Editorial: Elder Abuse and Social Work: Research, Theory and Practice

Abstract

This Special Issue of the British Journal of Social Work is dedicated to arguably one of the biggest challenges facing social work today: violence and abuse of older people. Despite increasing acceptance of elder abuse as a global public-health issue and violation of human rights, research, policy and practice in this area remain fragmented and there are serious gaps across all three areas. This Special Issue is devoted to examining the international development of research, theory, policy and practice in relation to elder abuse and domestic violence affecting older populations. The Western population is rapidly ageing. By 2030, over a billion people worldwide—one in every eight of the Earth’s inhabitants and almost double the current number—are forecast to be over sixty-five. In the UK, 10.3 million people are aged sixty-five or over and this number is projected to increase to over 16 million in the next twenty years (Minocha et al., 2013). As Herring (2009) points out, these demographic changes will impact on society in profound ways. Despite a growing number of healthy older people, their place in society is marginalised; the ‘golden years’ are not always golden and there is an increasing awareness that older people can, and do, experience violence and abuse in later life. There is no globally accepted definition of elder abuse. As Fox (2012, p. 128) notes, ‘elder abuse is a relatively new research field in comparison with the issue of child abuse. Due to this youth, standardised terminology is yet to emerge’. There is no official definition of elder abuse in the UK, and the difficulties in defining it have been acknowledged by the Department of Health and Home Office in their guidance on abuse of vulnerable people (2000), which provided a rather broad definition of abuse: ‘Abuse is a violation of an individual’s civil or human rights by any other person or persons’ (Department of Health, 2000, p. 9). One of the most common definitions utilised across the existing research is provided by the World Health Organisation (WHO), which defines elder abuse as an act of commission or of omission … either intentional or unintentional …. Of a physical, psychological, financial nature or other material maltreatment … that will certainly result in unnecessary suffering, injury or pain, the loss or violation of human rights, and decreased quality of life for the older person (WHO, n.d., p. 126). Despite the lack of definitional consensus, it is reassuring that most people concerned with the issue agree on the different types of abuse that can occur. Behaviours that fall within most definitions can be broadly categorised into five categories: physical abuse; psychological or emotional abuse; sexual abuse; financial or material abuse; and neglect (Krug et al., 2002, in Desmarais and Reeves, 2007), although it is worth mentioning that some definitions of elder abuse do not include sexual abuse (see Bows, 2017). In England and Wales, the category of discriminatory abuse was added in the policy guidance that was issued at the beginning of the century (Department of Health, 2000; WAG, 2000). Institutional abuse is also usually included within policy documents produced at the local level, and considerations of societal-level abuse may also appear in such documents. In the more recently introduced consolidating legislation in England, the Care Act 2014, the typology was expanded to include domestic violence, including honour-based violence; modern-day slavery, including human trafficking and domestic servitude; and organisational abuse (in place of institutional abuse), as well as self-neglect. In addition to the definitional ambiguities, it has been suggested that grouping together the different forms of abuse under the all-inclusive term of ‘elder abuse’ is also problematic in that it suggests it is a single collective issue that can be researched and responded to by a single intervention or policy initiative (Brandl and Raymond, 2012). Desmarais and Reeves (2007) argue that the de-contextualisation associated with the over-arching term of ‘elder abuse’ has arguably contributed to an ‘overemphasis on types of abuse and perpetrators unique to elders, such as abuse by adult children, disregarding abuse occurring between partners’ (p. 381). Likewise, it has been argued that, with ‘a problem as complex as elder abuse, it is unlikely that any single theoretical perspective could explain all forms and situations’ (Anetzberger, 2004, p. 10). In general terms, it is rare to find single, stand-alone legal statutes in relation to elder abuse in countries across the world and indeed only a few countries, such as Israel and Japan, have enacted specific legislation relating to elder abuse. In the USA, the majority of states have Adult Protective Services provision, largely initially enacted within the 1965 Older Americans’ Act, but subsequently strengthened via the 2010 Elder Justice Act. This Special Issue includes papers from Australia, Canada, Ireland, Oman, Poland and the USA, as well as different UK nations, so the jurisdictional variation between them is relatively large. What all of the papers have in common, however, is to explore different aspects of the phenomena of elder abuse and neglect and examine advances (or the potential for advances) in prevention in this area. Across the UK, there are many different pieces of legislation used by professionals working in the field of abuse. As in many countries, the range of such professionals includes social workers, social-care staff and allied professionals from health-care settings as well as the criminal justice sector. All practitioners in this type of work need to have essential knowledge and understanding of legislation and, although it may be most likely social workers who are primarily and predominantly involved in application of the law (excluding the police), other professionals also need to have some basic knowledge of the law, depending on the situation involved. Of the core social work functions, helping to protect individuals from others, from themselves, from circumstances and from various types of disadvantage in life is a fundamental role. However, in some ways, social workers can additionally act to protect society from danger and harm by regulating individuals’ lives through functions that are predominantly about control rather than care. In order to do this, a wide range of law and policy is needed. Within the UK setting, the general approach taken to issues of protection is that of adult safeguarding, concerning the abuse of adults who might be considered at risk of harm, rather than a specific focus on elder abuse. In Scotland, the term used is (still) adult protection, whilst, in Wales and Northern Ireland, there have been shifts in recent years to use of the term safeguarding, but again covering all adults who might be covered by health and care statutes in a more general sense, rather than specifically older people. People with impairments or disabilities (physical and/or cognitive) or complex health problems can at times be vulnerable due to their situations and may be at risk of harm and abuse from other people in a variety of contexts. They may also put others at risk of harm by their actions. It is important to note, however, that there is no single piece of legislation that specifically (and uniquely) concerns the protection of vulnerable adults (of any age) in England, Wales or Northern Ireland, although this might develop in future. Instead of a single law, there are a number of different pieces of legislation, different parts (or specific ‘sections’) of which may be used by individuals who are in need of support and/or protection. At times, another person, such as a professional practitioner, can use legislation on behalf of an individual. The Care Act 2014 was introduced as a consolidating law in order to bring many different areas of social-care law relating to adults into one over-arching piece of legislation. Although adult safeguarding is included within the remit of this legislation, this statute does not provide law in relation to specific types of abuse, but rather develops an overall framework within which the safeguarding of adults should take place within authorities and local areas—thus it is known as ‘framework legislation’—providing statute on organisational aspects of safeguarding processes. Concerning different types of legislation, there is law designed to protect people with mental illness from harm or harming others (e.g. the 1983 and 2007 Mental Health Acts, Supervised Discharge Procedures 1995). The legislation concerning mental health also extends to adults with severe learning disabilities, and includes such provision as guardianship arrangements, which may be used for older people with severe and enduring mental health problems or cognitive impairment. The 2005 Mental Capacity Act (MCA) covers those older adults who lack the capacity to take specific decisions for themselves (as well as other adults who also lack such decision-making capacity). This law includes some provision concerning the protection of those covered by the legislation from abuse, particularly in the creation of a specific offence of ill-treatment or wilful neglect of an adult who lacks capacity (section 44 of the MCA), with punishment resulting in a fine, or imprisonment. An amendment to the MCA through the 2007 Mental Health Act introduced the Deprivation of Liberty Safeguards (concerning the restriction of liberty of individuals in hospital and care settings); these became effective in England and Wales from 2009. More recently, these provisions have been subject to a review, with subsequent proposals for amendment by the Law Commission produced in 2017 (Law Commission, 2017), with recommendations for changes to the safeguards broadly accepted by the English government in spring 2018. Additionally, Part IV of the 1996 Family Law Act affords individuals some protection from violence that happens in the domestic setting. This legislation provides a range of measures that might be used, including non-molestation and ouster orders (concerning abusers/perpetrators) in certain situations. At the time of implementation, the scope of this legislation was broadened to include a wider range of individuals living together, not just spouses or those people in a cohabitation relationship. The possibility of action taken on behalf of an individual by third parties such as professional practitioners is also included, so this provision can also be used to ensure the safety and protection of older adults at risk of harm. Whilst legislation relating to domestic violence was expanded to include adults experiencing either elder or adult abuse (including the Family Law Act), the Domestic Violence, Crime and Victims Act, which was enacted in November 2004, introduced a further extension of this type of provision. This occurred through inclusion of a new offence of familial homicide, which covered abuse in the domestic setting including being killed by family members, but where it proves to a single In the government for the of social also specific of the need to and increase measures of protection for vulnerable individuals (Department of Health, changes over the As an of this type of the Act was introduced to provide protection for individuals who about situations within as care or the Act into in and strengthened relating to the health and care In research examining elder abuse largely into examining the of elder abuse or specific types of elder abuse; and and to elder abuse. have been in a number of countries including the and UK and a wide range of have been in to different measures and definitions of abuse et al., of existing by et in of older people abuse in the in general population of physical violence in their over the However, the wide range of definitions of in the existing et included from and over to and over in their The that only a of abuse was and at one in is at risk of abuse. more recent of the of abuse of older people in settings by et that, one in older people some of elder abuse They that the of abuse are psychological and financial abuse. 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