Editorial: Nurses need to prevent the abuse of older people

The abuse of older people is a world-wide problem. Older people in need ofhealth and/or social care and servicesare vulnerable to the power, authority,attitudes and behaviours of others –mostly, care workers. For the majorityof older people their experience of theirrelationships with care workers is pos-itive. However, for many others it is farfrom a positive experience and at worse,they experience abuse.

‘Action on elder abuse’ (UK, http://www.elderabuse.org.uk/) defines abuseas ‘a single or repeated act or lack ofappropriate action, occurring within anyrelationship where there is an expectationof trust, which causes harm or distress toan older person’. This definition empha-sizes the importance of two things in thecare of older people – relationships andtrust. It is widely recognized that rela-tionships between nurses and older peo-ple have the potential to be therapeutic,leading to positive outcomes from careand positive experiences of being caredfor. Central to such a relationship (like allrelationships) is ‘trust’. Abuse of all kindseats away at this trust and whilst theerosion of trust can at best lead to careomissions, at worse it can lead to system-atic abuse of older people. Statistics fromthe National Centre on Elder Abuse(2006) in the USA suggest that elder abuseis on the increase. Findings from their2004 survey of State Adult ProtectiveServices suggested a 19.7% increase inreported incidents of abuse. Whilst in theUK, Cooper et al. (2006) suggest thatcognitive impairment was the leadingindicator of abuse among older people.Statistics about the prevalence of abuseamong older people in healthcare settingsare hard to come by. The most recent datacollected by ‘Action on elder abuse’ sug-gest that 25% of all calls to their tele-phone helpline raised concerns aboutabuse in institutional settings. However,it is widely acknowledged that any datareporting the prevalence of elder-abusehave to be treated with caution as accu-rate monitoring is difficult to achieve

because abuse is under-reported due tothe complex psychosocial factors associ-ated with it. However, it is no secret thatabuse continues in many healthcare set-tings and a lack of leadership in combat-ing abuse among care workers continuesto be problematic.

The ‘Commission for Health Improve-ment’ report into the abuse of olderpeople in a mental health unit in Man-chester, UK, found that the abuse mani-fested itself through ‘old fashioned’ and‘regimented nursing care’. In referring tothis case (known as the Rowan WardReport) (Commission for Health Impro-vement Investigations, 2003) during thelaunch of a new Royal College of NursingLeadership Programme for nurses work-ing with older people, the governmentminister launching the initiative stated:

I am pretty tough, but I had tears in my eyes

about what had gone on. It was nurses and

doctors who turned a blind eye because the

abuse had become systematic. No one was

the leader they should have been – people

kept their mouths shut and their eyes closed.

(Parish, 2005, p. 12)

Many lessons have been learned fromthis case and greater attention has beenpaid to ensuring that care services aremore rigorously monitored, clinical gov-ernance frameworks act to prevent andmonitor abuse, leadership is streng-thened and that more carefully regulatedstandards of care are in place (Depart-ment of Health, 2005). How any evi-dence is translated and implemented intopractice is problematic and it is no less thecase for the prevention of abuse. Rich-ardson et al. (2002) for example identi-fied that an education intervention hadonly a limited impact preventing elderabuse and they suggested that the lack ofidentification, documentation andreporting of abuse limits the impact ofmost interventions. Studies such as thishighlight an increasingly recognized real-ity that changing practices cannot hap-

pen through a single intervention such asan education course. Practice culturesthat harbour abuse tend to have deeplyingrained characteristics that are incon-sistent with clinical effectiveness andeducation alone cannot change these.Systematic approaches to changing suchcultures that provide spaces for careworkers, patients/residents and familiesto ‘have a voice’ are crucial or as the oft-cited phrase suggests, ‘when people whoare not used to speaking are heard bypeople who are not used to listening thenreal changes can be made’. Staying quietabout elder abuse is not an option and isinconsistent with any standards of pro-fessional practice we may endorse.

Brendan McCormackCo-editor, IJOPNE-mail: brendan.mccormack@royalhospitals.n-i.nhs.uk

References

Commission for Health Improvement Investi-

gations (2003) Investigation into MattersArising from Care on Rowan Ward. Man-

chester Mental Health and Social CareTrust, The Stationary Office, Norwich, UK.

Cooper C., Katona C., Finne-Soveri H.,

Topinkova E., Carpenter I. & Livingston

G. (2006) Indicators of elder abuse: acrossnational comparison of psychiatric

morbidity and other determinants in the

Ad-HOC study. American Journal ofGeriatric Psychiatry 14, 489–497.

Department of Health (2005) No Secrets:Guidance on Developing and Implement-ing Multi-Agency Policies and Proceduresto Protect Vulnerable Adults from Abuse.

Department of Health, London, UK.

National Centre on Elder Abuse (2006)

Abuse of Adults 60þ 2004 Survey of AdultProtective Services, Fact Sheet. National

Centre on Elder Abuse, Washington, DC.

Parish C. (2005) Leadership programme will

help prevent abuse of older people. Nur-sing Standard 19, 12.

Richardson B., Kitchen G. & Livingston G.

(2002) The effect of education on knowl-edge and management of elder abuse: a

randomized controlled trial. Age andAgeing 31, 335–341.

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