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

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