Public perceptions of the neglect and mistreatment of older people: findings of a United Kingdom survey

‘Knowledge is everything?’ How well do the general public understand aged care and how does this affect their attitudes towards quality of care and future funding?

The recent Royal Commission into Aged Care Quality and Safety in Australia has documented systemic failures and shocking incidences of abuse and neglect, a not uncommon story internationally. As aged care in many countries is predominantly publicly funded, it is important to understand the general public's attitudes towards aged care quality, what aspects of care quality they think are most important and their willingness to contribute to increased funding to the sector. This paper asks specifically whether self-reported aged care literacy impacts expectations and willingness to pay. More than 10,000 members of the general population were surveyed stratified by age, gender and state. Regardless of the level of aged care literacy, there was consensus about what constitutes quality care, and care priorities for the sector. However, aged care literacy affected willingness to pay to fund a better-quality aged care system. The current crisis facing Australia's aged care system and that of many other countries internationally demonstrates the central importance of general public support to drive quality improvements, recognising that increasing public expenditure on aged care is a necessary part of the solution. This study provides important baseline data from which to commence national and international conversations to consider all options for ensuring the quality, safety and sustainability of aged care now and into the future.

Organisational aspects of elder mistreatment in long term care

Purpose

– The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It derives from one set of findings from the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults programme.

Design/methodology/approach

– A knowledge synthesis method was selected to identify organisational aspects of elder mistreatment in residential care settings. The method was selected for its suitability in examining ill-defined and contested concepts such as; elder mistreatment – where the available evidence is dispersed and produced in varied forms. A rapid review comprising a search of three academic databases and a detailed examination of selected investigation reports into institutional mistreatment was followed by panel meetings with subject matter experts to complete the knowledge synthesis.

Findings

– This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality.

Research limitations/implications

– Further research is needed to elaborate the influence of these organisational factors on mistreatment and to understand any interactions.

Practical implications

– As an adjunct to personal factors, the knowledge synthesis indicates common organisational factors contributing to institutional abuse. This suggests that care quality is produced systemically and that it can collapse as a result of seemingly minor and unrelated organisational changes.

Social implications

– Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. However, as “problem” organisations are closed down, “problem” organisational factors continue to recur elsewhere.

Originality/value

– The paper identifies and elaborates organisational aspects of elder mistreatment in residential care settings. The findings are original, valuable and grounded in relevant experience by the method of analysis and synthesis of the findings from inquiry reports as well as research and the contribution to the development of findings by those central to the issue, residents, relatives and care providers.

Elder mistreatment, ageism, and human rights

BACKGROUND

Elder mistreatment, social ageism, and human rights are increasingly powerful discourses in positioning older people in society, yet the relationship between them has rarely been subjected to critical investigation. This perceived relationship will have implications for how mistreatment is understood and responded to.

METHOD

Critical gerontological approach based on narrative and textual analysis.

RESULTS

Reports of public attitudes toward mistreatment suggest that it is thought to be more common than scientific evidence would suggest; however, reporting is much lower than prevalence. While the discourse over mistreatment has tended to focus on interpersonal relationships, ageism has emphasized social attitudes, and human rights have concentrated on relations between the state and the individual.

CONCLUSIONS

In this paper, a series of models have been examined which mark a tendency to restrict and then attempt to reintegrate individual, interpersonal, and social levels of analysis. It is concluded that a focus on the processes of transaction across boundaries rather than contents would facilitate both integrative modeling and deeper understanding of the qualities of abusive situations.

Interactional perspectives on the mistreatment of older and vulnerable people in long-term care settings

This article draws on a study aimed at developing theoretical and methodological understanding of the abuse and neglect (mistreatment) of older people in long-term care settings such as care homes and hospitals. It presents an interactionist account of mistreatment of older people in such establishments. Starting with an outline of definitional issues surrounding the topic, the allied concept of dignity is also briefly explored, and one important model described; we present dignity as the converse of mistreatment. The article argues for the potential of a positioning theory analysis of mistreatment. Positioning theory proposes that interactions are based on taking of 'positions', clusters of rights and duties to act in certain ways and impose particular meanings, which enable or prohibit access to certain storylines. It is argued that 'malignant' positioning can contribute to the creation of a climate that allows mistreatment to take place, or fails to prohibit its development. Mistreatment of people with dementia is used as an illustration, and it is argued that this is potentially generated by negative feedback loops of behaviour patterns, interpretations and malignant positioning by staff or family carers and subsequent response to these interpretations by the person with dementia. Positioning theory also allows for an explanation of the importance and impact of organizational cultures and social factors such as ageism. Individual staff members take positions, use meanings and develop storylines imbued with such factors. This understanding therefore overcomes some of the potential confusions created by concepts such as organizational or institutional abuse, removing the need to ascribe intentions and personal responsibility to such constructs. The article concludes with some suggestions for further research to develop an understanding of the kinds of cultures that allow mistreatment and consequently to inform the development of protective measures.

Student nurses' perception and understanding of elder abuse

AIM

The aim of this study is to investigate student nurses' perception, knowledge and awareness of elder abuse.

BACKGROUND

It is evidential that elder abuse tends to be unrecognized and is often hidden from public awareness. Nurses who work with older people are expected to be knowledgeable of the causes and detection of elder abuse.

DESIGN

A quantitative approach using a questionnaire was used to collect data from 245 student nurses from year 1 and 3 of a 4-year bachelor's degree programme.

METHOD

Convenience sampling was used to recruit participants from the two cohorts of the nursing programme. A 25-item questionnaire was used to investigate participants' perception and awareness of elder abuse.

RESULTS

Some 47.8% (n=86) year 1 students and 76.9% (n=50) year 3 students perceived that they were not well trained in identifying or handling elder abuse. Year 1 and 3 students ranked the top three most common abuses differently. In addition, 38% of year 3 students thought that it was largely the responsibility of social workers rather than nurses, to deal with cases of elder abuse.

CONCLUSIONS

The study reveals that nurses-to-be, who are generally expected to be part of the joint force to protect older people against abuse, did not find themselves adequately prepared to fulfil this responsibility.

RELEVANCE TO CLINICAL PRACTICE

The findings provide useful information from which more comprehensive content about elder abuse can be developed in the gerontological nursing curriculum, to better prepare future nurses by increasing their basic understanding of elder abuse.