Defining a vulnerable adult and abuse

Adult

The Family Reform Act (1969) identified the age of majority (becoming an adult) as 18 years or older within England, Wales and Northern Ireland and 16 years or older in Scotland.

Vulnerable adult

The definition of a vulnerable adult therefore refers to anyone of 18 years or older in England, Wales and Northern Ireland or 16 years or older in Scotland:

who is or may be in need of community care services by reason of mental or other disability, age or illness: and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. (DH, 2000) The definition identifies that anyone over the age of 18 years (16 years in Scotland) who is being abused or is at risk of another person taking advantage or harming them in some way constitutes a vulnerable adult. This covers a huge array of individuals within British society:

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A 94-year-old lady who has just become blind and turns to a voluntary carer to spend her pension for her

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A 23-year-old man with severe learning disabilities who needs all his personal care needs met by health care professionals

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A 54-year-old lady who is admitted for surgery for a ruptured appendix and is in excruciating pain on arrival in the accident and emergency department

Each of these individuals is reliant on nurses and other health care professionals who, it is anticipated, will protect their rights and ensure they are given every opportunity to make autonomous decisions about their health care needs.

Abuse

Sexual abuse

Psychological abuse Discriminatory

abuse Institutional abuse

Physical abuse

Neglect/acts of omission

Financial/

material abuse Figure 2.1 Types of abuse.

Abuse

There are several definitions of abuse available and one of those is cited by the DH (2000) as:

a violation of an individual’s human and civil rights by any other person or persons.

When receiving any health care input, individuals have human and civil rights that have to be maintained. When any of those rights are ignored or infringed, abuse has taken place. There are many types of abuse that can occur and each will now be defined with examples.

Types of abuse

There are several types of abuse that can occur; being aware of these can help you to help your patients. Figure 2.1 identifies the various types of abuse.

Physical abuse

This is where a vulnerable individual’s body is harmed. Examples of physical abuse are kicking, slapping, biting, hitting, misuse of medication and excessive use of restraint. For a relative to tie a person to their bed so they cannot wander off in the night is physical abuse.

Sexual abuse

An individual who has been pressured into a sexual act, could not consent or did not consent to a sexual act, is said to have been sexually abused. This covers abuse such as rape and sexual assault. When an individual has sexual intercourse, for example, with a patient without their consent, it is deemed sexual abuse.

Psychological abuse

Psychological abuse is a non-physical attempt to emotionally undermine or damage vul- nerable adults’ well-being. To use words to undermine someone’s self-worth by informing them they are useless or using the threat of violence are just two examples of psycho- logical abuse. For a carer to constantly demand an individual get up at 0530 hours using threatening language is an example of psychological abuse.

Financial or material abuse

To steal or attempt to steal money or material goods from a vulnerable individual is financial abuse. This can take many forms such as stealing jewellery from a locker in the ward, using patient’s money to purchase items that the patient is unaware of and was not intended for, or deliberately isolating an individual so that their financial matters are controlled and abused by another.

Neglect and acts of omission

Neglect is defined as a failure to implement care that would meet clients’ needs, such as physical or medical needs (DH, 2000). This may constitute not providing basic necessities such as food, heat or medication. It may also include a limiting or denying access to appropriate health care services. Access to health care services is a basic human right, the interference in which constitutes neglect.

Discriminatory abuse

To abuse another by discrimination is to verbally or physically harm another due to spe- cific characteristics, attributes or beliefs of an individual. There are many characteristics or attributes that abuse can be directed to, such as race, gender, age, ethnicity, disability and sexuality (DH, 2000).

Institutional abuse

Institutional abuse relates to any organisation knowingly harming any individual in its care. Hospitals and care homes have many demands to meet, but this must not be knowingly detrimental to the care they offer. If a hospital knows they have an outbreak of methicillin-resistantStaphylococcus aureus (MRSA) and continue to take patients into that area, then it would be an example of institutional abuse.

Identification of abuse of the vulnerable adult

Statistics for abuse of the vulnerable adult are broken down into many differing cate- gories, which makes it difficult to identify the scale of adult abuse in the UK. Categories of adult abuse include elder abuse, domestic violence, racial abuse and sexual abuse. There is a clear understanding and statistical analysis for child abuse with the child protection and at-risk register, yet there appears to be little clarity when it comes to adult abuse (The House of Commons Health Committee, 2004). The segregation of data into differ- ent categories for vulnerable and abused adults can only serve to dilute the impact of the scale of abuse that vulnerable adults experience. Data that are collected and reported must be used with caution as it is clearly an underestimation of the problem.

Action for Elder Abuse (2008) identified that approximately 4% of the elderly popula- tion in the UK experience abuse. This equates to approximately 342 000 people over the

Table 2.1 Some health values.

Health values Agree Disagree

A carer should be able to access all the financial affairs of the patient if the patient lacks capacity

Voluntary euthanasia should be legalised for the terminally ill patients

Alcoholics should have access to liver transplants

Gender reassignment operations should not be funded by the NHS

age of 65 years having experienced some form of abuse (Mowlam et al., 2007). Domestic violence is another category of abuse of the vulnerable adult. Although the incidence of domestic abuse has fallen from 23% in 1995 to 16% in 2006/2007 (Office for National Statistics, 2008), it still equates to a large number of people experiencing abuse. The reality is that adult abuse occurs within the UK and therefore nurses need to ensure their clinical care attempts to protect the vulnerable adult. This begins with nurses having an awareness of their own health values and beliefs and ensuring professional health values are maintained in the clinical environment.

Health values

Values exist within everyone, as a set of attitudes that guide actions towards others and objects within society. They are socially constructed and malleable in the face of changing circumstances (Hawley, 2007). Many of the values individuals have are acted upon but not often consciously thought through. So a person may value the sanctity of life, but when confronted with a terminally ill patient asking for their life to be prematurely ended, it may cause a nurse to reflect whether he or she would change his or her values.

By reading the provocative statements given in Table 2.1, you may become aware of some personal health values. In Table 2.1, you are invited to review the health values and decide why you agree or disagree with the statements.

By exploring personal values, it can become evident that some vulnerable adults in society may be at a disadvantage because of the values you hold. When personal values are consciously thought through and discussed, it can create a review and reshaping of individual values. Therefore, it is vital to become aware of personal values and be- gin to understand that in the clinical setting, differences in individual values will often cause debate and dilemmas. Developing an understanding of ethics may help guide the student through the myriad of opposing values in society, especially those concerning safeguarding vulnerable adults (Holm, 2006).