Elder Abuse in the United Kingdom

ABSTRACT

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

Elder abuse in the United Kingdom

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

The Hospital Elder Assessment Team:

Elder abuse literature shows that health care professionals are aware of elder abuse/neglect laws but do not understand the requirements nor have the skills to diagnose the problem (Clark-Daniels & Daniels, 1990). Many victims of elder abuse appear in hospital emergency rooms for medical evaluation. Although 42 of the 50 states now have mandatory elder abuse/neglect reporting laws, few hospitals have responded with interdisciplinary elder protective teams in contrast to the situation with child abuse reporting laws. One exception has been the establishment of a multidisciplinary elder assessment team at Beth Israel Hospital, Boston, MA, to address the complex issues of recognition and assesssment of elders seen in the hospital who are suspected victims of abuse. Included in the mission of the team are consultation, support, and education to hospital staff about elder abuse and neglect.     

Elder Abuse and Neglect-The Legal Framework

This article looks at the legal framework for defining and responding to elder abuse and neglect in the English legal system. The role of the criminal law, domestic violence legislation, the provision of Local Authority services, registration and inspection of residential homes and dealing with financial matters are considered for their appropriateness to deal with issues and abuse. The emphasis throughout is on a legal paradigm of rights, duties and remedies. Proposals for legal reform are also discussed, and some comparisons are made with other legal systems.     

Depression and elder abuse and neglect among a community-dwelling Chinese elderly population

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51-5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53-5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35-5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10-4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49-7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Domestic Violence and Aging

Women of all ages experience domestic violence, and the population of middle-aged and older women is growing rapidly. This article discusses how women’s issues, domestic violence, aging, and elder abuse all relate to social work education and then suggests how they can be integrated together into the social work curriculum through teaching about elder domestic violence.     

Depression and Elder Abuse and Neglect Among a Community-Dwelling Chinese Elderly Population

ABSTRACT

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51–5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53–5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35–5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10–4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49–7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Elder Abuse: Risk Factors and Use of Case Data to Improve Policy and Practice

ABSTRACT

Countering the generally reactive community approach to prevention and treatment of elder abuse, this study employs analysis of local elder abuse case data to estimate the incidence of elder abuse, neglect, and exploitation and to measure the risk factors, including co-location of other forms of abuse, that predict elder abuse in Miami-Dade County, Florida. The authors also compare the model of intervention used in Florida and elsewhere to best practice models that incorporate elements of domestic violence treatment models. They present a series of specific recommendations for improving local abuse data-collection, analysis, and training so that local policy makers, planners, and practitioners can make proactive, community-specific, culturally-sensitive preventive efforts effective. The findings and recommendations have direct relevance for policy and practice in any community in the United States.     

Senator Breaux's Elder Justice Proposal of 2002 Executive Summary

ABSTRACT

The purpose of this exploratory study was to investigate an English sample's perceptions on elder abuse, inflicted by adult children against their aging parents. Fifty participants (14 males, 46 females) provided examples of extreme, moderate, and mild elder abuse. As examples of extreme abuse, most participants mentioned neglect and physical aggression. Various forms of neglect and psychological abuse were their most common examples of moderate and mild abuse. References to physical aggression appeared most often as examples of extreme abuse rather than of moderate or mild abuse. Within these main categories, the specific subtypes most frequently mentioned by the sample included physical neglect, psychological neglect, verbal abuse, and deprivation. More females than males provided examples of financial abuse and physical neglect. Females were also more likely than males to list psychological neglect as an extreme form of abuse and disrespect as a form of mild abuse. At the moderate level, males referred to abuse relating to power more often than females. A positive relationship was found between age and the number of examples of physical neglect given at the moderate level and the number of examples of emotional abuse given at the mild level.     

The Norwegian police and victims of elder abuse in close and familial relationships

Over recent decades, domestic violence or family violence, violence against women and child abuse has received much attention in the media, in political discourse and in social research. However, abuse of older adults arouses limited interest. In government action against domestic violence and in police guidance manuals, the elderly receive little attention. The aim of this article is primarily to demonstrate how the police attempt to prevent elder abuse in close relationships, especially in parent-child relationships. This article highlights some contradictions between the need of the police to produce criminal cases (often contrary to the interests of the victims) on the one hand, and the police's duty to prevent further abuse on the other. Research has documented that help and prevention measures in question make the situation even worse for the victims they are meant to help.     

Elder Abuse and Neglect in an Urban Chinese Population

ABSTRACT

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

English perceptions of elder abuse

The purpose of this exploratory study was to investigate an English sample's perceptions on elder abuse, inflicted by adult children against their aging parents. Fifty participants (14 males, 46 females) provided examples of extreme, moderate, and mild elder abuse. As examples of extreme abuse, most participants mentioned neglect and physical aggression. Various forms of neglect and psychological abuse were their most common examples of moderate and mild abuse. References to physical aggression appeared most often as examples of extreme abuse rather than of moderate or mild abuse. Within these main categories, the specific subtypes most frequently mentioned by the sample included physical neglect, psychological neglect, verbal abuse, and deprivation. More females than males provided examples of financial abuse and physical neglect. Females were also more likely than males to list psychological neglect as an extreme form of abuse and disrespect as a form of mild abuse. At the moderate level, males referred to abuse relating to power more often than females. A positive relationship was found between age and the number of examples of physical neglect given at the moderate level and the number of examples of emotional abuse given at the mild level.     

Tolerance of Elder Abuse and Attitudes Toward Third-Party Intervention Among African American,Korean American,and White Elderly

SUMMARY

Studies have found that professionals and the lay public differ consistently from one another in the ways in which they perceive elder abuse. A potential variable that may explain this observed difference is cultural norms among ethnic groups. Using 18 statements, this study examined similarities and differences among elderly from three ethnic groups in their tolerance for potential elder abuse, perceptions regarding perpetrators and the causes of elder abuse, and attitudes toward third-party intervention and reporting of elder abuse to the authorities. Results suggest that while African American and White elderly are remarkably similar in their responses to most statements, Korean American elderly differed significantly from the other two groups in their tolerance for medical mistreatment, financial exploitation and neglect, perceptions of causes, and attitudes toward reporting elder abuse. These findings have implications for understanding potential barriers to preventive outreach efforts, investigation, and intervention in cases of elder abuse in a culturally diverse community.     

Elder abuse and neglect in an urban chinese population

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

Elder Abuse and Neglect in South Africa: A Case of Marginalization,Disrespect, Exploitation and Violence

ABSTRACT

The problem of elder abuse and neglect in South Africa is widespread, but the definition of abuse remains problematic. An expanded typology is needed to classify certain types of abuse reported commonly, such as marginalization, disrespect, exploitation and violence. The history of elder abuse and responses is traced, relevant legislation and selected intervention programs are reviewed, and research and the status of elder abuse are evaluated. Interventions to address sociostructural factors that impact elders' settings, increase their vulnerability, and diminish their ability to realize human rights can contribute to an improvement in their condition and a reduction in abuse and rights violations in the long-term.     

Interpersonal violence against people with disabilities: understanding the problem from a rural context

Interpersonal violence against people with disabilities is a significant social problem. Little attention has focused on the rural context and the relevance for understanding violence. Given the dearth of literature exploring interpersonal violence, disability, and rurality, a review of rural-focused literature on domestic violence, sexual violence, and elder abuse was conducted to identify themes that could provide insight into this problem for people with disabilities. Themes include geographic isolation, traditional cultural values and norms, lack of anonymity, lack of resources, and poor response of systems. Implications for understanding interpersonal violence against rural people with disabilities and for social work practice are discussed.     

Elder Abuse and Neglect—“Old Phenomenon”: New Directions for Research,Legislation, and Service Developments

This article poses the question: Is elder abuse and neglect a social problem, showing that it is. Elder abuse, though, is still the most hidden form of mistreatment and a key to governmental responses to an ageing population. It is an important facet as a family violence problem, an intergenerational concern, as well as a health, justice and human rights issue. Because the phenomenon of elder abuse and neglect is so complex and multi-dimensional, it has to be addressed by multi-professional and inter-disciplinary approaches. Raising awareness is a fundamental prevention strategy and an important step in causing changes in attitudes and behaviors. This has been accomplished by INPEA and the article was developed from the lecture given by the author on receiving the International Rosalie Wolf Award from INPEA. The discussion focuses on elder abuse as a product of global ageing, stemming from population ageing, which is consistent with an increased prevalence of abuse of all vulnerable groups, older people among them. It is pointed out that baseline and trend data on the nature and prevalence of senior abuse are crucial to policy responses and the development of appropriate programs and services. Difficulties in assessing the scope of the phenomenon, though, are due to: problems in definitions and methodology, which create difficulties in comparing data from various countries; lack of social and familial awareness; isolation of some elders, especially migrants; elder abuse as a ‘hidden issue’ that usually occurs in the privacy of the home and is viewed as a family affair; limited access to institutional settings. Difficulties also exist in constructing a unifying research framework in order to study the phenomenon due to a lack of comparison groups, a lack of representative national surveys and difficulties in measurement. There is currently, however, an increase in prevalence and incidence studies from both sides of the Atlantic and especially from Europe. But while prevalence studies provide base-data on numbers, little is known about key conceptual issues for policy, practice and the understanding of different forms of abuse and neglect. Theoretical under-development hampers the collection of systematic cumulative knowledge which is based on universally agreed upon and standardized tools, and reduces the ability to discover unifying themes and their relationship to local idiosyncrasies existing in the field. Additionally, there has been no attempt to develop theoretical knowledge grounded in data from the study of elder abuse itself. The following vehicles for action are, thus, suggested: Developing international, national and regional research agendas and data bases; developing policy and legislation; developing services and interventions and developing educational programs.     

Elder abuse and neglect in South Africa: a case of marginalization, disrespect, exploitation and violence

The problem of elder abuse and neglect in South Africa is widespread, but the definition of abuse remains problematic. An expanded typology is needed to classify certain types of abuse reported commonly, such as marginalization, disrespect, exploitation and violence. The history of elder abuse and responses is traced, relevant legislation and selected intervention programs are reviewed, and research and the status of elder abuse are evaluated. Interventions to address sociostructural factors that impact elders' settings, increase their vulnerability, and diminish their ability to realize human rights can contribute to an improvement in their condition and a reduction in abuse and rights violations in the long-term.     

Recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect

Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report.