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Rapid Responses: Rapid Responses published:
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Misunderstanding elder abuse
- Jill Manthorpe, Steve Iliffe, Professor of Primary Care for Older People, University College London (31 January 2009)
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Abuse of demented patients
- Abdul Majid Wani (5 February 2009)
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Violence in dementia sufferers
- Rizaldy Pinzon (7 March 2009)
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Inadequate training: the elephant in the room.
- Alexander M Thomson (10 March 2009)
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Doctors need to engage in education and research in elder abuse
- Kit M Tan, Desmond O'Neill (11 March 2009)
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Jill Manthorpe, Professor of Social Work Social Care WOrkforce Research Unit, King's College London, Strand, London WC2R 4LL, Steve Iliffe, Professor of Primary Care for Older People, University College London
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Claudia Copper and her colleagues run the risk of medicalising the issue of mistreatment and neglect of older people with dementia. Use of ideas like a ‘spectrum’ of abuse, ‘detection’ and ‘thresholds’ may do more harm than good to those struggling to care for older people, and to those professionals trying to aid them. They also misunderstand the current Consultation on the Review of the No Secrets Guidance being undertaken by the Department of Health, Home Office and Ministry of Justice in England. Safeguarding adults in vulnerable situations, including domestic settings, is a priority of government, as outlined in recent documents and initiatives, such as the Mental Capacity Act 2005 and the Safeguarding Vulnerable Groups Act 2006, and there is much debate on what is effective and acceptable. Older people who are family carers, and who are themselves increasingly disabled or unable to provide the level of care and support to a family member are frequently those who occupy vulnerable positions in caring relationships. This finding from the recent UK prevalence study (1) has influenced the Consultation on the Review of No Secrets. In whatever area of the UK a practitioner works, there are policies and practice guidance which can assist practitioners in judging the level of risk and deciding whether to pursue matters through joint investigations with the Police or to consider providing or extending support. While social care resources are limited, the criteria for publicly funded social care include addressing risk of harm. In our experiences, very few practitioners view elder abuse as an ‘all or nothing’ phenomenon. Reference O’Keefe M., Hills A., Doyle M., McCreadie C., Scholes S., Constantine R., Tinker A Manthorpe J., Biggs S and Erens B (2007) UK Study of Abuse and Neglect of Older People: prevalence survey report, London, National Centre for Social Research. Competing interests: JM was chair of an adult safeguarding board for 5 years, has conducted research into adult safeguarding for the Department of Health (including the O’Keefe study), is a member of the Programme Board for the Review of No Secrets, and is currently undertaking research on professional and public understanding of the Mental Capacity Act 2005. SI is chief investigator for the EVIDEM programme (evidence based interventions in dementia care). |
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Abdul Majid Wani, CONSULTANT MEDICINE HERA GENERAL HOSPITAL, MAKKAH- SAUDI ARABIA -21955
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Dear author, this article is interesting and highlights the abuse of demented patients. In our experience in a secondary care hospital, we have come across patients who have been abused to an extent beyond human imagination. We have seen cases with fractures, pressure sores deep enough to reveal bones and dura mater, pressure sores with maggots coming out from inside, malnutrition to the level that only bones are palpable, soiling in fecal matter to be noxious for onlookers, contractures which were difficult to release even after death.
Competing interests: None declared |
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Rizaldy Pinzon, Neurologist Bethesda hospital Yogyakarta Indonesia 55224
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This interesting article showed that elderly dementia sufferers are not exempt from aggression. Abuse is very common in this study. The study showed over half reported some abusive behavior. Elder abuse is common and can take many forms, including physical, psychological, financial and sexual abuse, or neglect. Physiological abuse is much more prominent in this article. Frustrating caregiver tends to make an abuse to the dementia sufferers. Previous study showed that carer distress was predicted by depression, psychosis and cognitive impairments in patients. Physicians must be aware about the possibility of abuse in taking care of patients with dementia. Good education about the clinical course of dementia to the carers is strongly needed. Good understanding about dementia in the carers may reduce the distress in taking care a patient with dementia. There is need of simple screening test for detecting the possibility of abuse in dementia patients. Competing interests: None declared |
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Alexander M Thomson, Consultant Geriatrician Salford Royal Hospital, M6 8HD
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The work by Cooper et al is a positive contribution to the evidence base relating to abuse of vulnerable adults, and those with dementia in particular (1). Work like this is essential given the variety in epidemiological work in this field. Current evidence is found across a number of studies, but all with different study populations and sampling techniques (2). Research in this area of adult protection is vital but, critically in the UK, delivery of training in recognition, investigation and management of cases of abuse remains inconsistent or even absent in some areas. This is true for both undergraduate and postgraduate training in medicine, and is probably also the case in the nursing and allied health professions. Even within my own speciality, proponents of comprehensive care and advocates for the frail and vulnerable, there remains a paucity of training. Although training in elder abuse was highlighted in the Department of Health’s “No secrets” publication in 2000 (3), it still needs to be addressed more rigorously. This is necessary during early training and, importantly, throughout one’s career. Only then will it become a cornerstone of excellent practice for those at risk and subject to harm. 1. Cooper C, Selwood A, Blanchard M et al. Abuse of people with dementia by family carers: representative cross sectional survey. BMJ 2009;338:b115. 2. Lachs MS, Pillemer K. Elder Abuse. Lancet 2004.;364:1263-72 3. Department of Health. No secrets: guidance on developing multi- agency policies and procedures to protect vulnerable adults from abuse. London: DoH;2000. Competing interests: None declared |
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Kit M Tan, Specialist Registrar Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin 2, Ireland, Desmond O'Neill
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The significant levels of elder abuse reported by family members of those with dementia (1) (Jan 22) should prompt scrutiny as to whether those involved with the care of older people, and in particular those with dementia, have adequate training in the prevention, detection and management of elder abuse. The medical profession in particular may be challenged in this regard. In one study, 45% of junior doctors had never heard the term ‘elder abuse’, although 85% felt elder abuse was common and all felt it was under-reported: only 5% interviewed had heard of guidelines in place for its management. Hospital-based social workers fared better, but only 58% were aware of management guidelines (2). Any such training needs to be based on a foundation of gerontological skills: Lachs and Pillemer have outlined eloquently how detection and management of elder abuse share many characteristics with the detection and management of other geriatric syndromes (3). However, an equally important message from Cooper’s paper is that of the need for doctors to continue to engage in research into elder abuse, a subject which is rich in conjecture, but short on data. The United States National Academy of Sciences has lamented this paucity of empirical research, with less than fifty peer-reviewed papers in the elder abuse literature (4). A recent review of the child abuse literature has underscored the need for continuing involvement of physicians in research and practice (5). This need is just as great for a topic as complex and subtle as elder abuse, and the knowledge base for prevention, detection and management of elder abuse needs the insights of all elements of a biopsychosocial model of elder abuse. References 1. Cooper C, Selwood A, Blanchard M, Walker Z, Blizard R, Livingston G. Abuse of people with dementia by family carers: representative cross sectional survey. BMJ. 2009;338:b155 2. Kennelly S, Sweeney N, O'Neill D. Elder abuse: knowledge, skills, and attitudes of healthcare workers. Ir Med J. 2007;100:326. 3. Lachs MS, Pillemer K. Elder Abuse. Lancet 2004.;364:1263-72 4. National Academies of Sciences , Bonnie R, Wallace R, eds. Elder abuse: abuse, neglect, and exploitation in an aging America. Washington DC: National Academy Press, 2002. 5. Reading R, Bissell S, Goldhagen J, Harwin J, Masson J, Moynihan S, Parton N, Pais MS, Thoburn J, Webb E. Lancet. 2009 24;373:332-43. Competing interests: Professor O'Neill was the Chair of the Irish government's Working Group on Elder Abuse |
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