UK Study of Abuse and Neglect of Older People: Qualitative Findings Josie Dixon

Related research The research programme 1) Exploratory focus groups with stakeholders and service providers 2) National prevalence survey 3) Qualitative findings 4) Care home feasibility study for researching elder abuse in residential settings The team King’s College London Professor Simon Biggs, Claudine McReadie, Anthea Tinker, Jill Manthorpe NatCen Bob Erens, Madeleine O’Keefe, Josie Dixon, Amy Hills, Alice Mowlam, Ros Tennant, Susan Purdon, Svetlana Speight, Melanie Doyle Cornell University Karl Pillemer

Study design In-depth interviews with 39 respondents reporting abuse or mistreatment In-depth interviews with 2 of their family members Follow-up to national survey (37 respondents) and identified through BME community groups (2 respondents) Explored impacts, coping strategies, resilience and barriers and facilitators to reporting

The sample Perpetrators – spouse, family, paid carer, neighbour, friend, acquaintance or stranger Neglect and psychological, physical, financial and sexual abuse Different ages, gender, living circumstances, times and duration, multiple and single incidents, health and severity

Types of incident captured Domestic abuse and exploitation Conflicts, disputes and harassment involving family members and neighbours Theft and financial exploitation involving spouses, grandchildren, carers and friends Abuse from those respondent cares for, including spouses with dementia and mental illness and foster children Unwelcome sexual advances from neighbours and acquaintances Targeted/ doorstep fraud

Institutional and service failure Not intention of study to focus on service/ institutional neglect and failure but respondents told us about: Care workers failing to turn up Failure to be given medication in a short-term health facility Failure to be given sufficient information by GP Failure to access social service support which was perceived as needed Poor quality residential care of person with dementia Set in context of positive experiences of support from service providers

Definition Trust: Problems equating ‘expectation of trust’ with particular perpetrator groups Not all family members trusted in practice and wide range of friends, neighbours, acquaintances and strangers trusted Problems classifying perpetrators into perpetrator groups Directionality of expectation of trust - dependents/ not responsible for actions Levels & expressions of trust; subjective and contextualised

Definition Distinguishing abuse from ‘normal’ levels and expressions of conflict and discord in adult relationships Sometimes excluded most distressing/ harmful experiences and respondents wondered why we were focusing on lesser incidents Excluded some where age/ vulnerability explicit and included others where age/ vulnerability not obviously a factor Respondent focus - on experiences rather than categories of abuse

Reporting abuse and taking action Action Telling someone – friend, family, services or authorities Taking active steps to avoid the perpetrator Motivations Change the perpetrator’s behaviour Place distance between them and perpetrator Seek legal or formal redress Seek emotional support

Barriers Personal circumstances Low self-esteem Bereavement Physical frailty Nature of incident Not perceived to be serious enough Fear of consequences Becoming isolated Being seen to be ‘making a fuss’ Fear of being blamed Embarrassment and shame Consequences for family and significant others Consequences for perpetrator

Barriers Role and remit of services Not knowing where to go for help Not knowing if it is appropriate to report their experience or whether it will be seen as serious enough Perception that services have limited ability to take effective action on their behalf Fear of authorities Lack of awareness of legal rights Facilitators Fear for personal safety Encouragement and moral support from others

Impacts Emotional distress Mental health difficulties Deteriorating physical health Social isolation Loss of self-confidence/ self-esteem Deteriorating financial position Deteriorating quality of life and loss of independence Family relationships Living circumstances

Mediating factors The incident/ experience Type and severity of incident Proximity of perpetrator and predictability Degree of resolve achieved, practically and emotionally Respondent’s situation and personal characteristics Values and norms Social and community connectedness Religious and spiritual beliefs Living alone/ fear of living alone/ bereavement Health Previous life experiences Specific tactics like keeping a diary/ not thinking about it

Lessons for future Substantial diversity of abusive situations Need for greater clarity about purpose and function of definition, role of trust and age Broad negative impacts - but not to equate with loss of autonomy and dependence in terms of decision-making Varied resilience and ability to cope, including broad socio-economic and social factors Ensuring people know where to go to access help and making it easy and non-threatening ‘First port of call’ for wide range of problems and sign-posting In contact with police, GPs and healthcare Domestic violence in older age - more understanding and review of current services Support for carers of those with challenging behaviour