Elder abuse and neglect
Elderly mistreatment is a hidden, and often ignored problem in society. In the general population many will have heard the phrase ‘Granny Battering’ but will know little more than that, other than perhaps some awareness of problems publicised in television programmes on Care Homes. The term ‘Granny Battering’ dates back to 1975 [1], so this is not a new phenomenon; but in the UK we have been slow to respond to the challenge, with persisting resistance to the idea that such a problem could exist.By the late 1980s every state in the USA had legislation related to elder abuse. In the UK, however, a major catalyst was a multi-disciplinary British Geriatrics Society Conference ‘Abuse of Elderly People: an Unnecessary and Preventable Problem’ [2]. This led to various projects and research; the first British Medical Journal paper about elder abuse, concerning the abuse of older people by their carers, was published in 1990 [3]. Subsequently the charity Action on Elder Abuse was formed in 1993. In 2004 a major House of Commons Health Committee report [4] highlighted a series of problems and made several proposals including improved Care Home inspection, mandatory training in elder abuse recognition for professionals working with older people, mandatory local availability of multi-agency guidelines and better regulation of care staff.
Action on Elder Abuse developed a definition which was later adopted by the World Health Organisation: ‘elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person’. There has been debate about prevalence figures since the syndrome was first recognised. Cooper et al. in their systematic review [5] of international elder abuse prevalence looked at studies where abuse was reported by older people themselves or by family or professional caregivers, and was investigated using objective measures. In their extensive literature search they found only seven studies which fulfilled these criteria: one of these was the first major study in the United Kingdom, by Ogg and Bennett in 1992 [6]. The systematic review of studies found that more than 6% of the general population, a quarter of vulnerable adults and a third of family caregivers reported being involved in significant abuse: this suggests a much larger number of episodes than are known to statutory services.
Since Cooper et al. completed their work, Comic Relief with some additional Department of Health funding has sponsored another extensive survey of elder abuse which showed prevalence levels in the United Kingdom of around 4% of older people being abused by family members or acquaintances [7]. These figures suggest that the prevalence of elder abuse is similar in the United Kingdom to other Western societies though prevalence varies considerably worldwide.
The main types of elder abuse (neglect, physical, psychological, financial, sexual) were described in the early days of the recognition of the syndrome and will be well known to most geriatricians. Less well known perhaps will be the range of impacts, with individuals often experiencing a range of these: including emotional distress, loss of self-confidence and self-esteem, depression, attempts at suicide and self-harm, social isolation, financial loss and negative impacts on physical health. Barriers for older people seeking help include low self-confidence and self-esteem (perhaps following bereavement or a move into care), fear of the consequences of action (e.g. being blamed in some way, or alienating family and friends) and lack of awareness of the role and remit of services which could help [7].
Everyone involved in the care and support of older people must be aware of the existence of elder abuse and be able to provide advice on how to deal with the situation. The vast majority of caring relationships will never experience the problem but for the minority who do, the problem must be solved and the impact minimised. Government and other agencies have produced a succession of initiatives such as in England ‘No Secrets’ and ‘Safeguarding Adults’, and ‘Breaking the Silence—Elder Abuse’ in Scotland. There is an annual world Elder Abuse Awareness Day and the International Network for the Prevention of Elder Abuse has United Nations and World Health Organisation support. Major voluntary organisations such as Age Concern and Help the Aged have well-organised systems to provide advice and support to older people who may have been abused. Action on Elder Abuse also runs a telephone hotline both for people who may have been abused or for people who have witnessed possible abuse and are uncertain what to do; they also provide advice for health professionals asked to deal with the problem.
All doctors working with older people must be alert to the possibility of elder abuse; they must be aware of how to identify it, and should be strongly in support of multi-agency working in both prevention and management of elder abuse to minimise the impact on older people.
Clinical Director, Stroke and Disability Services, NHSGGC, Lead Clinician, Glasgow Stroke Managed Clinical Network, Department of Medicine for the Elderly, Stobhill Hospital, Glasgow G21 3UW, UK
E-mail: christine.mcalpine{at}northglasgow.scot.nhs.uk Tel: 0141 201 3247 Fax: 0141 201 3218
References
- Baker AA. Granny battering. Mod Geriatr (1975) 8:20–4.
- Tomlin S. Report of a Symposium: Abuse of Elderly People: an Unnecessary and Preventable Problem (1989) London: British Geriatrics Society.
- Homer A, Gilleard CJ. Abuse of older people by their carers. Br Med J (1990) 301:1359–62.
[Abstract/Free Full Text] - House of Commons Health Committee. Elder Abuse (2004) London: The Stationery Office.
- Cooper C, Selwood A, Livingston G. The prevalence of elder abuse and neglect: a systematic review. Age and Ageing 2008; doi:10.1093/ageing/afm194.
- Ogg J, Bennett G. Elder abuse in Britain. Br Med J (1992) 305:998–9.
[Free Full Text] - O'Keeffe M, Hills A, Doyle M, et al. UK Study of Abuse and Neglect of Older People: Prevalence Study Report. (2007) National Centre for Social Research.
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