SOLUTIONS TO PREVENT ABUSE OF ELDERLY PEOPLE
What can we do about this growing area of concern? Carers were asked what their requirements were, using this as a starting point. They not unreasonably wanted assessments at regular intervals of their dependent sufferer. New problems could then be referred to the correct agency and appropriate back-up provided. Medical treatment was seen as very important, especially of the intercurrent problems that many frail handicapped elderly people develop, e.g. constipation, incontinence, hearing and sight problems, as well as dental disorders and foot trouble. Information, advice and counseling on the major underlying medical problem was seen as vital, be it Alzheimer's, Parkinson's or whatever. Practical help was necessary as well as regular breaks. It was interesting to note, however, that breaks did not bring down the stress levels by very much; this was only achieved by long-term residential care. Financial support was also necessary. Residential care was seen as needed and necessary by many carers.
Institutions need a different set of solutions. One area of change is in the designing of patterns of care, and not their imposition. Much, however, is dependent on resource allocation. The provision of small units with single rooms and bathrooms, adequate numbers of care assistants - paid well and trained for the job -allowing choice and privacy, does not come cheaply.
Interest in the problem of abuse of elderly people is undergoing a marked resurgence of interest. A new charity - Action on Elder Abuse - has been formed with the mission statement: to prevent abuse in old age by promoting changes in policy and practice through raising awareness, education, promoting research and providing information. This organization is initially aimed at educating and informing professionals working in the field as to the importance of the topic and where to go for research information. Hopefully it will develop further into a major pressure group, aimed at establishing interest at local and central government level. Elder abuse is not yet identified as a social problem. To achieve this status it must be recognized as a problem by society which in turn puts pressure on government to achieve change. Society is becoming increasingly better informed about the topic and as professionals become aware more and more cases are being discovered.
Guidelines have been mentioned. They are in place in only a minority of health authorities but in an increasing number of local authorities. The major obstacle to full scale reform is the lack of legislation. Hopefully this too will change as elder abuse becomes a bona fide social problem on a par with child abuse and other forms of family violence. Currently most authorities use the case conference format for dissemination and discussion of information. A multidisciplinary group of people (social worker, GP, district nurse, hospital doctor, home help organizer, etc.) try to resolve the issues to the best of their ability. Some cases may need the involvement of the police but legal or other specialist help may also be needed. The client should be present (for at least part of the proceedings) as well as the alleged abuser (this obviously has to be handled sensitively). Many groups such as Action on Elder Abuse and Age Concern are putting this issue on the political and media agenda. They feel, quite rightly, that the interests of the elderly person are paramount. The vulnerable old person in the community currently has no rights to ensure that they are protected against abuse in its widest sense. The alarming paradox that there is a legal duty to protect children from abuse but that there is no such legal duty to protect equally vulnerable adults has to be laid at the politicians' door.
The law needs to be changed so that this particularly vulnerable group is protected and their human rights upheld. Age Concern feel that this may involve a Charter of Rights which is legally binding and could extend to institutions; that there should be a proper complaints procedure such as an ombudsman, guardian or advocate system and that this concept of advocacy would allow the frail person's views to be expressed. The problem is complex but there is now no doubt that it is here to stay and we should act now.
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GENERAL HEALTH
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