistreatment who were attending lunch clubs and day centres. These patterns that related visits to lunch clubs and/or day centres to reports of mistreatment were not found for men.
We found that women who attended a lunch club/day centre were seven times as likely to have reported neglect as those not attending. This may partly be explained by the greater likelihood of those using these services requiring the level of care and support that we saw in Table 1 above. Again, the questions are raised about whether those running lunch clubs and day centres are aware of potential mistreatment, and, if they are aware, what they do about it. Do they express any concerns to GPs, or community nurses, or care managers, or to their own line managers? And if they do so, what happens? Alternatively, is a place in a day centre or lunch club being offered or taken up in the context of knowledge about possible abuse or neglect? Our research was not designed to address these questions, but it would be very interesting to know some of the answers.
We also asked respondents who had experienced mistreatment whether they had sought help or advice about it. Of those who answered this question (the number was smaller than the total number mistreated because some respondents used a computer version of the questionnaire to answer questions about mistreatment and their answers remained confidential) and experienced mistreatment in the past year, 30% said they did not report the incident or seek help, but the majority (70%) did take some action. They mainly sought help from a family member or friend (31%), or a health or social care professional (e.g. GP, nurse or social worker (30%). (See O’Keeffe et al, 2007, Table 5.3.) We did not ask what the consequences of asking for help were, but again, it would be interesting to know how these practitioners responded, and, in particular, whether they, in turn, were in touch with the Adult Protection co-ordinator in their area. We applied our 2.6% rate to two local authority areas, for which there were reliable referral statistics on cases of older people mistreated in the community by family members, close friends or care workers. Although these two areas are not necessarily representative of Adult Protection services across the UK, these figures do suggest that, in these two areas at least, only a very small proportion of cases (approximately 3%) are apparently picked up by Adult Protection services.
These findings raise more questions than they answer in relation to what is happening about mistreatment on the ground. They carry a number of implications for practitioners, particularly those who are managing front-line workers and those in care management roles. Since a substantial number of people who report experiencing mistreatment, particularly in the form of neglect or financial abuse, are apparently in touch with services, are the professionals with whom they are in touch aware of this mistreatment? This is the first question, because we do not know whether the mistreatment is hidden, or whether, care workers are aware of it and their response is individually tailored, acceptable and non-stigmatising. There are important issues around how far mistreatment is understood, and how well equipped care workers are for addressing it. Currently we do not know whether the multi-agency training initiatives equip care workers to feel confident about addressing mistreatment issues appropriately. This relates to a second question about the appropriateness of labelling some of these harmful behaviours as ‘abuse’. It may be, that social care workers are aware of mistreatment, and try to address it, but do not label it as mistreatment. If this is the case, how are they addressing it, and how satisfactory are the resources at their disposal? Future research might do well to examine responses to adult protection concerns now we have this study of prevalence on which to build.
O’Keeffe, M. et al. (2007) UK study of abuse and neglect of older people. Prevalence survey report. London: National Centre for Social Research. Order, price £15, from NatCen, 35 Northampton Square, London EC1V 0AX, or download from the Comic Relief web site. A summary is available on the Comic Relief web site, the NatCen web site or the Institute of Gerontology web site.
Please note that the Action on Elder Abuse ‘briefing paper’ (based on the research report) should be read in conjunction with the research report.
In 2005, King’s College London (KCL) (Institute of Gerontology and Social Care Workforce Research Unit) and the National Centre for Social Research (NatCen) were commissioned by Comic Relief and the Department of Health to carry out the UK Study of Abuse and Neglect of Older People. This is the first dedicated study of its kind in the UK. The aim of this research was to explore the life experiences and well being of older people living in their own homes (including sheltered housing) in the UK in order to discover the extent (prevalence) of abuse and neglect. The research involved face to face interviews with over 2000 people aged 66 and over between March and September 2006.
The research was undertaken by a team of researchers:
The views expressed in this publication are those of the research team and not necessarily those of the Department of Health or Comic Relief.