An ‘epidemic’ of elder abuse?

The House of Commons Health Committee has uncovered another ‘hidden, and often ignored’ problem in British society – elder abuse. This hidden problem, said Liberal Democrat committee member Paul Burstow MP, ‘is still a taboo and is all too often a case of “out of sight, out of mind”’, and this report must act as a ‘wake-up call’. Conservative committee member Simon Burns said: ‘For too long, elderly abuse has been the problem that dare not speak its name.’ (1) ‘”Half a million” elderly abused’, screamed the news headlines. ‘Epidemic of attacks on elderly.’ (2)

I await with eager anticipation the Health Committee’s forthcoming report on ‘Cliché Abuse: The Silent Epidemic’. In the meantime, it’s worth asking some very basic questions about its findings on ‘elder abuse’. To start with: what is it?

It might be easier to rule out what isn’t defined as elder abuse by the Commons Health Committee. The report uses a definition employed by Department of Health guidance in 2000, which states: ‘Abuse may consist of a single or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.’ (3)

The guidance lists six main forms of abuse: physical abuse, sexual abuse, psychological abuse, financial or material abuse, discriminatory abuse, and ‘neglect and acts of omission’. Physical abuse includes hitting, slapping, and ‘inappropriate sanctions’; psychological abuse includes a whole range of behaviour from emotional abuse and threats of harm or abandonment to deprivation of contact and withdrawal from services or supportive networks. ‘Financial or material abuse’ ranges from theft and fraud to ‘pressure in connection with wills, property or inheritance or financial transactions’. ‘Neglect and acts of omission’ is the ultimate catch-all: abuse is not just doing bad things, but failure to do good things. The report points out that ‘any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance’.

So, what is it? According to this definition, elder abuse is just like child abuse – with some mercenary concerns tagged on. Like child abuse, the definition is promiscuous and expanding, ranging from criminal assault (against which there are already many laws) to any experience that older people find unpleasant. Is it any wonder, as the report admits, the term elder abuse ‘would not be recognised by many older people’? If the ‘hidden problem’ of elder abuse effectively amounts to every interpersonal tension that arises with old age, the term becomes meaningless.

Who is affected by elder abuse? The existing official guidance relies on seeing elderly adults as ‘vulnerable persons’. An officially vulnerable person is one who ‘is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’. However, the report notes that ‘this definition has been criticised by some commentators as appearing to exclude those individuals who do not require community care services and who can care for themselves’, and it recommends that the definition is expanded to include ‘those individuals who do not require community care services, for example older people living in their own homes without the support of health and social care services, and those who can take care of themselves’.

In other words, elder abuse should be a problem that is assumed to afflict all old people – including, indeed in particular, those who live with their families. ‘Abuse in domiciliary settings is the commonest type of abuse, but the most difficult to combat’, blithely states the Health Committee’s report. The definition of abuse seems to focus on all the characteristics of intergenerational conflict that have been recognised, and caricatured, for decades. From emotionally charged family arguments to an excessive focus on wills and inheritance, the shifting relationships between ageing parents and their grownup children can and do cause real tensions in life. But how does it help, to view all this through the prism of abuse?

Of course, old age brings problems. The thought of losing your mobility, even your faculties; the likelihood of more frequent illness; becoming dependent on the children you once raised yourself; residing in a care home with lots of (other) old people; thinking about death and, eventually, inevitably, dying – it’s not a life-stage guaranteed to put most people in the most positive frames of mind. Grownup children also find this process difficult to deal with, and often unpleasant, and this can unhappiness. But this is not abuse – and it is wrong to view it as such.

How prevalent is elder abuse? One of the problems flagged up by the Health Committee report is that nobody really knows. ‘The figure of at least half-a-million older people experiencing some form of abuse at any point in time appears to offer the only estimate that is currently available’, it states – and this is a figure derived from a survey conducted in 1992, of ‘approximately 2000 people living in the community’.

The survey inquired about ‘older people’s own experience of physical, verbal and financial abuse from close family members and relatives’, and found that ‘approximately five per cent of older people (aged over 60) had experienced psychological (verbal) abuse, and two per cent reported physical or financial forms of abuse’. The Health Committee’s report admits that ‘researchers who analysed the survey acknowledged that some of the behaviour reported “was probably not ‘abusive’ in terms of severity and intensity”’ – but claimed nonetheless that ‘the results provided the “first systematic British evidence of elder abuse in the domestic setting”’.

In its own terms, this survey seems a shaky basis for quantifying the problem. The fact that it took place 12 years ago makes the half-a-million figure more dubious still. Yet the lack of evidence about the prevalence of abuse only seems to provide more ammunition for those determined to give this issue more attention and more intervention, loudly proclaiming that Something Must Be Done about it.

The Health Committee report assumes that the figure of half-a-million abused elderly people must be too low, as ‘abuse is frequently hidden, may not be obvious even to the victim, and is likely to be underreported’ – and does not allow the lack of evidence to stop it from issuing pages of recommendations about how to counter the problem. ‘At present, little is known about the prevalence of elder abuse, particularly the abuse of older people in their own homes’, said Jonathan Ellis of Help the Aged, commenting on the report. ‘We urge the government, the health service, local authorities and primary care trusts to act quickly and collectively to end elder abuse.’ (4)

The mantra seems to be: if we don’t know how bad elder abuse is, it must be worse than we thought. And woe betide anybody who dares to disagree with this outlook. The report notes, in scandalised tones, the reaction of Dr Stephen Ladyman, junior minister at the Department of Health, to the half-a-million estimate of elder abuse – which he ‘felt was perhaps an overestimate’. He indicated the difficulty with the definition of abuse that underpins such estimates:

‘The concern I have about those earlier definitions is that they include things that can be as innocuous as raised voices. There is a difference in my view, between a raised voice when somebody loses their temper under stress and immediately apologises, realises they have done things and the apology is accepted. That should not be counted as abuse, in my view, unless it is happening every day in a systematic way. Those broad definitions, in terms of the realities of providing care to people, are not helpful.’ (5)

This seems an entirely reasonable and constructive comment. However, the Health Committee gives him short shrift. ‘We were somewhat surprised by this comment’, it states, before giving a lengthy paragraph arguing why he is wrong – ending, in horror: ‘The minister’s own view of what constitutes abuse appears therefore to contradict the clear definition stated in the No Secrets [2000] guidance.’ (6) You can’t help feeling that somebody should put this committee in its place.

The Health Committee’s attempt to see abuse everywhere and anywhere, regardless of the lack of clarity about what it is and how much of it is about, indicates that the new focus on ‘elder abuse’ is not driven by the discovery of a real ‘epidemic’, a genuine problem of serious abuse that has only recently been discovered. Rather, it is driven by the abuse industry, and its relentless pursuit of relationships that it can poison and pathologise. Having successfully represented relationships between parents and young children as child abuse, now there is a concerted attempt to see relationships between adults and their ageing parents as elder abuse. This will happen, it seems, regardless of the lack of any evidence that a major problem exists – or that official intervention could do anything to solve it.

It is hard to see who gains from the promiscuous application of notions of ‘elder abuse’. It is officialdom, after all, which is constantly bemoaning the breakdown of the extended family, and worrying about how to handle the complexities of professional elder-care. How it hopes to improve things by stoking up distrust between family members and presenting often poorly-paid, overstretched professional carers as potential abusers of the Harold Shipman school is anybody’s guess.

People already coping with the practical difficulties and emotional strain of coping with elderly relatives are made to feel like monsters. As for old people themselves – has anybody bothered to ask them? Because it would not be surprising if they found the Select Committee’s presentation of the elderly as childlike victims, easy prey for grasping relatives and smooth-talking charlatans, patronising in the extreme.

There have always been granny-in-the-attic stories: horrific, isolated tales of serious elder abuse. The desire to prevent such terrible abuses is laudable. But broadening the definition of abuse to include family arguments, and viewing all old people as potential subjects of abuse, only trivialises these cases of serious abuse.

Furthermore, the discussion about ‘elder abuse’ assumes that there is some clear category of the vulnerable elderly, who can be lumped in together as one single group of victims. Yet as Phil Mullan has discussed on spiked, the reality of ‘ageing’ today means that the old person lying sick in a care home is only one part of a diverse picture (see Ageing: the future is affordable). It is not only the case that people in the UK are living for longer than ever before – the age at which they become ‘old’ is receding year upon year.

Many retired people today enjoy active, fulfilling, healthy lives in what used to be known as their ‘twilight’ years, and are increasingly able to override the limitations placed upon them by the ‘natural’ ageing process – to the point where one husband’s success with the anti-impotence drug Viagra has provoked his wife to divorce him for placing ‘unreasonable’ demands upon her. Today’s ‘older folk’ are, in general, more than capable of living their own lives and negotiating their own relationships. They play an active, positive role in the family, in such ways as looking after grandchildren. It is insulting in the extreme to present the elderly as helpless children.

Far from becoming victims or ‘burdens’ in their old age, the elderly today arguably make a greater independent contribution to society than at any point in history; and far from sitting around dreading ‘the end’, they can increasingly look for ways to postpone and organise it. Surely, the role of government and Commons committees in this should be to maximise the options available to ageing members of our society, by finding innovative ways to support them and their families in what they want to do – rather than issuing dire warnings about the misery they may well face at the hands of carers whom they have paid to trust – or, worse, their loved ones.

Read on:

Ageing: the future is affordable, by Phil Mullan

spiked-issue: Parents and kids

(1) ‘Half a million’ elderly abused, BBC News, 20 April 2004

(2) Epidemic of attacks on elderly, Gaby Hinsliff, Observer, 18 April 2004

(3) Elder Abuse (.pdf 391 KB), House of Commons Health Committee, 20 April 2004

(4) ‘Half a million’ elderly abused, BBC News, 20 April 2004

(5) Elder Abuse (.pdf 391 KB), House of Commons Health Committee, 20 April 2004

(6) Elder Abuse (.pdf 391 KB), House of Commons Health Committee, 20 April 2004