Guest editorial

Citation

Lonbay, S.P., Mackay, K. and Montgomery, L. (2023), "Guest editorial", The Journal of Adult Protection, Vol. 25 No. 3, pp. 101-104. https://doi.org/10.1108/JAP-06-2023-082

Perspectives on safeguarding older people: voice, choice, and control

This special issue is concerned with the safeguarding of older people who have experienced abuse and neglect. The papers included within this special issue explore aspects of involvement and participation in adult safeguarding from a range of perspectives across the United Kingdom (UK) and the Republic of Ireland (RoI). Adult safeguarding is defined in different ways in different countries. Collectively, the term describes national and local policy and practice responses to neglect, abuse and harm of an adult by another person; in some countries, it also covers self-neglect. Older people make up the largest proportion of adult safeguarding concerns, and yet their voices on this topic are rarely heard. This special issue brings together a collection of papers which illuminate some of the individual, cultural and structural factors which contribute to a lack of voice, choice and control for older people in adult safeguarding.

Elder abuse is a key global issue with estimates that one in six older people living in their own homes experience abuse every year (WHO, 2022). However, the prevalence is likely to be much higher as this figure does not include older people living in institutions. The prevalence of abuse in these settings is not well established; however, findings from Yon et al.’s (2019) systematic review and meta-analysis (which included Czech Republic, Israel, Slovenia, the USA, Germany and Ireland) showed that as many as 64.2% of staff working in institutional settings admitted to perpetrating elder abuse and neglect. Additionally, staff reported abuse as “sometimes” happening in 91 of the 92 English care homes included within Cooper et al.’s (2018) research. There is also evidence that older people who have a diagnosis of dementia are more likely to experience abuse and neglect than those without (Fang and Yan, 2018). Within the UK alone, several horrific cases of elder abuse have been reported within the news; for example, the deaths of four older people in hospital because of poor care and health and safety breaches (Press Association, 2015). Others have been exposed through documentaries such as Panorama’s “Behind Closed Doors: Elderly Care Exposed” episode which highlighted issues with poor care, neglect and mistreatment (BBC, 2014).

Adult abuse itself has been conceptualised within safeguarding in an individualistic manner, as interpersonal abuse, which ignores structural issues. However, as this issue highlights, structural issues intersect with individual issues in reducing opportunities for older people to have a voice and the way in which older people are positioned within society contributes to a lack of voice, choice and control. For example, a key factor which authors included within this collection have highlighted is the role of ageism in reducing opportunities for older people to be heard. Ageism contributes to abuse and can be experienced by older people as being abusive. Combatting ageism was highlighted as the first concern in WHO’s (2022) priorities for preventing and responding to elder abuse. WHO (2022, p. 4) identified that:

Ageism was considered to be both the major reason for the low global priority of and a major risk factor for abuse of older people. The shame and stigmatization associated with abuse of older people were also viewed as contributing to the low priority of the issue.

Recent global challenges have highlighted how ageism leads to an erosion of human rights for older people. For example, the Covid-19 pandemic impacted older people in the community who faced increased social isolation and reductions in care and support in their own homes due to government restrictions on interpersonal contact (Pentaris et al., 2020). It also impacted older people within institutions where violations to their human rights, including rights to life, liberty, private and family life as well as prohibition of torture and discrimination, were noted by Anand et al. (2022). It was also widely reported that abuse and neglect increased during the pandemic (Yunus et al., 2021). Public response to the pandemic also exposed negative attitudes about older people and a narrative that was permeated by ageism. Lichtenstein (2021, p. e210), for example, examined ageism in public media on Covid-19 and found a “rhetoric of disposability and blame” and three years after this research was published reports and news articles are still forthcoming about ageism and the pandemic (Bowdish, 2023; Scheirber, 2022). The way in which ageism intersects with a lack of voice, choice and control by older people is a key theme within the papers included within this special issue.

The importance of older people’s voices being heard within responses to elder abuse is clear from existing research; for example, Sherwood‐Johnson et al. (2013) noted that when adult safeguarding is not performed in partnership with adults at risk, the process itself can be experienced as abusive, and Montgomery et al. (2017, p. 241) found that adults at risk who participated in their study “identified the safeguarding process as traumatic, and suggested that the stress of involvement in the investigation process impacted on their ability to fully understand the information provided”. It is therefore crucial that adult safeguarding is undertaken in a manner that supports the full involvement of adults at risk and allows them to have voice, choice and control within safeguarding investigations and decision-making about possible support and protection responses. There are many factors which contribute to difficulties in achieving this for older people and the articles within this special issue illuminate some of the challenges and opportunities that exist.

The authors within this special issue explore the different ways in which a lack of an intersectional lens in research and practice related to the safeguarding of older people contributes to lack of diversity within the few older voices who are heard. For example, authors comment on the current advances and challenges within the policy frameworks for elder abuse, the need for a human rights convention for older people, on lack of LGBT* voices, and highlight tensions between different conceptual understandings of abuse in later life. The need for an overarching theoretical framework that is informed by intersectional risk factors is outlined, and practice examples and challenges are explored. There are clearly important gaps in research and practice that need to be addressed for adult safeguarding to meet the needs of older people. The papers in this issue each explore the concepts of voice, choice and control for older people in adult safeguarding through a range of different approaches and perspectives and suggest ways forward for practice, policy and service provision.

The first paper in this special issue, titled “Human Rights and Older People – process and perspectives” and authored by Bridget Penhale, lays out the importance of, and need for, a human rights framework for older people. The argument is made that older people often experience intersecting issues and multiple forms of discrimination. This policy paper outlines the arguments for creating such a framework, as well as the developments that have already taken place towards achieving this and some of the barriers, including institutional and individual ageism.

Amanda Phelan’s practice paper, titled “Adult Safeguarding: An Irish Perspective”, critically reviews the context of adult safeguarding in Ireland. Gaps in provision are identified, including the “vacuum” in legislation around the rights of older people and adult safeguarding. The paper highlights the need to maximise self-determination and collaborative approaches to ensure the prioritisation of older people’s voice, choice and control within adult safeguarding.

The third paper, titled “Participatory Rights of Older Adults in Adult Protection Case Conferences” and written by Kate Fennel, draws on the author’s practice experience to challenge the exclusion of older people from adult protection case conferences. This practice paper is situated within the Scottish legislative context, and the author uses case scenarios from an amalgamation of practice situations to draw out and discuss the participatory principles of the Adult Support and Protection (Scotland) Act 2007. Key areas which impact on the ability to enact participatory principles in practice are drawn out through the discussion.

This is followed by Alisoun Milne’s paper, titled “Older Women and Domestic Abuse: Through a glass darkly”, which focuses on the domestic abuse of older women and highlights some of the conceptual tensions that link to this topic, as well as exploring the impact on the health and wellbeing of older women who experience this type of abuse. The paper draws attention to this “hidden phenomenon”, citing structural age discrimination as a key contributing factor to this invisibility. The way in which work on elder abuse and domestic abuse has developed is also explored. This discussion is used to illustrate the importance of how abuse perpetrated against older women is conceptualised in terms of its impact on research, policy and practice.

The fifth paper, co-authored by Fiona Sherwoord-Johnson, Kirstein Rumery, Julia Lawrence, Kathryn Mackay, Kathryn Ramsay and Rebecca McGregor, titled “Dangerous Care: developing theory to safeguard adults in caring relationships in the UK”, explores abuse which takes place within caring relationships. This paper uses the term “dangerous care” to refer to abuse or harm that takes place between disabled people and carers in family or intimate relationships. Within the paper, the authors explore and discuss the social and structural factors which impact on people’s ability to give and receive care. They argue for the need to use a co-production approach to develop responses that enable older people to have greater control in reducing or removing dangerous care in their lives.

The final paper in this special issue, titled “Making the invisible, visible: Older lesbian, gay and bisexual victim-survivors” “lived experiences’ of domestic abuse” and co-authored by Sarah Wydall, Rebecca Zerk and Elize Freeman draws attention to the use of co-production as a tool for promoting voice, choice and control for older lesbian, gay and bisexual (LGB) victim-survivors of domestic abuse. The paper introduces the co-produced “Do you see me?” film which exposes the marginalisation of LGB victim-survivors and highlights experiences of coercive control from the perspectives of these people. The authors draw attention to the impact of intersecting inequality and oppression and reflect on the use of coproduction as a means of challenging the hegemony of a heteronormative and ageist lens.