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 TinkerKing’s College London

IAGG, Paris, 8.7.09

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Outline of presentation

1. The UK prevalence study of older people in their own homes – methods

2. Findings – prevalence figures and more detailed ones on abuse and neglect

3. 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)

Total (%) 95% confidenceintervals

Estimated no. inUK population*

Any mistreatment 2.6 1.9 to 3.8 227,000

Neglect 1.1 0.6 to 1.8 93,200

Financial 0.7 0.3 to 1.3 56,600

Psychological 0.4 0.2 to 1.0 38,600

Physical 0.4 0.2 to 1.1 38,100

Sexual 0.2 <0.05 to 1.1 13,100

Unweighted bases:UK 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)

Broaderdefinition (%)

95% confidenceintervals

Estimated no. inUK population*

Any mistreatment 4.0 3.0 to 5.3 342,400

Neglect 1.2 0.7 to 2.0 105,000

Financial 1.0 0.6 to 1.8 86,500

Psychological 0.7 0.4 to 1.3 58,600

Physical 0.7 0.4 to 1.4 62,400

Sexual 0.5 0.2 to 1.2 42,500

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 depressionso 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 people’s resilience as well as specific responses to abuse.

• Influence of study in prompting English Government’s 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_ageing.htm

Anthea.tinker@kcl.ac.uk and Jill.manthorpe@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 O’Keeffe, Amy Hills, Bob Erens, Melanie Doyle, Josie Dixon, Alice Mowlam, Rosalind Tennant, Susan Purdon, Svetlana Speight

• King’s College LondonSimon Biggs,* Claudine McCreadie,* Anthea Tinker,* Jill Manthorpe**

• Karl Pillemer, Cornell University, USA

*Institute of Gerontology **Social Care Workforce Research Unit