Debbie Preston

May 2007

This essay focuses on the current public health issue of elder abuse. I chose to research this issue because a lecturer briefly touched on the subject in a module and I came out of that class believing that as a student nurse I should be more prepared in recognising and responding to abusive behaviour. Further study in this area lead me towards vulnerability of the elderly and how increasing frailty and loss of independence can end in mistreatment and neglect. From working in practice I was made aware of the appropriate action I would have to take if I came across any abusive situations. The essay tells the reader the prevalence and incidence of elder abuse and addresses the associated risk factors. I have written about the epidemiology of the health issue and how this is changing. Being a public health issue and demonstrating that I have researched widely on this topic I have considered the effects both short term and long term. It also discusses elder abuse in relation to the Human Rights Act 1998 and other legislation in England. I have referred to the most recent documents on how health promotion aims to improve this issue to all individuals. This paper discusses the Nurses role in conjunction to elder abuse and finally concludes my main points. The Nurses’ Dictionary defines abuse as “misuse, maltreatment” and could be “physical, sexual, psychological or neglect” (Weller 2005, 2). My research shows me that the actual definition of elder abuse remains disputed but the most recent definition is “Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it” (Department of Health 2000a, 9). When researching why elder abuse happens I came across it being a general combination of psychological, social, and economic factors and in England “it has only recently been identified as an emerging social problem” (Biggs 1995, 1). When reading more up to date literature on why, I learnt that there are numerous reasons and “many casual factors of abuse” (Pritchard 2007, 100). In respect to this health issue and considering what may have caused elder abuse to occur it could be due to something that has happened in the past e.g. relationships and the problems of violence, neglect or abuse experienced. Other reasons as to why, is that the abuser might have a history of committing violent or sexual offences, or most common is the abuser could have financial problems and need money to finance a gambling or drug habit. The abuser may have experienced a loss in their life and not been able to come to terms with it. This loss could be physical resulting in a disability or it could be loosing a loved one and blaming someone else for that loss. Elder abuse also happens in institutions and the reason why this could be is because of the “high dependency levels of the vulnerable adult” and “the behaviour traits of the dependent person” (Pritchard 2007, 104). Elder abuse is a huge problem in the England and from reading literature from the early nineties elder abuse was only then being discovered and comments from Bennett and Kingston (1993) suggest that they are about to embark on the difficult voyage through the

rough waters of definitions, its context in the family violence debate, the worries of the carers lobbies and many other storms. By researching I found that the prevalence of elder abuse was difficult to quantify because it can be frequently hidden and may not even be obvious to the victim so is likely to be unreported. I found that difficulties were established because of the lack of research and the ongoing disagreement of the definition of abuse. In England the first prevalence study was completed in 1992 (through the nationwide Office of Population Censuses and Surveys omnibus survey) by Ogg and Bennett of the Department of Health Care of the Elderly at the Royal London NHS Trust. This study used a survey of two thousand older people living in the community and inquired about any experiences of physical, psychological and financial abuse from family members and close relatives. Their findings suggest that approximately five per cent of older people experienced psychological abuse and two per cent experienced physical or financial abuse. This study did not include those who were living in residential settings. From reading the House of Commons Health Committee report on Elder abuse from 2003-2004 I found that because of such a small majority of the population being surveyed in 1992 they found it difficult to obtain reliable figures when estimating the prevalence rate in 2003. Professionals did agree that the figure was probably lower than 500,000. In June 2007 a UK prevalence study into elder abuse was launched by Comic Relief and the Department of Health. This study found that in the UK almost 350,000 people over the age of 66 and living in a private household experienced mistreatment. The most common incidence of abuse was neglect followed by financial abuse. The incidence of elder abuse was higher in Wales than in England or Scotland. When considering how this may have changed over time and using research on statistics I found that the incidence of elder abuse seems to be decreasing. There are many reasons as to why this is and I think it’s because abuse is a very sensitive subject and the elderly might not know how to report it. They may be unable to due to poor health, disability or embarrassment. Prevalence studies completed in the United States show that there are some important characteristics in elders who have experienced abuse. Biggs et al. (1995) suggests that “victims tend to be in poor health” and are “likely to be living with someone else”. Their literature also states that from the studies the “neglected elders were most likely to have no one to turn to for support”. These are linked with being risk factors. I found that “research to date has produced limited insights into the risk factors that pertain to elder abuse and neglect” (Kingston et al. 2000) and by reading other books I found that the people at most risk of being abused were those that have psychological or physical impairment with increased dependency and vulnerability, those that are socially isolated, and in some cases the fact that the elderly person or the caregiver will not accept any help. Through studies it was noted that abused elderly people tend to have fewer social contacts and “vulnerable, elderly members of families are isolated from the support of other people by distance or design and are probably at greater risk than elders who have social support” (Baumhover and Beall 1996). Intra-individual dynamics are a risk factor as there is “clear

evidence of abusers having either mental health problems or alcohol misuse and abuse” (Bennet et al. 1997). I have found that intergenerational transmission of abuse to be a risk factor but is “notoriously difficult to research” (Parker et al. 2000) because of extremely sensitive questions about family relationships that are included in questionnaires. Caregiver stress is another risk factor and Baumhover and Beal (1996) suggest that this could be because of role dissatisfaction and “the difficult situations in their personal lives that influence their ability to deliver care”. Pritchard (1992) suggests that “we need to get better at monitoring an older persons health” and “adopt the multi-disciplinary approach so that information is shared regularly, clear objectives are set, there is co-ordination of services, decisions are made and workers can support each other as well as the older person with whom they are working”, all of these could lower the chance of elder abuse occurring. From researching I found that elderly victims of abuse were not receiving the kind of long term help they needed to escape ill treatment. When elders are abused the long and short term effects often include problems with immobility, incontinence, pressure sores, dehydration, malnutrition, starvation, depression, loss of dignity or self esteem, loss of friendships, loss of assets, poverty, homelessness, worsening or irremediable medical conditions and death. These are all linked with the victims’ physical ability, emotional wellbeing and environmental factors. According to the Human Rights Act 1998 it states that everyone has the right to life, prohibition of torture and the right to liberty and security. Pritchard (2007) suggests that “Every vulnerable adult has the right to live their live free from fear, violence, abuse and neglect. They also have the right to be protected from harm and exploitation”. Other specific policies which address this health issue have been researched by the government over recent years and contribute significantly to the prevention, recognition and the reduction of abuse of older people. A number of these stem from the provisions of the Care Standards Act 2000 and includes the National Care Standards Commission and the General Social Care Council. The policy No Secrets was produced in 2000 by the Department of Health and comes under section 7 of the Local Authority and Social Services Act 1970. This and the National Service Framework for Older People’s Services were all put in place to improve practice and raise the standards of the delivery of care. Within the Care Standards Act 2000 the government launched the Protection Of Vulnerable Adults (POVA) scheme in July 2004. This is most commonly known as Criminal Records Bureau (CRB) and targets people that work in the care industry to undergo police checks as a way of safeguarding adults. When researching on what is being done to address the public about elder abuse I found that there are charities which can help those affected, including giving advice to concerned friends and family members. Action on Elder Abuse, Age Concern and Help the Aged are just some of the several charities that are accessible and provide information and support. They work towards the protection and prevention of abuse against vulnerable adults and raise awareness to people working in social care settings. Nurses should be aware of elder abuse so that they can make appropriate assessments to identify potentially dangerous situations and actual cases of mistreatment. I think that Nurses play a central role in both the detection and resolution of elder abuse and should be alert to

any signs or symptoms. The role of the Nurse is to work within their own scope of knowledge and if needs be consult with more experienced colleagues. When in a short or long term situation it is the Nurses role to liaise with both the elderly person and caregivers to implement appropriate plans that alleviate any risks for that elder person in their home environment. Through my research I have come to the conclusion that it is incredibly difficult to get reliable statistics when measuring the extent of elder abuse. On reflection to the legislation concerning elder abuse, I feel that it is all very complex and overlaps with other various bits of legislation. This to me shows that the government isn’t going to considerable lengths to bring in policies that recognise and respond to those suffering. This could be misinterpreted to mean that elder abuse is secondary to other groups within our society. Through my research I understand that elder abuse was first written about in the 1970’s although it had been occurring for hundreds of years. Considering this I could not believe that it took twenty years before any sort of study in England was done. The reason for this is because of the ongoing debate I mentioned earlier about certain terminology. Although I can see the point of getting words and meanings correct so not to offend, abuse is abuse and this was continuing in institutions, private housing and residential settings all along. I feel that more awareness of elder abuse is needed publicly so to obtain a deeper insight into the way that elder maltreatment is growing as a social problem. I feel that the epidemiology of elder abuse is widely focused on throughout the world as a continuous problem, and to achieve the goal of ensuring that older people live a life free of violence and mistreatment will always be complex and difficult.

Sign up to vote on this title
UsefulNot useful