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Elder Abuse (Part 1 of 3)

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Abuse can occur anywhere and take many forms, especially in the context of care homes.

A shocking catalogue of abuse at nursing and care homes, frequently exposed by secret filming showing hundreds of incidents of restraint and dozens of assaults on patients, has featured regularly in the press and on radio and TV. The Care Quality Commission (CQC) has closed residential homes where similar concerns were raised.

Many of the systems that could have prevented the abuse of patients in cases such as Winterbourne View clearly failed and other care home scandals continue to surface. The national charity Action on Elder Abuse also maintains that abuse is still occurring and can take a number of forms – physical, mental, sexual, and financial or neglect.

The common denominator of many of these appalling cases is that owners and operators of care homes, various health regulators, local authority health services and police all failed to act on increasingly clear and repeated warning signs of abuse by staff. Compelling and consistent evidence that something was seriously amiss at Winterbourne View, for example, was repeatedly ignored or dismissed by the appropriate authorities.

The latest Adult Social Care statistics published in 2016, confirm that the safeguarding enquiries which concluded in the year 2015-2016 highlighted that those most at risk of abuse are those who live at home (43%) followed by those in care homes (36%).

Of those who were at risk in care homes, those living in the North West and Yorkshire and the Humber regions were most at risk – 42% whilst those in London were at the least risk (23%.) Londoners were, however, most at risk within their own homes. 

What is elder abuse?

In 1993 the charity Action on Elder Abuse established the following definition of 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.'

This definition has been adopted by the World Health Organisation, is promoted by the International Network for the Prevention of Elder Abuse, and has been adopted by various countries throughout the World.

The crucial element of this working definition is the violation of the expectation of trust that the elderly person may reasonably expect of anyone charged with their care – whether that’s a paid staff member or a relative.

Both older men and women can be at risk of being abused, and this can potentially happen wherever they live. This can include: someone’s own home, in a day centre, in a residential home, in a nursing home or in a hospital.

Statistically, the majority of those abused are females over the age of 75. Shockingly, 51% of those who abuse are known to the abused individual, while 34% of abusers are those who provide social care support.

The key issue therefore is not about where the elderly person lives – at home or in residential care - but about whether or not the opportunity exists for someone to abuse the relationship of trust that ought to exist in order to exploit or harm them.

Many victims suffer in silence because they are afraid, embarrassed or simply lack the capacity to understand what’s happening.

Types of abuse

Physical abuse

This form of abuse or assault is probably the easiest to recognise and it is also the most distressing since few of us would be comfortable with the idea of someone in a position of trust physically assaulting any vulnerable person.

Physical abuse is more than slapping, rough handling or hitting and can include the over prescription or inappropriate administration of medication. The Alzheimer’s Society claims that at least 150,000 elderly people are over prescribed or needlessly prescribed anti dementia drugs as a form of ‘chemical cosh’ to keep them docile and compliant.

Signs of physical abuse

The signs of physical abuse (bruising for example) are often evident but any unexplained injuries resulting from, allegedly, ‘walking into things’ should always be fully investigated. The older person may tell you that they have been hit, slapped, kicked, or mistreated. Other warning signs to look out for include:

  • Cuts, lacerations, skin discoloration, black eyes, burns, bone fractures or broken bones
  • Injuries that appear untreated
  • Soiled clothing or bedclothes
  • Broken glasses or frames or signs of being restrained
  • Inappropriate use of medication - overdosing or under-dosing

Bed sores

Bed sores or pressure sores are an obvious sign of inadequate care and can potentially be fatal.

Nationally, treatment of the distressing effects of bed sores costs £1.4 billion a year but if not recognised and treated soon enough, pressure sores can predispose a patient to a fatal infection. Indeed, according to health authorities in the UK and USA, bed sores are the second most common ‘unexpected reason for death caused by medical treatment' just behind adverse drug reactions.

Bed sore/pressure ulcer grading system

The more severe the ulcer, the longer it takes to heal and the greater the incidence of complications in more severe cases.

Grade 1

Non-blanchable erythema of intact skin (i.e. a redness of the skin surface that persists even when pressure is applied), discolouration of the skin or warmth such as you'd get with a wound or infection.

Grade 2

Partial skin loss involving epidermis, dermis, or both. The ulcer looks like an abrasion or blister. Surrounding skin may be red or purple.

Grade 3

Full skin loss involving damage to or necrosis (tissue death) of subcutaneous tissue.

Grade 4

Extensive destruction, tissue necrosis or damage to muscle and bone. Difficult to heal and liable to lead to a fatal infection.

Pressure sores or ulcers are much more common among patients who are unable to move because of paralysis, illness or old age and can be caused by friction, temperature or incontinence but are most frequently brought on by unrelieved constant pressure on one part of the body including bony areas such as the elbows, knees, ankles and sacrum (the triangular bone at the base of the spine between the two hip bones).

Back in the 1950s, a nurse called Doreen Norton demonstrated that the best treatment and prevention of bed sores was removing the pressure by turning the patient every two hours. Norton, who died in 2007, was instrumental in changing nursing practices to effectively treat pressure ulcers which only a few decades ago were a major killer.

However, if that's all it takes - turning a patient or resident every two hours - to prevent bed sores you may well ask why there has been a recent upsurge in cases?

In the UK, it is estimated that between 4% and 10% of all hospitalised patients develop at least one pressure ulcer and almost 70% of elderly patients with mobility problems will develop them. There can be no defence against allowing a bed sore of grade 3 or 4 to develop and their existence strongly suggests very poor standards of care. Even with excellent medical and nursing care, bed sores can be hard to prevent, especially among vulnerable patients. But if those same patients or residents are not being cared for as frequently and attentively as they should be (for whatever reason) then developing pressure sores is almost a certainty and that should call for investigation.

Mental/Psychological abuse

Psychological abuse is the most common type of abuse but it is rare for it happen in isolation and often it accompanies physical or financial abuse. Mental abuse usually involves identifying something - a person or an object - that matters to an older person and then threatening that person or object unless the older person complies with demands.

That could include actions such as threatening to restrict or remove access to grandchildren (if someone lives at home) or denying access to family visits (if someone lives in a residential home) or threatening physical injury to a cherished pet or friend.

Unscrupulous attorneys will often use psychological pressure to coerce elderly people into changing their Will to their advantage. That’s why, when choosing an attorney, you need to be certain you can trust that individual and put your own long term interests first. With a Health and Welfare Lasting Power of Attorney (LPA) you could, literally, be giving someone the power of life and death.

A Property and Financial Affairs LPA will allow your attorney to make decisions about your finances, so it pays to think about what might happen if an attorney is also someone who is in line for an inheritance in your Will. In those circumstances you need to be sure they would be able to put your immediate best interests ahead of their own as an eventual beneficiary.

Signs of psychological abuse

Psychological abuse can have a profound impact on someone's mental health but the most obvious way this form of abuse manifests itself is through changes in behaviour. The abused person may show any or all of the following warning signs:

• Hesitation to talk openly

• Anger without apparent cause

• Unusual or inappropriate behaviour (sucking, biting, or rocking)

• Seeming to be extremely withdrawn and non communicative or non responsive

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