The Mistreatment and Abuse of Older People in the community in the UK

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The Mistreatment and Abuse of Older People in the
community in the UK are there lessons for
policy and practice? Professor Jill Manthorpe and
Professor Anthea Tinker Kings College London
IAGG, Paris, 8.7.09
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Outline of presentation

• The UK prevalence study of older people in their
  own homes methods
• Findings prevalence figures and more detailed
  ones on abuse and neglect
• Some lessons for policy and practice

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1. Prevalence Survey

• KEY AIMS
• estimate prevalence of mistreatment (abuse
  neglect) among older people in private households
  in the UK
• examine characteristics of mistreatment (abuse
  neglect)

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Methods

• Interviewed 2,111 people aged 66 and older in
  England, Scotland, Wales Northern Ireland
• probability (random) sample
• private households, including sheltered housing
  (institutions not included)
• 1 person interviewed per household, face-to-face
• and self-completion
• no proxy interviews
• Sample based on national health surveys except
  Wales where a new survey took place
• Data weighted to be nationally representative of
  the UK population aged 66

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Defining mistreatment

• Starting point definition from Action on Elder
  Abuse
• 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
• Harmful behaviour neglect, financial,
  psychological, physical, sexual abuse
• Expectation of trust - family, close friend, care
  worker
• Also gathered information about neighbours
  acquaintances (broader definition)

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Defining neglect

• The repeated deprivation of assistance needed for
  important activities of daily living, in 3
  categories
• daily activities (e.g. shopping)
• personal care (e.g. getting in / out of bed,
  washing)
• help with medication.
• 10 instances of neglect in the past year by
  family member, close friend, care worker OR less
  than 10 instances in the past year but judged by
  respondent to be very serious.
• Respondents must have stated they need receive
  help with an activity, have difficulty carrying
  out the activity themselves.

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2. Findings

• Prevalence in general about mistreatment
• Detailed findings about abuse and neglect

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One year prevalence of mistreatment(family,
friends, care workers)
Unweighted basesUK 2106 (bases vary slightly,
base shown here for neglect) Based on UK
household population of 8,586,890 aged 66 and
over (ONS, NISRA)
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One year prevalence - broader definition (i.e.
including neighbours acquaintances)
Unweighted base 2106 (bases vary slightly, base
shown here for neglect) Based on UK household
population of 8,586,890 aged 66 and over (ONS,
NISRA)
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Findings general 1 Differences by sex and age

• Findings based on mistreatment in the past year
  by family, friends, care
• workers
• Men
• Most reports of mistreatment were financial
  (0.6) or neglect (0.5)
• Excluding neglect, abuse increased with age
  prevalence of financial abuse higher among men
  aged 85
• Women were more likely than men to say that they
  had experienced mistreatment (3.8 vs. 1.1)
• High prevalence of neglect among women aged 85
  (5.0)
• Similar rates for financial, psychological
  physical abuse (approx. 0.8)
• Excluding neglect, abuse decreased with age

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Findings general 2Mistreatment by
socio-demographic factors

• Likelihood of having been mistreated in the past
  year varied by
• marital status, ranging from 9.4 of those who
  were separated or divorced to 1.4 of those who
  were widowed
• tenure, those who lived in rented accommodation
  (social or private) tended to have higher
  prevalence rates than owner-occupiers
• general health, the likelihood of having been
  mistreated increased with declining health status
• loneliness, depression and quality of life, those
  feeling lonely, depressed or with a lower Quality
  of Life more likely to have experienced
  mistreatment

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Findings general 3Impacts

• 76 said the effect on them was serious or very
  serious
• Most commonly reported effects were emotional and
  social
• 70 of those asked told someone about the
  mistreatment or sought help. Most commonly from
• Friends or family (31)
• Health professional or social worker (30)

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Findings general 4alleged perpetrators

• Half of those who experienced mistreatment had
  been neglected or abused by their partner (51)
  a similar proportion by other family (49)
  (respondents could mention more than one person)
• Spouse or partner most commonly reported
  perpetrator for neglect (70) and interpersonal
  abuse (57)
• Other family most common for financial abuse
  (54)
• Overall, abusers more often men (74) than women
  (26) about equal for financial abuse (56 men)

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Findings Neglect 1

• The risk factors appear to be
• being female
• aged 85 and over
• suffering bad/very bad health and depression
• so probably
• already in receipt of, or in touch with,
  services

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Findings Neglect 2

• Although numbers are relatively small, situations
  often seemed to involved lack of care by partners
• Is there a partner effect ? - not deliberate
  neglect but two people with increasing
  disabilities trying to support each other and
  increasingly failing.

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Discussion of results

• 2.6 prevalence rate broadly in line with other
  research
• Relatively high prevalence of financial abuse and
  neglect contrasts with commonly assumptions of
  abuse as physical violence
• Our data suggests only a small of cases come to
  professional attention
• Information about mistreatment involving
  neighbours and acquaintances reveals issues
  beyond family and caring arenas.

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3. Some messages for policy and practice

• Do we need to revisit the term elder abuse?
  There is wide diversity and complexity of cases
  (especially noted in the qualitative research)
• Importance of redesigning mainstream services
  prevention, community services, support for
  carers, advice and information, support for long
  term needs, fostering of older peoples
  resilience as well as specific responses to
  abuse.
• Influence of study in prompting English
  Governments review of policy (No secrets) due
  summer 2009.

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Further Information

• Summary of findings
• www.natcen.ac.uk
• Full report
• www.comicrelief.com
• www.dh.gov.uk
• Qualitative report
• http//www.natcen.ac.uk/natcen/pages/op_agei
  ng.htm
• Anthea.tinker_at_kcl.ac.uk and Jill.manthorpe_at_kcl.ac.
  uk

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UK Study of Abuse Neglect of Older People

• Research team
• National Centre for Social Research (NatCen),
  London
• Madeleine OKeeffe, Amy Hills, Bob Erens, Melanie
  Doyle, Josie Dixon, Alice Mowlam, Rosalind
  Tennant, Susan Purdon, Svetlana Speight
• Kings College London
• Simon Biggs, Claudine McCreadie, Anthea
  Tinker, Jill Manthorpe
• Karl Pillemer, Cornell University, USA

Institute of Gerontology Social Care
Workforce Research Unit