Select Committee on Health Second Report

2  Defining elder abuse

7. No standard definition of elder abuse applies within the UK public sector. The term itself has been imported from the USA. It has no legal status and would not be recognized by many older people. Guidance issued by the Department in 2000 on the protection of vulnerable adults from abuse (No Secrets) adopted a definition that included, but was not restricted to, older people. Thus, a 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.[4]

8. 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. It is based on a health/social care model and assumes that the vulnerable person must be in need of external support.[5] Nevertheless, the definition is comprehensive, taking as its starting point that "Abuse is a violation of an individual's human and civil rights by another person or persons" and continuing:

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.[6]

9. The guidance lists six main forms of abuse:

·  Physical abuse, including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions;

·  Sexual abuse, including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, could not consent to or was pressured into consenting;

·  Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks;

·  Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits;

·  Neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating; and

·  Discriminatory abuse, including racist, sexist, that based on a person's disability, and other forms of harassment, slurs or similar treatment.[7]

10. As the guidance points out, "any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance." Clearly, the term encompasses an extensive continuum, extending as far as criminal activities. This was also illustrated in the submission from the Nursing and Midwifery Council, which reviewed conduct committee hearings that have involved abuse ranging from not respecting dignity, to actual "physical abuse" and "inappropriate personal relationships."[8]

11. Several memoranda suggested that we should address abuse of all vulnerable adults, rather than focusing solely on older people. It was pointed out to us that, within the context of No Secrets and the protection of vulnerable adults, "elder abuse doesn't exist as a concept", and "people are not abused because they are 'elders' but because they are unable to effectively protect themselves."[9] However, we were concerned that the particular issues relating to the abuse of older people might have been overshadowed if we had looked at the wider group of vulnerable adults.

12. We found wide support from many of our witnesses for the definition of abuse and guidance set out in No Secrets. That this has been adopted by 82% of local multi-agency codes of practice for the protection of vulnerable adults indicates its acceptability.[10]

13. Given the wide range of personal circumstances of older people, their relationships and the settings in which they live or visit, there is no single definition of elder abuse which would satisfy every test. Nevertheless, we consider that the reference to the violation of an individual's human and civil rights by another person or persons provides a useful foundation. The proposed Commission on Equality and Human Rights, which is due to come into being in 2006, could be an important step in offering further protection to older people whose human rights are infringed by abuse. The Commission will take on the responsibilities that are currently split between three commissions (the Commission for Racial Equality, the Equal Opportunities Commission, and the Disability Rights Commission), and will assume additional responsibilities in respect of age, sexual orientation and religion/belief. However, we are concerned that while the new Commission will generally have both promotion and enforcement powers, in respect of human rights it will have only promotion, but not enforcement, powers. We would be very disappointed if this were the case, and we urge the Government to enable the Commission on Equality and Human Rights to promote and enforce both equality and human rights on an equal basis. We believe that the credibility of the new Commission will be seriously damaged if it is unable to respond in this way, and if it is seen to treat the issue of human rights as a lower priority.

14. We recommend that the No Secrets definition of elder abuse should be 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. We recommend that all government departments and statutory agencies, independent bodies, charities and organisations working within the area of care for older people apply this definition of elder abuse to promote consistency and conformity throughout government and the health and social care sector.

4   Department of Health, No Secrets, 2002, para 2.3 Back

5   Ev 7 Back

6   No Secrets, paras 2.5- 2.6 Back

7   No Secrets, p 9 Back

8   Ev 161  Back

9   Ev 163 Back

10   Centre for Policy on Ageing, No Secrets-Findings from an analysis of local codes of practice, June 2002. Back

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