Elder abuse

"Older people are weak": perceptions and meanings of ageing and abuse against older people

Introduction

This paper addresses the broader issue of elder abuse and seeks to analyse how victims and non-victims of abuse connect and explain the perception of ageing and the phenomenon of violence against older people.

Methods

A qualitative study was conducted based on evidence gathered through 45 semi-structured interviews with people aged 60 or above who are part of the Portuguese EPIPorto population cohort. The interviews were analysed using grounded theory.

Results/discussion

The results show that respondents link the ageist narratives that exist in our societies to the prevalence and naturalisation of violence against older people, that the risk of abuse increases with the weakening of family support networks, and that abuse is both a manifestation of asymmetrical power relations between victims and perpetrators and a severe violation of human rights. The findings also highlight the need to broaden the concept of violence against older people to include offences in the public sphere and not just in the context of the family and institutions.

Insights into caregivers' perspectives on abuse of older persons: a qualitative exploratory study in southwest Nigeria

OBJECTIVE

Elder abuse perpetration by caregivers is well documented, particularly from the perspectives of older persons who are victims of abuse. However, few studies in Nigeria have examined the caregivers' viewpoints. This study explored the perception about the perpetration of elder abuse perpetration among adults aged 18-59 in Nigeria.

DESIGN

Using a qualitative descriptive approach, this study generated data through four in-depth interviews (IDIs) and eight focus group discussions (FGDs). All IDIs and FGDs were audiorecorded, transcribed coded and analysed thematically with Atlas ti.

SETTING

Rural and urban communities in Oyo State, southwest Nigeria.

PARTICIPANTS

73 purposively selected adults who had provided care for or lived near an older person in southwestern Nigeria.

RESULTS

Types of elder abuse identified were verbal (grumbling, insulting, snapping and shouting at older persons), physical (shoving and beating an older person) and neglect (refusing to render assistance, cook or carry out chores for an older person). Participants believed relatives of older persons were unlikely to perpetrate abuse compared with neighbours and paid caregivers. They, however, felt that people whose parents had maltreated them during childhood could perpetrate abuse especially neglect of their older parents. Identified possible provocation for abuse included an unkempt physical appearance, poor attitude or offensive behaviour in the older person. Participants further opined that lack of communal unity or mutual respect, loss of moral ideals and religious values and erosion of cultural values could also provide an environment where elder abuse can thrive.

CONCLUSION

Interventions for community-level prevention of elder abuse can leverage on the identified moral and religious values, relationship and cultural factors for successful deployment.

Identifying and enhancing risk thresholds in the detection of elder financial abuse: a signal detection analysis of professionals' decision making

BACKGROUND

Financial abuse of elders is an under acknowledged problem and professionals' judgements contribute to both the prevalence of abuse and the ability to prevent and intervene. In the absence of a definitive "gold standard" for the judgement, it is desirable to try and bring novice professionals' judgemental risk thresholds to the level of competent professionals as quickly and effectively as possible. This study aimed to test if a training intervention was able to bring novices' risk thresholds for financial abuse in line with expert opinion.

METHODS

A signal detection analysis, within a randomised controlled trial of an educational intervention, was undertaken to examine the effect on the ability of novices to efficiently detect financial abuse. Novices (n = 154) and experts (n = 33) judged "certainty of risk" across 43 scenarios; whether a scenario constituted a case of financial abuse or not was a function of expert opinion. Novices (n = 154) were randomised to receive either an on-line educational intervention to improve financial abuse detection (n = 78) or a control group (no on-line educational intervention, n = 76). Both groups examined 28 scenarios of abuse (11 "signal" scenarios of risk and 17 "noise" scenarios of no risk). After the intervention group had received the on-line training, both groups then examined 15 further scenarios (5 "signal" and 10 "noise" scenarios).

RESULTS

Experts were more certain than the novices, pre (Mean 70.61 vs. 58.04) and post intervention (Mean 70.84 vs. 63.04); and more consistent. The intervention group (mean 64.64) were more certain of abuse post-intervention than the control group (mean 61.41, p = 0.02). Signal detection analysis of sensitivity (A´) and bias (C) revealed that this was due to the intervention shifting the novices' tendency towards saying "at risk" (C post intervention -.34) and away from their pre intervention levels of bias (C-.12). Receiver operating curves revealed more efficient judgments in the intervention group.

CONCLUSION

An educational intervention can improve judgements of financial abuse amongst novice professionals.

Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England

BACKGROUND

The risks of financial exploitation and abuse of people with dementia remain under-researched. Little is known of the views of those responsible for local adult safeguarding systems about prevention and redress. We explore current repertoires of responses of such persons and consider barriers and facilitators to minimizing risks of financial abuse for people with dementia.

METHODS

Fifteen qualitative interviews were undertaken with a purposively sampled group of Adult Safeguarding Co-ordinators in England in 2011. Framework analysis delineated themes in the transcripts; these were included in an iteratively developed coding framework.

RESULTS

Five themes were explored: (1) incidence of financial abuse; (2) impact of dementia on safeguarding responses; (3) warning signs of financial abuse, including neglect, unpaid bills, limited money for provisions; (4) encouraging preventive measures like direct debit to pay for bills, advance care plans, appointing Lasting Power of Attorney; and (5) barriers and facilitators in safeguarding, including the practice of financial agencies, cultural barriers, other systemic failures and facilitators. Not all systems of financial proxies are viewed as optimally effective but provisions of the Mental Capacity Act 2005 were welcomed and seen as workable.

CONCLUSIONS

Healthcare professionals may need to be more alert to the signs and risks of financial abuse in patients with dementia both at early and later stages. Engaging with safeguarding practitioners may facilitate prevention of abuse and effective response to those with substantial assets, but the monitoring of people with dementia needs to be sustained. In addition, professionals need to be alert to new risks from electronic crime. Researchers should consider including financial abuse in studies of elder abuse and neglect.