Safeguarding adults in Kent & Medway: adult protection for older people

1. Safeguarding adults in Kent & Medway: adult protection for older people Alisoun Milne E-MAIL: A.J.Milne@kent.ac.uk

2. Context of paper • Over the last decade increasing policy & practice emphasis has been placed on researching, recognising & challenging abuse of vulnerable adults, including older people • Systems to manage, monitor and address elder abuse are being implemented across the UK • Evidence drawn from a local study complements national data & extends understanding of the nature of elder abuse & its management

3. National Evidence • Although older people represent the significant majority of victims of mistreatment, research about prevalence in the UK is limited • Current evidence base is marked by a number of limitations (House of Commons Select Committee, 2004) • Historically studies tend to have focused on community based samples or on older people already using services • The perspectives of victims are little explored • Further, there remains definitional confusion and lack of clarity about terms; in particular what constitutes ‘abuse’ • Estimates have tended to be based either on generalising from small scale research studies or from analysing calls to ‘Helplines’

4. National Evidence (2) • A very recent representative UK wide survey suggests that overall 2.6% (227,000) of people aged 66 years and over living in private households reported mistreatment by a family member, friend or care worker • Neighbours & acquaintances; overall 4% • Mistreatment by partners account for a third (35%) of all incidents and ‘other family members’ (33%) (O’Keeffe et al, 2007) • Prevalence rates for types of mistreatment: neglect (1.1%), financial abuse (0.7%), psychological abuse (0.4%), physical abuse (0.4%), sexual abuse (0.2%) • Women more likely to report mistreatment than men • Men aged 85 and over were more likely to have experienced financial abuse than men in younger age groups (O’Keeffe et al, 2007)

5. National Evidence (3) • Some of these findings mirror those of earlier work - a 2003 survey reported a prevalence rate of 4.7% (Shugarman et al., 2003) • A widely quoted figure from a 1992 survey identified up to 5% of older people as experiencing verbal abuse and up to 2% physical or financial abuse (Ogg & Bennett, 1992) • Work focused on service users suggests higher rates of abuse: • In 1990, Homer and Gilleard (1990) found that 45% of a sample of carers accessing respite care reported abusing their elderly relative • A similar study reported that 34% of carers subjected their relatives to verbal abuse ‘regularly’ whilst 10% acknowledged physical abuse (Compton et al. 1997, cited in Penhale, 1999) • Both studies also showed high rates of co-abuse

6. National Evidence (4) • Two thirds of calls to the Action on Elder Abuse Helpline relate to incidents of domestic abuse • Although abuse in institutional settings is well documented no prevalence studies exist • Recent study by the Royal College of Psychiatrists (2000) concluded that, ‘... abuse not only occurs in rare, dramatic and well publicised incidents; it is a common part of institutional life’ • In 2003 the Commission for Social Care Inspection (2004) received 12,685 complaints about care homes - 10% made specific allegations of abuse • In its most recent ‘State of Social Care Report’ (2008) the CSCI states, ‘All care services need to improve procedures concerning the safeguarding of people from physical, financial, psychological or sexual abuse, neglect and degrading treatment’

7. National Evidence (5) • In terms of ‘risk factors’ most evidence relates to domestic abuse • Prominent features are: being female & aged 85 or over; isolation; a history of poor quality long term relationship between abuser & abused; a pattern of family violence; conflict; dependence on the person who abuses; & history of mental health and/or alcohol problem in the abuser (British Geriatrics Society, 2005) • A shared living situation is a risk factor for all types of abuse except financial for which victims disproportionately live alone • Older people with depression &/or dementia are particularly vulnerable to abuse; co-abuse is also prevalent (Cooper et al., 2006) • Challenging behaviour is often cited as a ‘trigger’ • There is no single pattern of domestic abuse

8. Findings: Older People • Older people dominate the adult protection landscape • 60% of all AP alerts relate to older people including OPMH • Mean age = 65.7 (Table) • Vast majority are women (73%) • Over a third of alerts raised are in relation to care home residents; a fifth live in a ‘family home’ & two fifths live alone

9. Percentage alerts: older people, older people with mental health problems vs. younger adults

10. Findings (2): Types of abuse alerts • Overall, alerts relating to older people are most likely to relate to physical or multiple abuse; also neglect or financial abuse (Graph) • Neglect is most prevalent type of alert in care homes • Abuse tends to take place where the older person lives • Axiomatic that perpetrator is person closest to the OP or caring for them in that setting

11. Percentage alerts: By user group & type of abuse

12. Findings (3): Setting & Perpetrator • Two thirds of alerts relating to OPMH & half of ‘other older people’ are based in a care home (Graph) • ‘Other’ older people are much more likely to experience abuse in their own homes than OPMH or younger adults • For OPMH perpetrator most likely to be a care home worker • For ‘other older people’ perpetrator most likely to be a relative

13. Percentage alerts: By user group & location

14. Findings (4): Outcome of Alerts • Analysis of outcomes of alerts reveals that two fifths of all cases relating to older people were confirmed (Graph) • The vast majority of alerts involve multi-agency consultation and most result in ongoing monitoring by social services • ‘Other older people’ are less likely to generate an adult protection alert that results in ‘no further action’ than OPMH & younger adults • Police are less likely to be involved in alerts relating to older vs. younger people • For health agencies the converse is true • Inspection agencies more involved in OPMH cases; this reflects care home location

15. Percentage alerts: By user group and outcome of abuse alert

16. Findings (5): Management of alerts • Although not significant, findings suggest that areas that have an adult protection co-ordinator raise more alerts and adopt a more consistent approach to case management • The current system of recording adult protection information appears to be more advanced than that operated in many authorities • Local lessons include: • Collecting data on user - & carer – need in more detail and in a way that can be analysed alongside case management data • Apply consistent definitions & reduce variability • Stronger focus on multi agency working

17. Conclusions • Local study echoes & adds to national picture • Older people at greatest risk: women, those living in a care home & those with a chronic LT illness especially dementia • Vulnerability to abuse: OPMH living in a care home; elders living alone in the community @risk of financial abuse • Risk likely to be deepened by challenging behaviour & ltd communication skills • Although both local authorities employ robust AP systems, data collection could be more detailed & AP & CM systems could dovetail more effectively • Continue to evaluate the role of the AP co-ordinator • Disseminate local lessons more widely

18. Selected References • House of Commons Select Committee, Elder Abuse (2004) Volume 1, HC111-1, London, Stationary Office • Hussein, S., Manthorpe, J & Penhale, B (2007) Public perceptions of the neglect & mistreatment of older people: findings of a UK survey, Ageing & Society, 27, 919-940 • Milne, A., Cambridge, P., Mansell, J & Beadle-Brown, J (in preparation) Abuse Alerts relating to Older People: evidence from two local authorities, Age & Ageing • O’Keeffe, M., Hills, A., Doyle, M., McCreadie, C., Scholes et al (2007) UK Study of Abuse & Neglect of Older People, Prevalence Survey Report