Different understandings of elder abuse:
Implications for professional practice and policy
Janet Carter Anand
Queen’s University Belfast
The team
• Marita O’Brien Independent Researcher
• Emer Begley Social Inclusion Officer, Age Action Ireland
• Janet Carter Anand Research Fellow, Social Policy and Ageing
Research Centre, Trinity College Dublin and Lecturer in Social Work,
Queens University, Belfast
• Campbell Killick Research Officer, South East Health and Social Care
Trust, Northern Ireland
• Brian Taylor Senior Lecturer, Institute for Research in Social Science,
University of Ulster
• Evelyn Doyle, Peer Researcher (NI)
• Mary McCarthy, Peer Researcher (ROI)
• Sam McCrossan, Peer Researcher (NI)
• Evelyn Moran, Peer Researcher (ROI)
Introduction
 Little is known about older people’s conceptualisation of elder
abuse
 Research highlights that older people placed particular emphasis
on the themes of rights, choice, dignity, respect and the devaluing
of older people in families and communities (WHO 2002)
 Evidence of inconsistency in professional response to elder abuse
(Taylor and Killick 2012)
 Limited consensus between older people and health professionals
regarding what constitutes elder abuse(Selwood et al. 2007;
Thompson-McCormack et al. 2009)
 Heath professionals are more likely to identify abusive and
potential abusive strategies than older people (Hempton et al.
2011)
Defining and Responding to
Elder Abuse
adapted from Harbison and Morrow (1998)
crime
vulnerability
protection
legal
Older Adult
victimhood
personalisation
Personhood
agency
Study Aims
– Investigate what older adults perceive to be elder abuse
– Identify what older adults consider to be the main threats
to their personal safety and well-being in their
communities
– Identify what services older people would use if they
experienced abuse
– Identify what changes to services older people would like
to see
Qualitative Methodology
Ireland
Northern Ireland
Number of participants
21
37
Gender
17 female
4 male
33 female
4 male
Age
6 in each category, 65-69,
70-74, 75-79
And 3 between 80-84
9 in 65-69 range
8 in 70-74
10 in 75-79
4 in 80-84
2 in 85-89
4 age not indicated
Location
12 rural
9 urban
19 rural
18 urban
occupation
17 worked outside of home 33 worked outside of home
4 home based work
4 home based
FINDINGS: Safety and Wellbeing
• You become more vulnerable as you become
older for the simple reason that maybe your
health isn’t good, become dependent on people
(Paula, ROI, rural)
• My experience of homes is terrible and the smell
of urine when you went in the door, it was
terrible…I dread the stage of where maybe I
would have to go to one of those places myself,
seeing all that I have seen (Liz, ROI, urban)
Loss of decision-making
• “a big mistake...it’s absolutely lethal no-one with cop on will do it,
you’ll end up in a nursing home [in] 2 seconds flat” (Joan, ROI,
urban).
• The one thing that would set me off, trying to put me in a care
home...I would gladly go into sheltered accommodation, provided it
was within Suburb, [where Joe lives] where I’ve got friends…care
homes, it’s like a very gentle prison for doting people…but in
sheltered accommodation you have a certain independence, you
are still paying a rent…a [name of organisation] dwelling with a
good size communal hall in it, where people, men and women
could play bowls or play other indoor games…and still have their
own flat within it, where they would still have that degree of
independence (Joe, NI, urban).
Reasons for non-disclosure
•
Report it…sometimes they think you are a busy-body and are afraid to get involved
in case people say oh you shouldn’t be interfering, it’s none of your business
anyway (Stella, NI, urban).
•
The neighbour knows that they are being abused, what can that neighbour do
because the person that’s been abused will not turn against their own family and
support the person that might make the complaint. If you made a complaint to
somebody about that, it is you that would get into cold water, the people that are
doing the abusing, would go free (John, NI, rural)
Vera: You won’t really want anybody to know, you would hide it rather than let
anyone know if your family was being bad to you, won’t you.
•
•
John: Or otherwise they’d put you into a home (Vera and John, NI, rural)
•
[They are] over efficient, [as they] look into things they have no need to look into”
(John, NI, rural)
Staying Connected
• There is a great bus service, I’m collected at my house on a Friday
morning …we can do our bits and pieces and leave everything at
the shop in our bags, and when it’s time to go home, the minibus
comes for us and the driver of the bus lifts all the bags out and then
when he leaves us off at our houses, he walks us to the door and
will carry the stuff in and put it on the kitchen table…people
otherwise won’t be able to get out to do their own shopping unless
a member of their family [brings them] and when your with [a]
member of family ‘oh hurry up’, you have only so long and all this
sort of thing whereas when older people go out like that…you can
sit in the wee place [local grocers with bar] they have for us to sit
until the bus comes and we can chat away, whereas if you are with
your family, what are you doing talking there, will you hurry up
come on, they can’t wait for you, why are you taking so long (Helen,
ROI, rural)
Supporting Family Carers
• I mean we didn’t want to have her in a home,
we couldn’t, we were spread all over the place
and we couldn’t, and there was nothing done
to ease the sort of guilt, that we felt about
having to have her there (Janet, NI urban).
• All the books in the world about babies but
there is nothing to tell you this may happen
[to an older person] (Eve, NI urban).
Creating Awareness
• the importance of social interaction and
friendship networks for positive mental health;
• planning for future care needs;
• dementia education and training;
• practical education for family caregivers;
• educating young people through multigenerational programmes at post-primary level
and civic programmes in national school to teach,
“respect for elders”.
Interaction with Professionals
• If they knew someone was coming round, the airfreshener was gone into the carpets, and there
was vases of flowers, my reckoning is that, they
should never be told when someone is coming
(Sarah, NI, urban)
• The needs of vulnerable older people for
emotional support…how do you vet a home for
warmth, I’m talking about human dignity, warmth
impossible to legislate or ensure the meeting of
older people’s emotional needs for warmth and
human dignity (Amy, NI, urban)
Personhood, Recognition and Trust
“I think it comes under the categories of physical abuse, financial and
emotional, and emotional comes at the very top where I’m concerned…in the
withdrawal of interaction, where the older person becomes almost invisible
in the corner or wherever, and even touching you know, the whole
withdrawal of human kindness almost” Amy ( NI, urban)
…[family] they take you somewhere and they leave you and they say I
haven’t time to stop... Well won’t you like them to come in and sit down and
have a chat, usually they are saying I have to rush to take so and so home
from school and I have to rush to do that, but you know they are so good but
still. Tara (NI rural)
…denying them of their basic rights and I would go as far to say even the
knowledge of their basic rights, a total indifference to their dignity. Patsy (NI
urban)
Discussion
• Withdrawal of Personhood – a new type of
abuse?
• How can professional practice and policy
enhances personhood ?
Implications for Professional
Practice
• Practice that supports personhood at the subjective,
interactive and social interface – Personhood
Framework, Person Centred Practice
• Centrality of knowing the person, their values,
biography, relationships, seeing beyond the immediate
needs and authenticity (McCormack 2004) -Life Course
Perspective
• Addressing issues of loss and trauma (neglected area)
• Professional responsibility i.e. dignity and rights
Implications for Policy
Inclusion and Rights
– Safety and security e.g. fear of nursing homes
– Barriers to accessing services e.g. stigma
– Empowerment and enablement e.g. transport, role of
community based groups, Good Morning Service, HOPE
Choice and Control
– Person-centred and self directed services
– Supporting families e.g. mediation services
– Addressing fear e.g. fear of nursing homes
Creating Awareness
– Professional education
– Promoting personhood and citizenship
It can be argued, that more sustainable and proactive models
of service delivery which interweave informal sources of
support (family, friends, peers, community etc.) with formal
services (health, welfare, advocacy and legal services) are
the key to empowering older people in communities.
However, we first need to establish how older people think
and feel about the issues and involve them in the response!
Contact details
For further information please contact:
Dr Janet Carter Anand
Email: j.anand@qub.ac.uk
Telephone: 028 90975158
Report available to download from
www.ageaction.ie or www.cardi.ie