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Abuse, neglect and lack of dignity in the institutional care of older people

Definitional issues

Elderly ladies
Published: December 2009

Aim

To clarify issues relating to the use of key concepts when studying cases of abuse, neglect and dignity in care, focusing on research with older people living in residential and nursing care settings.

Findings

Definitions are not theoretically well developed in the study of elder abuse, neglect and dignity

We need clear, unambiguous research definitions so there is clear agreement on what is being measured, even if there continues to be disagreement about what should be measured.

The idea of ’trust‘ is often interpreted very broadly

The idea of ‘trust’ occurs in a number of key definitions of abuse but it is not well specified and is often interpreted very broadly.

We recommend limiting the definition of trust in this context to ‘position of trust’ and using the idea of ‘circles of trust’ to reflect different degrees and types of dependence that older people may have on others.

‘Intentionality’ has been an issue in definitions of elder mistreatment

We recommend a balance of concern between the intent of the person causing the harm and the experience of the older person. A ‘perpetrator’ should know, or be reasonably expected to know, that their action or inaction would cause harm.

The perpetrator-victim model is of limited use in identifying responsibility for mistreatment

In an organisational setting, responsibility for mistreatment is more complex than suggested by a perpetrator-victim model.

Research definitions need to take account of the duty of care that the organisation has towards the older person and incidents of organisational failure.

Qualifiers and thresholds are particularly relevant in residential care settings

Mistreatment may be defined by the way care tasks are conducted (e.g. roughly). Thresholds are critical for measuring cumulative harm from low level incidents. Defining qualifying terms clearly and setting appropriate thresholds will be critical.

Methodology

  • Mapping existing research definitions and descriptions of abuse, neglect and dignity in care.
  • Seminars with practitioners, academics, NGOs, private sector organisations, policy bodies and Government.
  • Interviews with six residents living in care institutions.
  • Interviews with two leading academics conducting related research in other countries.

Read the report