Rosanna Thurlow Policy Development Officer Action on Elder Abuse

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

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

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)

The Categories Physical Abuse – Hitting, Kicking, Slapping, Punching, Spitting, Restraint – chemical and physical? Psychological Abuse – Using against a person what they love or value. – JSP! Financial Abuse – Remains too easy to gain control of an older persons finances. Many abusers never deny spending or having access to money Sexual Abuse – Forcing a person to participate in sexual acts and conversations against their will. Must ignore prejudices and assumptions about people with dementia, mental health issues and/or a learning disability Neglect – Failure to provide people with what they need to live. Neglect is not a separate thing to abuse and crime!

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.

Leicester population: 330,574 UK Study of Abuse and Neglect of Older People - 2007 The overall prevalence of abuse, defined by ‘expectation of trust’ in the year preceding the survey was 4% This equates to 342,000 people aged 66 and over, or 1 in every 25 of the population aged 66 and over 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 staff Leicester population: 330,574 Excluded Care homes, NHS institutions and people with dementia! (2.6% of older people were abused by someone in a ‘position of trust’)

Percentage of all respondents who experienced abuse UK Study of Abuse and Neglect of Older People - 2007 Abuse by Gender Percentage of all respondents who experienced abuse 6 5.4 Women 5 4 Percentages 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 Nations 3 2.1 Men 2 1

UK Study of Abuse and Neglect of Older People - 2007 Percentage of all respondents who had experienced abuse in the last year The Abusers 40 35 Partner 33 Other family 33 Neighbours and Acquaintances 35 30 25 Percentage 20 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. 15 9 Home Help 10 3 Friend 5

UK Study of Abuse and Neglect of Older People - 2007 Abuse and Health 14 Percentage of respondents who had self-reported their health, and had experienced abuse 12.5 Women 12 9.2 All abuse Bad Health 10 Percentage 8 5.1 Neglect 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. Good Health 1.2 6 4.8 Men 4 1.9 2 0.4 0.5

UK Study of Abuse and Neglect of Older People - 2007 Percentage of abuse that had occurred in the last year Types of Abuse 1.4 0.7 Psychological Neglect 1.2 Ten instances in order to be counted once in the Survey 0.7 Physical 0.5 Sexual Financial 1 One instance in order to be counted once in the Survey 1.2 1 0.8 Percentage 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. 0.6 0.4 0.2

Types of abuse Source: Hidden Voices 2004 5 10 15 20 25 30 35 40 5 10 5 10 15 20 25 30 35 40 5 10 15 20 25 30 35 40 34 Psychological 3 Sexual 12 Neglect 20 Financial 19 Physical Percentage of calls excluding ‘Other’

UK Study of Abuse and Neglect of Older People - 2007 Abusers and Type Percentage of those who had been identified as abusers in the last year 70 62 Partner Neglect Domestic Violence 60 51 Other family 50 45 Percentage 9 Financial 40 35 31 Other 35 30 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 20 20 20 13 Home Help 11 Neighbour or Acquaintance 10 4 3 Friend 1

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 etc

Abuse and Crime Hitting, slapping, pushing, kicking Common assault s.39 Criminal Justice Act 1988; actual bodily harm s.47 Offences Against the Person Act 1861; grievous bodily harm/with intent s.20 and 18, OAPA 1861 Misuse of medication to manage behaviour Assault; false imprisonment; applies stupefying/overpowering drugs/matter or thing with intent to commit indictable offence s.22 OAPA; poisoning with intent to injure, aggrieve or annoy, s23/24 OAPA; unlawfully administering medication s.58 Medicines Act 1968; injuriously affecting the composition of medicinal products, s63 Medicines Act 1968; failure to comply with conditions/contravention of regulations s.24, 25 Care Standards Act 2000

Percentage of all respondents who experienced abuse UK Study of Abuse and Neglect of Older People - 2007 Abuse by Age Percentage of all respondents who experienced abuse 6 5.5 85+ 5 4.2 75 -84 4 3.5 66 - 74 Percentages 3 KEY MESSAGES: Again, in keeping with what we know from the helpline, the potential for abuse increases with age. 2 1

The Demographic ‘Time bomb’ 16% of UK population are aged 65 or over Dementia affects 5% of people over 65 yrs old and 20% over 80 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 violence in cell over night – this has to change

Safeguarding from abuse - the wider agenda Empowerment Preventing isolation Valuing Re-humanising

Safeguarding Vulnerable Adults Social Services are coordinating agency Multi agency partnership Prevent abuse and protect people from abuse

But… Less than one in ten older people who experience neglect, psychological, physical or sexual abuse is having their case referred to local authority adult protection services

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?

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?

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 intervention 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 indicators attached We have produced a document based on a survey of 150 practitioners. It outlines what we would like to see in such legislation, based on out work and the views of the practitioners who responded. We are asking for feedback from anyone with a stake in AP work on this. There are debates to be had – is it acceptable to over rule wishes of adult with capacity if we feel they are being abuse? Conversely, is it right to rely on the alleged perpetrators co operation so much? Shouldn’t we apply a positive action approach similarly to domestic violence? Are existing measures / guidelines / legislation acceptable?

Elder Abuse Response Line 080 8808 8141 9.00am – 5.00pm Monday - Friday Action on Elder Abuse: 0044 (0)20 8765 7000 rosannathurlow@elderabuse.org.uk WWW.ELDERABUSE.ORG.UK