Claudine McCreadie

The acceptability of assistive technology to older people

Assistive technology (AT) is defined in this paper as ‘any device or system that allows an individual to perform a task that they would otherwise be unable to do, or increases the ease and safety with which the task can be performed’ (Cowan and Turner-Smith 1999). Its importance in contributing to older peoples independence and autonomy is increasingly recognised, but there has been little research into the viability of extensive installations of AT. This paper focuses on the acceptability of AT to older people, and reports one component of a multi-disciplinary research project that examined the feasibility, acceptability, costs and outcomes of introducing AT into their homes. Sixty-seven people aged 70 or more years were interviewed in-depth during 2001 to find out about their use and experience of a wide range of assistive technologies. The findings suggest a complex model of acceptability, in which a ‘felt need’ for assistance combines with ‘product quality’. The paper concludes by considering the tensions that may arise in the delivery of acceptable assistive technology.

Defining elder mistreatment: reflections on the United Kingdom Study of Abuse and Neglect of Older People

ABSTRACT This paper critically reflects upon policy and research definitions of elder mistreatment in light of the findings of the United Kingdom Study of Abuse and Neglect of Older People that was commissioned by Comic Relief with co-funding from the Department of Health. The study uniquely comprised a national survey and follow-up qualitative research with survey respondents. This paper focuses on the findings of the qualitative component. One focus is the idea of ‘expectation of trust’, with an argument being made that the concept needs clarification for different types of relationships. It is particularly important to distinguish between trust in affective relationships and ‘positions of trust’ (as of paid carers), and to articulate the concept in terms that engage with older peoples experiences and that are meaningful for different relationship categories. The qualitative research also found that ascriptions of neglect and abuse tend to be over-inclusive, in some instances to avoid identifying institutional and service failures. We also question the role and relevance of the use of chronological age in the notion of ‘elder abuse’. Given that ‘abuse’, ‘neglect’ and ‘expectation of trust’ are ill-defined and contested concepts, we recommend that although consistent definitions are important, especially for research into the epidemiology and aetiology of the syndrome and for informed policy discussion, they will unavoidably be provisional and pragmatic.

Elder abuse: do general practitioners know or care?

A pilot survey in Tower Hamlets, London, indicated that many general practitioners (GPs) might not be recognizing abuse of elderly patients through lack of training. The survey was replicated on a large scale in Birmingham, to allow further analysis. 561 Birmingham GPs were mailed questionnaires and responses from 291 were analysed, providing data from 95% of the practices. The findings were similar to those in Tower Hamlets: just under half had diagnosed elder abuse in the previous year. Regression analysis of the combined data-sets (n=363) indicated that the strongest factor predicting GP diagnosis of abuse was knowledge of 5 or more risk situations (odds ratio 6.77, 95% confidence interval 4.19, 10.93). The findings of these surveys suggest that research-based education and training would help GPs to become better at identifying and managing elder abuse.

The response to ''No Secrets''

This article reports the results of a survey of local authorities, which asked about progress in responding to the Department of Health guidance, No Secrets. The findings of the survey suggest that the majority of local authorities are taking action in response to the guidance. However, there is variation in progress with the different components of the framework for the protection of vulnerable adults outlined in No Secrets.

Enabling Older People to Stay at Home: The Costs of Substituting and Supplementing Care with Assistive Technology

A wide-ranging multiprofessional research project explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to remain at home. The financial relationship between assistive technology and packages of formal care was also explored. The costs of residential care and those of a number of packages containing differing quantities of assistive technology, formal care and informal care were compared. The analyses provide a strong financial case for substituting and/or supplementing formal care with assistive technology, even for individuals with quite disabling conditions. Although needs and hence the cost of provision rise with an increasing level of disability, the savings in care costs accrue quickly. The consideration of a variety of users with different needs and informal care provision, and occupying a very wide range of housing, leads to the conclusion that in comparison with traditional care packages, at worst, incorporating significant amounts of assistive technology into care packages is cost neutral, but that with careful specification of assistive technology major savings are feasible.

A review of research outcomes in elder abuse

This paper provides a commentary on research outcomes in the field of elder abuse and challenges assumptions about older people, carers, vulnerability and risk.

No Secrets: guidance in England for the protection of vulnerable adults from abuse

Launched in the spring, No Secrets, the governments latest adult protection guidance is expected to have a major impact on all agencies involved and interested in adult abuse. Here, using a novel approach, Claudine McCreadie, one of the countrys leading elder abuse researchers, looks at what No Secrets will involve for those charged with its implementation in local areas, while providing a range of useful insights and hints.

Improving the provision of information about assistive technology for older people

The importance of assistive technology (AT) in helping older people maintain independence is increasingly recognised in policy. The article reports on a modest piece of research, funded by the Helen Hamlyn Foundation, that looked at an important corollary of this development — the provision of relevant and appropriate information about AT. The research involved mapping both AT and information sources, focus groups with 28 users aged 75 and over and 12 carers, interviews with 40 professionals and information providers and a postal questionnaire to 131 care home managers (response rate of 45%). The findings point to the large volume of available information, but suggest that there are problems in identifying needs and in accessing all necessary information. Professionals share these problems and organisational issues impact on professional capacity to provide satisfactory information. The situation in care homes appears ambiguous in terms of responsibility for AT provision for residents and hence for information. The researchers concluded that there is considerable scope for improving both access to information and the design of that information. They also concluded that there are terminology issues that need addressing in further research.

Enabling older people to stay at home: How adaptable are existing properties?

A multiprofessional research project examined in detail the factors that affect the adaptability of existing housing and explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to ‘stay put’. The research reported here investigated the feasibility of adapting the existing stock of social housing and the resulting costs and outcomes of introducing assistive technology. This paper outlines that part of the project that examined in detail the adaptability of 82 properties representing a variety of property types to accommodate the needs of seven notional users, characterising the most common range of impairments of older people. The factors that affect a propertys adaptability include property type and specific design and construction features. The implications for housing providers, clients and occupational therapists are discussed. The research identified the unique expertise of occupational therapists, spanning the areas of housing, older people and assistive technology, and it introduced methods and tools that can help to determine best housing outcomes as well as cost implications. It is crucial that the profession is proactive in contributing to the development of housing policies that address the needs of an ageing population effectively.

Why should they be abused any more than children? Child abuse protection and the implementation of No Secrets

The parallels between child abuse and adult abuse have been frequently noted as public awareness of both has increased in recent decades. Both can involve the concealed victimisation of a weaker family member, for both interventions are difficult to implement because practitioners are loath to intrude into the privacy of the family and risk causing harm, and combating abuse of either type demands multi‐agency working. Significant differences between the two abuse constituencies have also been stressed, namely that adults are not invariably dependents reliant for care on the persons mistreating them and have the autonomy to resist efforts to intervene on their behalf.