Activists and researchers are struggling to ensure that awareness of child sexual abuse and child sexual exploitation are embedded in the minds of practitioners. Quite rightly – no child should have to find ways to overcome traumas that could be prevented; traumas that twist and cramp spontaineous growth and development. But we also have the challenge of an older age population for whom no such committment existed. Many of our elderly are carrying a lifetime of abuse and a legacy of trauma that shapes their experience of accessing support and care. The political withdrawal of funding from the violence and abuse sector delivers us into a climate where we have no option but to haggle over the resources that scarcely cover the categories of child and/or adult vulnerability. A question that troubles me as I age is how we might balance our concern for future generations with our concern for the children of yester-year. In a culture that is demonstrably ageist in outlook – invisibility for those age 55+ appears to be the norm.
At the European conference on domestic violence in Belfast last year a number of presenters explored the similarities and differences between elder abuse and domestic abuse. What became clear was that there has been limited development in research or service provision for this population.Since that conference I have had cause to examine london based service responses to vulnerable adults at risk of current abuse from partners, family and carers. One of our students looked in depth at experiences of domestic violence in the older age population in Kent. Our findings left us both very troubled by the lack of knowledge and skills available to practitioners and the consequent experiences of older women in particular. This aspect of abuse prevention now falls far below the level of protection we try to provide to children who are vulnerable to the coercive behaviours of sex offenders or domestically abusive father figures. The level of research, training, policy and legislation we can draw on for child protection is not matched at the level of adult vulnerability. When adults lose capacity (either physically or mentally) they too become dependents on the care of family or services, often without adequate safeguards to ensure the safety of that care.
What becomes evident as you look into the older age experience of current abuse is the extent to which previous experiences of abuse(s) complicate the picture. Adults of both genders reaching their 80s have had little or no opportunity to disclose child or adult sexual abuse over their lifetime. Conditions like dementia break down the psychological defences that they may have used to block out or supress unwanted memories or flashbacks. Suddenly they are confronted by triggers like being touched, washed or dressed by adults who may or may not feel trustworthy. Although we have the Care Quality Comission (CQC) inspecting care homes we hear of abuses and neglect – sometimes only detected when relatives instal hidden cameras. As with children, going into care may be the most appropriate option but the care setting can also be a site of harm. Limited investment in adult care means that homes are frequently staffed by poorly paid undervalued migrant workers with very limited training. The training gaps around dementia and around violence and abuse conflate to create a vacuum in adult services. For example, how will those workers know that sexual abuse trauma lies behind the distress a person with dementia shows when receiving everyday physical care? How are these expressions of trauma deciphered when they are so often classified as symptoms of confusion or memory loss?
For those elderly who remain in their homes their evident vulnerability makes them easy target for a host of rogue traders or unscrupulous family members. Cast around any social group of women in their 50’s and you will hear accounts of elderly relatives being taken by builders to cash point machines to ‘pay up front in cash’. These are not stories the elderly easily tell as they battle to retain an appearance of independence and avoid the indignity of a care system that will strip their identity of sexuality, religion and dietry choice. For the person managing a history of abuse related trauma the sanctuary of their own home may be their only space where they felt safe. Even this possibility will be compromised by abusive partners, adult children or other close relatives who take control of the older person. That control is coercive control – threats with consequences; affection proferred or withdrawn; financial control; isolation and intimidation. Adult social workers fall to colluding with relatives who claim to be speaking for the older person or who offer to take on care and relieve a public service of the strain on staffing. The Court of protection is most areas is full of cases of disputed care management, and situations where one side or the other claims that the older person has or lacks the capacity to change wills, spend money or make basic decisions. In this setting where vulnerable adults are the focus, the concept of coercive control has yet to take root. Health and Social care workers involved in the earlier stages of the case appear unable to identify coercion and give equal weight to all the accounts they hear from people around the older person. Consequently the charity Action on Elder Abuse is swamped with calls from distressed relatives and friends who spot a sudden change in the life pattern of the older person.
I am not sure how we should proceed with this problem in economic terms – funds are short and we have many children and adults in a category of need. Raising awareness amongst ourselves and our fellow workers, friends, community is at least a start. Training people to keep alert to issues of violence and abuse in the older population is a critical need. I have seen no evidence that this occurs so perhaps anyone reading this who has evidence that such training occurs can respond. The interplay of dementia and abuse related trauma is something I am trying to track down in the literature out there. I hope to come back with some more on this in a future post.