Elder Abuse Prevention, Detection and Management 22nd January

1. Elder Abuse � Prevention, Detection and Management22nd January Rosanna Thurlow Policy Development Officer � Action on Elder Abuse

2. Who are Action on Elder Abuse? Formed in 1993, Action on Elder Abuse (AEA) works to protect, and prevent the abuse of vulnerable older adults.� We were the first charity to address these problems and are the only charity in the UK and in Ireland working exclusively on the issue today

3. What do AEA do? The Helpline: Established in 1999 - Provides advice and guidance to older people and others Lobby government Speak at conferences Provide training Raise awareness wherever possible

4. Abuse and Definitions A violation of an individuals human or civil rights by any other person or persons - No Secrets A single or repeated act or lack of appropriate action, occurring in any relationship where there is an expectation of trust that causes harm or distress to an older person - AEA �any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults, aged 18 and over, who are or have been intimate partners or family members, regardless of gender and sexuality.� (Family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family.) (ACPO definition)

5. The Categories Physical abuse Psychological abuse Financial abuse Sexual abuse Neglect

6. The Prevalence Study UK Study of Abuse and Neglect of Older People � 2007 In 2004 the House of Commons Health Select Committee concluded an Inquiry into elder abuse. Following representations by AEA, a major recommendation was that there should be comprehensive research into the prevalence of elder abuse in the UK The Prevalence Study was undertaken by the Institute of Gerontology at Kings College London, and the National Centre for Social Research. In 2004 the House of Commons Health Select Committee concluded an Inquiry into elder abuse. Following representations by AEA, a major recommendation was that there should be comprehensive research into the prevalence of elder abuse in the UK The Prevalence Study was undertaken by the Institute of Gerontology at Kings College London, and the National Centre for Social Research.

7.  UK Study of Abuse and Neglect of Older People - 2007 Prevalence of abuse established at 4% 342,000 people abused each year Excluded Care homes, NHS institutions� And people with dementia! (Leicester population: 330,574)

8. KEY MESSAGES: Prevalence figure is 4%, or 342,000 older people � more than the population of some of our cities. 2.6% of older people face abuse by those who society would consider to occupy a position of trust i.e. family or paid staffKEY MESSAGES: Prevalence figure is 4%, or 342,000 older people � more than the population of some of our cities. 2.6% of older people face abuse by those who society would consider to occupy a position of trust i.e. family or paid staff

9. KEY MESSAGES: In keeping with what we know from our Helpline, in general more women than men experience abuse But there is some variation across the NationsKEY MESSAGES: In keeping with what we know from our Helpline, in general more women than men experience abuse But there is some variation across the Nations

10. KEY MESSAGES: Victims could experience abuse from more than one person at a time. But primarily we are looking at partners, other family members, and neighbours/acquaintances: mention the potential for grooming. 9% of all abusers are home helps.KEY MESSAGES: Victims could experience abuse from more than one person at a time. But primarily we are looking at partners, other family members, and neighbours/acquaintances: mention the potential for grooming. 9% of all abusers are home helps.

11. KEY MESSAGES: And there is an obvious link between stated bad health and abuse. You are ten times more likely to suffer abuse if you are a man in bad health than good; and seven times more likely if you are a woman.KEY MESSAGES: And there is an obvious link between stated bad health and abuse. You are ten times more likely to suffer abuse if you are a man in bad health than good; and seven times more likely if you are a woman.

12. KEY MESSAGES: Neglect and psychological abuse has been under-reported in the survey and is in reality much higher � use of a twenty year old American model that does not reflect society�s increased intolerance of abuse Important to note that neglect can be wilful or unintentional, but the impact on the victim is the same. Example: one instance of psychological abuse can lead to the loss of a house or to sexual abuse. KEY MESSAGES: Neglect and psychological abuse has been under-reported in the survey and is in reality much higher � use of a twenty year old American model that does not reflect society�s increased intolerance of abuse Important to note that neglect can be wilful or unintentional, but the impact on the victim is the same. Example: one instance of psychological abuse can lead to the loss of a house or to sexual abuse.

14. KEY MESSAGES: Domestic Violence is a reality for some older people Financial abuse / Other abuse (Psycho/physical/sexual) is mostly perpetrated by partners or other family members and should be better described as domestic violence. (but prev study didn�t refer to it as such) Need to start calling it what it is to ensure older people receive appropriate interventions within domestic violence situations KEY MESSAGES: Domestic Violence is a reality for some older people Financial abuse / Other abuse (Psycho/physical/sexual) is mostly perpetrated by partners or other family members and should be better described as domestic violence. (but prev study didn�t refer to it as such) Need to start calling it what it is to ensure older people receive appropriate interventions within domestic violence situations

15. Older People and Domestic Violence Older People = Victims Older People = Perpetrators Key messages: need to stop patronising older people etc. Are and can be both vicims and pepetrators. 65th birthday etcKey messages: need to stop patronising older people etc. Are and can be both vicims and pepetrators. 65th birthday etc

16. Some interesting figures According to figures from the met police, positive action is less likely to be taken in domestic violence cases where the victim is over 60 and/or has a disability: Victim aged 18-29 = 47% chance that the suspect will be arrested Victim aged 60+ = only a 40% chance of the suspect being arrested Small in terms of percentage points but large in terms of numbers! The figures show that when the victim of domestic violence is aged between 18-29 there is a 47% chance that the suspect will be arrested, which is 2% higher than the average across the met.� However when the victim is aged over 60 there is only a 40% chance of the suspect being arrested. Small in terms of percentage points but large in terms of numbers! The figures also show that for victims of domestic violence who have a physical/mental or sensory disability there is a 35.7% that the suspect will be arrested compared to a 43.6% chance when the victim does not have a disability. The figures show that when the victim of domestic violence is aged between 18-29 there is a 47% chance that the suspect will be arrested, which is 2% higher than the average across the met.� However when the victim is aged over 60 there is only a 40% chance of the suspect being arrested. Small in terms of percentage points but large in terms of numbers! The figures also show that for victims of domestic violence who have a physical/mental or sensory disability there is a 35.7% that the suspect will be arrested compared to a 43.6% chance when the victim does not have a disability.

17. KEY MESSAGES: Again, in keeping with what we know from the helpline, the potential for abuse increases with age.KEY MESSAGES: Again, in keeping with what we know from the helpline, the potential for abuse increases with age.

18. Dementia affects 5% of people over 65 yrs old and 20% over 80 16% of UK population are aged 65 or over The implications of this? More vulnerable older people = More potential for abuse The older but no safer campaign Women disclosing when receiving palliative care Risk assessments: stabbed to death victim Coping mechanisms not working anymore � not acceptable to just offer domiciliary care packages � need to establish comprehensive risk assessments Provisions for older victims of domestic violence unacceptable: from basics such as refuges not having stair lifts to cater for people with mobility problems etc Police reluctance to put an older perpetrator of domestic violnece in cell over night � this has to changeThe older but no safer campaign Women disclosing when receiving palliative care Risk assessments: stabbed to death victim Coping mechanisms not working anymore � not acceptable to just offer domiciliary care packages � need to establish comprehensive risk assessments Provisions for older victims of domestic violence unacceptable: from basics such as refuges not having stair lifts to cater for people with mobility problems etc Police reluctance to put an older perpetrator of domestic violnece in cell over night � this has to change

19.  What to do if you are alerted? Who is suspected of causing the harm? What level of seriousness is it? Who do you report to? In what order? Do you seek to supplement the information you have? What support do you provide to victim? What support do you provide for alleged abuser � if any?

20. The Carer Stress Debate Assumption that an older person receiving care is �difficult� Therefore carer�s stress results in abusive behaviour which is understandable We would not accept carer stress as an explanation in child abuse � why do we for older people? Note-Victoria Climbie v Margaret Panting � would carer stress have been acceptable to explain what happened to that child?Note-Victoria Climbie v Margaret Panting � would carer stress have been acceptable to explain what happened to that child?

21. The infrastructure to cope? National Developments�

22. National Developments Dignity in Care Campaign: including development of the national dementia strategy Mental Capacity Act 2005 CSCI star ratings : �star ratings give you an overall picture of how your council is delivering its social care services for adults.� Direct Payments/Individual Budgets �World Class Commissioning� (Ivan Lewis 2007) Safeguarding Vulnerable Groups Act

23. Adult Protection Legislation Legislative situation currently confusing and piecemeal� Definition of a vulnerable adult varies, depending upon the legislation.� Processes and systems to protect older people are based on guidance and lack the resources and drive to ensure comprehensive protection.� Adult Protection Teams under-funded, under-resourced, and under-staffed.� Increased referrals to some teams would result in crisis.� Abusers escape through the huge gaps that exist Need parity with child protection Need for intevention orders Need to send out message to general public that vulnerable adults need protection worthy of legislation Would ensure that statutory agencies would have to participate in joint partnership working and wouldn�t prioritise other work that has performance idicators attached We have produced a document based on asurvey of 150 practitioners. It outlines what we would like to see in such legilation, based on out work and the views of the proactitioners who responded. We are asking for feedback from anyone with a stake in AP work on this. Therea are debates to be had � is it acceptable to over rule wishes of adult with capacity if we feel they are ebing abuse? Conversely, is it right to rely on the alleged pepetrators co operation so much? Shouldn�t we apply a positive action approach similalry to domestic violence? Are existing measures / guidelines / legislation acceptable?Need parity with child protection Need for intevention orders Need to send out message to general public that vulnerable adults need protection worthy of legislation Would ensure that statutory agencies would have to participate in joint partnership working and wouldn�t prioritise other work that has performance idicators attached We have produced a document based on asurvey of 150 practitioners. It outlines what we would like to see in such legilation, based on out work and the views of the proactitioners who responded. We are asking for feedback from anyone with a stake in AP work on this. Therea are debates to be had � is it acceptable to over rule wishes of adult with capacity if we feel they are ebing abuse? Conversely, is it right to rely on the alleged pepetrators co operation so much? Shouldn�t we apply a positive action approach similalry to domestic violence? Are existing measures / guidelines / legislation acceptable?

24.  What are AEA doing? Understanding Vulnerability Project Updating research already undertaken by the Alzheimer�s Society and linking it to the evidence available from the AEA helpline.� Need to explore situations where someone is affected by dementia, including understanding the nature of dementia (a disease process),ways of communicating, respecting personhood, using the remaining abilities and strengths of people with dementia.� Identify where abuse is most likely to occur, and what the best form of intervention might be to prevent these situations arising, or to deal with them effectively when they do arise.� Promote an understanding of the nature of dementia in all those�who meet or work with people with dementia who may live alone. In that context we will address the needs of people with dementia living alone who may be particularly vulnerable to abuse.� � This may range from those who work in the utilities services to social workers, home care workers, meals on wheels etc., and the police. In that context we will address the needs of people with dementia living alone who may be particularly vulnerable to abuse.� � This may range from those who work in the utilities services to social workers, home care workers, meals on wheels etc., and the police.