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
Further information
Contact the Authors
l.pinkney@sheffield.ac.uk;
tel: 0114 222 8314
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