Editorial
Article Type: Editorial From: The Journal of Adult Protection, Volume 16, Issue 3.
Welcome to the third issue of 2014, our first special issue of the current year, which contains a number of papers on different aspects of elder abuse. First, as usual, we begin with some comments of more general concern about recent events and reports in health, care and welfare sectors. This includes information specifically related to issues concerning older people.
During October 2013, the Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture by Ann Clwyd MP and Professor Tricia Hart was published. It is a sad and gripping read and, we believe, one that shows without ambiguity that variations on a theme of “if we have caused distress […] we regret that on this single occasion a sub-optimal clinical outcome resulted” have no place in credible healthcare provision.
Three cheers for the Illegal Money Lending Teams (IMLTs) funded by the National Trading Standards Board. Loan sharks have never had a good press but the work of these Teams reminds us just how shocking predatory extortionists can be. It emerges that across Britain, borrowers were paying an estimated £700 m a year to loan sharks. The scale of the lending is difficult to quantify. The victims of loan sharks are bullied and traumatised because in this cash economy there are no records of transactions and borrowers are punished for missing payments. This is one impetus for demanding extortionate rates of interest leaving some borrowers in perpetual debt. IMLTs in England, Scotland and Wales have brought more than 300 prosecutions and 60 victims are in witness protection (Meilke, 2014a).
Thanks to the Trussell Trust, charity food aid is available to people whose lives have been compromised by welfare cuts, reforms and inefficiencies in this current age of austerity. Foodbanks are becoming a familiar feature of supermarkets. A recent and bleak development, however, is the introduction of “kettle boxes”, i.e. packs for people who cannot afford to switch on their cookers to heat food; these boxes contain products which can be heated by adding boiling water. It has prompted the hierarchies across faiths to criticise the policies of the Conservative-led coalition and the critical urgency of preventing hunger –in Britain – in 2014. Since the Christian churches have representation from the inner cities to the House of Lords they cannot easily be ignored; even the foodbanks are under pressure. And, as if a reminder is required, the experience of being handed a food parcel is vastly different from that of being a market or food store customer.
Still, there is always the consolation of leisure. That is until the figures by the Campaign for Fairer Gambling were produced in February. It turns out that more than £13 bn was gambled on high speed, high stakes gambling machines by the poorest quarter of England's population.
There was depressing news that the welfare reforms have survived legal challenges at the court of appeal, after five disabled tenants failed in their attempt to get the implementation of the bedroom tax declared unlawful and judges ruled against claims that the £500.00 a week cap on benefits violated the human rights of vulnerable families (Meilke, 2014b).
Well done South Yorkshire Police for securing the imprisonment of David, Donna and Jamie Rooke of Sheffield for falsely imprisoning Craig Kinsella, subjecting him to regular beatings, starving him and keeping him in a garage. For years, Craig worked for them from 7.30 a.m. until midnight for no payment and yet they accompanied him to the post office to withdraw his benefits,which they stole. Unfortunately there are uncomfortable parallels with Michael Gilbert's life in Luton, before he was eventually murdered.
Before intense hurricanes, high tides and winter floods washed into the home counties of England and concern about the distribution of flood defences surfaced, Ministers were proposing to reduce to 1.5 per cent the amount by which English councils can increase council tax without seeking approval from residents. The Secretary of State for Communities and Local Government described the councils that had imposed increases of just under the 2 per cent threshold as “democracy dodgers”. The Conservative-led coalition has worked hard to persuade us of the necessity of curtailing local government spending, irrespective of the fact that it is compromising local services (Wintour, 2014). The impacts of government spending decisions can take years to become apparent – but spending less on maintaining flood defences and building new ones has had grim consequences. As media coverage of the floods crisis of the south west, Somerset and the home counties has confirmed, there are tangible environmental as well as human downsides to cuts in public spending.
Back to the floods. It took until February 2014 for reporters to discuss the mental trauma as well as the distress of people whose homes and livelihoods are flooded. Trauma and some of its consequences are reflected in the Care Quality Commission's annual review of the Mental Health Act in England. There were 50,408 people detained for compulsory treatment during 2012-2013– a 12 per cent rise over the previous five years. It seriously undermines the government's commitment to give mental health“parity of esteem” with physical health in the NHS. As the Organisation for Economic Co-operation and Development notes, mental health issues are costing Britain £70 bn a year. The Care Quality Commission's annual review of the Deprivation of Liberty Safeguards, which was published at around the same time also did little to reassure about the overall application of the safeguards,in particular relating to the notable increase in their use for older people.
In Lancashire, three nursing home staff were imprisoned and a fourth given community sentences for tormenting and abusing elderly residents with dementia at a nursing home in Slyne-with-Hest. At the relevant times, it appears that the home was inadequately managed; this view may be something of an understatement!
It seems we are all slow learners, irrespective of assertions that lessons will be learned. Croydon Hospital in South London,which is run by Virgin Care, was found to be in breach of basic standards. It turned out that patients were being “streamed”by non-clinical receptionists. A commendation in the Journal of Adult Protection Editorial awaits the reader who recalls which recent Public Inquiry identified a similar practice. Not to worry – there's a consultation paper outlining proposed new legislation concerning wilful neglect or ill treatment of adults who have decisional capacity[1].
In November, an expert meeting relating to Neglect, abuse and violence against older women was convened by the Department of Economic and Social Affairs at the United Nations and consisted of attendance by a number of experts from different regions of the world. A report of the meeting and aspects relating to the issue has been published. The report provides an overview of the current state of knowledge about the abuse of older women. The principal types of abuse against older women are discussed,particularly in relation to differing definitions of neglect, abuse and violence against women and older adults. The report also examines preventive measures to address abusive situations, and provides a summary of the main approaches to addressing the abuse of older women, and key interventions. The report is available at: http://undesadspd.org/Publications/tabid/83/news/390/Default.aspx
International Women's Day, celebrated in March also saw the introduction of a new initiative: Older Women Count, through the auspices of HelpAge International, INPEA and the Sub-Committee on Older women (a sub-group of the NGO committee on Ageing). This movement is attempting to address the lack of attention by the UN Committee on the Status of Women to issues relating to older women. Further information on the initiative is available at: www.helpage.org/what-we-do/post2015-process/international-womens-day-older-women-count/
There has also been recent development in relation to the development of a convention of Human Rights of Older People. Over the past three years (since December 2010) there have been regular meetings of an Open-ended Working Group on Ageing, which was established by a UN General Assembly resolution to undertake further work in relation to establishing the potential need for a UN convention.
In March at the 52nd session of the UN Commission for Social Development we saw the adoption of a resolution by the Economic and Social Council (ECOSOC), which promotes the rights of older people and reaffirmed the importance of the Madrid International Plan of Action on Ageing (MIPAA, 2002). The resolution emphasised the need to develop international cooperation and to integrate topics relating to ageing issues into the existing processes and work programmes of the UN. Further implementation of the MIPAA plan was discussed in a variety of contexts including: the need to recognise the contributions older people make within their societies; the need to mitigate the particular risks faced by older people; the need to address concerns faced by older women; and the need to reduce the prevalence of non-communicable diseases in an older population.
In addition, the resolution requested that the Secretary-General should seek the opinions of Member States and other stakeholders on a possible theme for the third review of MIPAA in 2017, on the challenges that still need to be addressed regarding older people's well-being, and on how ageing issues can be fully integrated and mainstreamed into the work of the functional committees of ECOSOC.
Much work has taken place to establish support amongst member States for a UN convention relating to older people and in December 2013 the Steering Committee for Human Rights at the Council or Europe adopted a draft recommendation relating to the rights of older people. This was followed in February by the Committee of Ministers of the Council of Europe adoption of Recommendation CM/Rec (2014)2 to member States concerning the promotion of human rights of older people, applying a rights-based approach to ensure that older people enjoy rights and freedoms on an equal basis with other citizens. This is viewed as a significant step forward towards a UN convention. At around the same time the Welsh government initiated a consultation exercise on a Welsh declaration on the rights of older people, in order to obtain views on the draft document that had been developed.
Finally, some readers may also be interested in the existence of the Global Alliance on the Rights of Older People, URL: www.rightsofolderpeople.org/
The alliance was established to promote the need for a UN convention and lobbies for change in this area and is open for organisations to become affiliated members.
In this special issue of the journal we are pleased to bring you a selection of papers about a number of different issues relating to the topic of elder abuse. This includes two international papers, from Norway and India, which we hope will be of interest to readers and provide useful comparison with situations that exist for readers in other nations.
The first paper in this special issue, by Malmedal and colleagues reports on research in institutional elder abuse that was carried out in Norway. The aim of the study was to explore the factors that might be involved in influencing whether care staff will commit acts of abuse, neglect and inadequate care. To achieve this, a survey was undertaken in one area of Norway and all staff in a sample of nursing homes in that area were invited to take part, with an excellent response rate (79 per cent) achieved. The key findings from the survey were that the location and size of the nursing home, age of the staff, education level, job satisfaction, resident aggression and conflicts between residents and staff predicted inadequate care, abuse and neglect. The most consistent findings were that resident aggression increased the risk for all three types of inadequate care,and that conflicts predicted different types of inadequate care depending on whether the conflicts were related to direct care-giving activities or not. This has implications for practice-related improvements in nursing home provision in order to reduce the occurrence of episodes of abuse, neglect and inadequate care to a minimum.
The following paper, by Iparraguirre, from AgeUK presents an econometric analysis of hate crime against older people based on data obtained for England and Wales for 2010-2011 disaggregated by Crown Prosecution Service area – which is a geographical unit co-terminus with local authorities. A number of structural regression models were developed and considered, that included one latent variable and accounted for a number of interactions between the covariates. Key findings from the analysis were that the higher the level of other types of hate crime is in an area, the higher the level of hate crime against older people was. Demographics were also significant: a higher concentration of old and young people partially explained hate crime levels against the former. Employment, income and educational deprivation were also associated with hate-based crime against older people. However, conviction rates for such offences appeared to reduce levels of hate crime against older people within specific areas. The paper proposes that factors underlying hate crime also influence hate crime against older people and that the results do not really support the concept of intergenerational conflict. The author argues that tackling income, educational and employment deprivation would significantly help to reduce the number of episodes of biased criminal activity against older people. Improving conviction rates of all types of hate crime would also contribute to the reduction of hate crime against older people.
In the third paper of this issue, possible causes of elder abuse in India and potential repercussions for society have been reviewed and analysed, based on real cases and reports in the media. In this study, a multiple case-study approach was used in order to explore material that was largely obtained from archived newspaper reports and publically available crime reports. In view of the general lack of research on elder abuse in India this paper provides useful information for further consideration and comparison with situations elsewhere. It is likely to be particularly helpful when considering the role of the media in representations of abuse and violence and also when trying to develop and establish responses and interventions in this area.
Our final paper is by Manthorpe and colleagues and concerns the issue of financial abuse of older people with dementia. The study consisted of a survey of staff from local groups of the Alzheimer's Society from across England, which was undertaken in 2011. The survey related to perceptions of staff members about potential risks concerning the management of finances when an individual has dementia and possible ways of assisting in their protection from the risks of financial abuse. In addition to survey questions, there were a number of opportunities for open-ended responses by participants. The majority of the respondents reported that individuals with dementia known to them had difficulties in terms of managing their money, with just under half of the participants stating that they had come across situations of financial abuse in the previous year. Generally respondents were aware of possible warning signs of such abuse and made a number of useful suggestions about both prevention and risk minimisation in such situations. Training and developmental needs for skills were also identified, as was the need for some further awareness-raising activities about adult safeguarding within support services in local communities.
We hope that this issue of the journal will provide much material for reflection and further consideration. If you are thinking about writing for the journal and have some ideas that you would like to discuss, or are interested in the possibility of acting as a reviewer for submitted papers as part of the publication process, please do contact one of the editors to discuss further. Enjoy your reading!
Bridget Penhale and Margaret Flynn
References
Meilke, J. (2014a), “The world of illegal lending: fear, violence and 60 victims under witness protection”, The Guardian, 25 JanuaryMeilke, J. (2014b), “Court of appeal dismisses challenge to welfare reform”, , 22 FebruaryWintour, P. (2014), “Pickles and May clash over squeeze on council tax”, , 11 January
The Guardian
The Guardian
Further reading
UN (2013), Neglect, Abuse and Violence Against Older Women, UN ECOSOC, New York, NY
