Steve Bartley is the Safeguarding and Access to Justice Programme Lead for the Older People’s Commissioner for Wales. Here he talks about the challenges they face in relation to older adult safeguarding.
There are approximately 800,000 older people aged 60+ in Wales making up a quarter (26%) of the population.
It is estimated that at least 20,000 of those older people with capacity are abused by a family member. Research also shows that up to 16% of people with dementia will be kicked, slapped or punched by their family carer – equating to over 7,000 people in Wales.
During 2013-14, the police in Wales recorded 2,268 domestic abuse incidents and crimes against older people, resulting in 806 crimes identified with 603 arrests made. Of these, the Crown Prosecution Service took 64 cases to court with 53 achieving a conviction. In addition, one third of domestic homicides in England and Wales relate to older people while last year, the Metropolitan police reported they had seen an increase in domestic homicides committed by grandchildren.
Older people are less likely to seek help
Opportunities to identify abuse of older people are often not recognised or are missed [PDF] and older people are least likely to seek help from social services or the police. There are many specialist domestic abuse and sexual violence support services who are able to assist, however many older people are not aware of them.
It’s important to remember that the dynamics of domestic abuse for older people can vary from those of a younger person. Whilst power and control is the main factor for many people, for some older people issues relating to mental health and substance abuse will become more prominent. It is also not unusual for older people to experience abuse by multiple family perpetrators.
What can GPs do?
The health impact of abuse will make it more likely for those experiencing abuse to have regular contact with their GPs, however some of the indicators of abuse or the opportunities to enquire are often missed.
If you are a GP, you can play an essential role in helping to prevent further abuse by sensitively asking your patient if they are being harmed, and if so, do they want to seek specialist support and advice to help them with their situation? The positive impact of intervention could eventually result in reduced visits to the GP and the improved health and wellbeing of the patient.
I would encourage GPs to ask their patients if everything is okay at home and where abuse is disclosed to ask and complete the questions contained in the Risk Indicator Checklist – something which would also be in keeping with the legal requirement to ‘ask and act’, identified in the Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act.
Standing up for older people
In 2013, the Older People’s Commissioner for Wales published her Framework for Action 2013-17, setting out her priorities, one of which is ‘Standing up for older people who are at risk of harm and ensuring that they are safeguarded and protected’. The aim is that we systematically recognise and address different forms of abuse faced by older people.
The Commissioner also undertook a review across Wales looking at safeguarding of older people where domestic abuse was the presenting issue. Whilst the review identified some areas of good practice, it also identified some working practices in need of improvement. In my role, I am subsequently working with organisations across Wales to make the necessary improvements through the development of a national action plan. This will look at things like data management, information sharing, risk assessment, detection and recording of domestic abuse.
To raise public awareness of the domestic abuse and sexual violence that affects older people, the Commissioner has produced a bilingual information booklet that clearly outlines the kinds of abuse they face and the support available to support this abuse. To date, nearly 25,000 copies have been distributed across Wales.
The Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act will change the infrastructure in Wales by creating stronger leadership and ensuring a stronger, more consistent, focus on tackling these issues.
I believe the legal duty to ‘ask and act’ is a positive move in helping to address a problem that affects so many people in Wales. I am working with the Welsh Government to develop guidance for health, social care and housing professionals to tackle domestic abuse and sexual violence of older people, which is due to be published later this year.
Risk Indicator Checklist
I have recently revised the Risk Indicator Checklist used by professionals to help identify the risk of homicide or serious injury for victims of domestic abuse and it now includes questions relevant both to older people and others affected by domestic abuse. This has now been adopted by numerous organisations across Wales, including Health Boards, and is available on our website.
The all Wales National Domestic Abuse and Sexual Violence Helpline (0808 8010 800) offers appropriate support and advice to everyone, including professionals, and will assist to identify the level of risk on completed Risk Indicator Checklists.
Please tell us your views and experiences of adult safeguarding and what you think the challenges are.
Steve Bartley is the Safeguarding and Access to Justice Programme Lead for the Older People’s Commissioner for Wales.
The GMC has guidance, resources and signposts to help doctors deal with issues related to adult safeguarding.