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The purpose of this study is to build on previous literature in this area thus, the views of professionals working with those who report institutional abuse was sought using a Delphi method.

Professionals working with those who report institutional abuse, such as psychologists, social workers and personal injury lawyers, were invited to engage in the Delphi study. Sixteen professionals completed the final round (with four rounds in total). This method was used to gain professional consensus on the considered impacts of institutional child abuse and what factors influence impacts.

Eight superordinate themes were developed, as follows: institutional abuse has lasting negative effects on well-being, functioning and behaviour; loss of trust in others and the system is a potential outcome of institutional abuse; negative impacts on future life chances; negative impacts of institutional abuse are exacerbated by numerous factors; protective factors reduced negative impacts; psychological intervention is useful for survivors; positive and negative impacts of disclosure – the response of others as important; and keep impacts individualised.

The need for an individualised approach when working with those reporting institutional abuse was a salient finding.

Institutional abuse is known to result in several negative impacts, although research into this area is limited with a need to better understand what may protect or exacerbate impacts.

Although in recent years elder abuse has attracted considerable social and professional attention, it is still in the opinion of many a taboo subject. In this paper the author examines why this is the case and considers what has been learnt. In doing so he considers causation and predisposing factors and the modes of intervention available

Reciprocal abuse inside care practices remain under-studied due to their invisibility and further research is required. The purpose of this paper is to explore different levels of conflicts inside organisations.

The paper is based on a self-administered questionnaire filled out by care workers (n = 150), in 16 Portuguese care homes.

Results indicated that, overall, 54.7% of care workers had observed abuse, in their daily practice, in the preceding 12 months: 48.7% psychological; 36.0% neglectful care practices; 14.0% physical and 3.3% financial abuse. The figures decreased significantly as regards abuse committed themselves, with 16.7% of those admitting to having committed at least one of these behaviours. The highest figures were also recorded for psychological abuse (13.3%) and neglect (6.7%). However, there is a statistically significant relationship between abuse committed by care workers and abuse committed by residents. Overall, 52.0% of care workers reported having been the target of at least one such behaviour by residents.

This paper has its limitations as the sample consisted of only 16 nursing homes (12 not-for-profit and 4 for-profit nursing homes). The fact that only 4 of the 16 LTC homes were for-profit is a potential limitation both in general and in particular because research has shown that lower quality of care and elder abuse and neglect are more common in for-profit nursing homes at least in Portugal. The results were also based on self-reported measures.

A reactive behaviour, the risk of retaliation, after a complaint, the difficulty in dealing with dementia and the residents' aggressive behaviour, an absence of a training and support policy in an environment where difficult working conditions prevail, are factors enhancing a reciprocal process of abuse. The analysis followed by a discussion of potential implications to prevent institutional elder abuse and neglect, based on communication and social recognition, including better working conditions and training, and a cooperative work environment.

Conflict is much more than reducing an interpersonal relationship problem between residents and staff (care workers, professional staff, managers) and extending to the whole organisation. Therefore, there are still uncertainties on how organisations, staff and residents interact between themselves, and affect care practises.

Reciprocal abuse in nursing homes is an important area of research and this paper enabled a discussion of potential implications concerning the quality of care, which required the identification of levels of conflict, in an organisational system, including interactions, the context where care is provided, difficult working conditions, lack of training and levels of support. All these factors are important when considering elder abuse and neglect and this calls for special attention by policymakers and researchers.

This paper considers the doctor's role in unravelling the causes of abuse of older people. The author argues that doctors have a responsibility to understand and address the ageism, ignorance and unthinking which lies is at the root of most institutional abuse.

The purpose of this paper is to interrogate and develop the conceptualisation of discriminatory abuse in safeguarding adults policy and practice beyond the current interpersonal definition. The paper draws on Safeguarding Adults Reviews (SARs) that refer to discriminatory abuse or safeguarding practice with adults who have care and support needs and protected characteristics.

A search of the national network repository of SARs identified 27 published reviews for inclusion. The contents were thematically analysed to understand how discrimination was experienced in these cases. Fricker’s “Epistemic Injustice” theory was adopted as a conceptual framework, informing the analysis of findings.

Evidence from SARs provides a challenge to the interpersonal emphasis on language and behaviour in national policy. Although the reviews acknowledge that interpersonal abuse occurs, a close reading spotlights practitioner and institutional bias, and inattention to social, structural and contextual factors. The silence on these matters in policy provides a narrow frame for interpreting such abuse. This suggests significant potential for epistemic injustice and signals a need to acknowledge these social, structural and contextual factors in safeguarding practice.

Discriminatory abuse is an under-researched and under-utilised category of abuse in safeguarding adults practice. The paper adopts Fricker’s theory of “Epistemic Injustice” to highlight the silencing potential of current policy approaches to discriminatory abuse to suggest a more inclusive and structural framing for safeguarding practice with those targeted due to their protected characteristics.

The aim of this study was to explore how Ghanaian staff in nursing homes and hospitals perceive abuse and neglect of older adults as well as to explore the nature and scope of abuse and neglect of older adults as it exists in Ghana.

This exploratory study used a qualitative research methodology that sets out to explore staff’s perception of elder abuse in nursing homes and hospitals in Ghana. Five nursing assistants and two caregivers were interviewed in two nursing homes and four nurses were interviewed in one hospital. A semi-structured interview guide was used for data collection.

The findings showed that elder abuse occurs in both hospitals and nursing homes, which might be attributed to different personal, situational and institutional characteristics as well as cultural and traditional value systems. Various factors at the level of interpersonal relationships contributed to elder abuse. Situational characteristics such as aggressive exchanges between residents and health workers and institutional characteristics such as limited facilities and resources to care for residents are all factors that were implicated in elder abuse. Finally, culture and traditional views, beliefs system and socioeconomic factors seem to be implicated in elder abuse and neglect.

To the best of the authors’ knowledge, this is the first study that explores elder abuse and neglect in Ghanaian nursing homes and hospitals.

The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It derives from one set of findings from the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults programme.

A knowledge synthesis method was selected to identify organisational aspects of elder mistreatment in residential care settings. The method was selected for its suitability in examining ill-defined and contested concepts such as; elder mistreatment – where the available evidence is dispersed and produced in varied forms. A rapid review comprising a search of three academic databases and a detailed examination of selected investigation reports into institutional mistreatment was followed by panel meetings with subject matter experts to complete the knowledge synthesis.

This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality.

Further research is needed to elaborate the influence of these organisational factors on mistreatment and to understand any interactions.

As an adjunct to personal factors, the knowledge synthesis indicates common organisational factors contributing to institutional abuse. This suggests that care quality is produced systemically and that it can collapse as a result of seemingly minor and unrelated organisational changes.

Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. However, as “problem” organisations are closed down, “problem” organisational factors continue to recur elsewhere.

The paper identifies and elaborates organisational aspects of elder mistreatment in residential care settings. The findings are original, valuable and grounded in relevant experience by the method of analysis and synthesis of the findings from inquiry reports as well as research and the contribution to the development of findings by those central to the issue, residents, relatives and care providers.

The purpose of this paper is to report the key findings from a study of adult protection referrals collected by two English local authorities during 1998‐2005.

Referrals were analysed for patterns relating to risk with client level data supplemented by information from the local authority databases and from the Care Quality Commission. The analysis also examined associations between adult protection processes and outcomes and looked at how adult protection monitoring data could be improved to better inform safeguarding management and practice at local and national level.

Sexual abuse was most frequently reported for people with intellectual disabilities, who were also at higher risk of abuse when living out of area. Older people were most at risk of financial abuse in community settings and of neglect in residential care.

The study identifies patterns of risk in the abuse of older people and those with intellectual disabilities and informs preventive interventions. It also indicates priorities for improving the quality and comparability of adult protection monitoring data.

A schema for more clearly understanding the emotional and psychological abuse and neglect of people with intellectual disability was developed to support a narrative study with people with intellectual disability, families and other supporters about the lived experience of this maltreatment in disability accommodation services in Australia. This paper aims to describe the underpinning review of emotional and psychological abuse and neglect and the evolving new framework.

A review of existing understandings of this form of abuse in research and policy was conducted, and a framework developed and tested for “trustworthiness” with participants in the research.

A framework of emotional and psychological abuse and neglect is presented. It centres on the misuse of power and control, details behaviours and interactions which can occur when it is inflicted, and is tested against the experiences of people who have experienced this sort of abuse and neglect.

This is an evolving framework, applied through one study only. Further application and research is needed to test the robustness of the framework.

A more complex construction of emotional and psychological abuse and neglect may inform the development of service policy and support education for people with disability, families, and workers.

Discriminatory abuse has been a distinct category of abuse in safeguarding adults policy since 2000, but it is rarely used in practice, according to recent official statistics. As part of a larger project, the authors undertook a literature review to clarify the concept, explore reasons for low reporting and consider recommendations for practice. The purpose of this paper is to present the findings of this literature review.

This literature review comprises 35 sources, which were identified using three academic databases, reference harvesting and sector-specific websites. Findings were developed through thematic analysis of the data.

The literature review demonstrates that definitions of discriminatory abuse stretch from an interpersonal emphasis in policy documents to a more structural approach. There are open questions about the status of discriminatory abuse as a category of abuse due to the complicated interface between discriminatory motivations and the abusive acts through which they are experienced. A range of factors can obscure its identification, particularly the hidden, stigmatised and normalised nature of discriminatory abuse. Some recommendations for practice are identified, but more work is needed to develop the practice vocabulary and required skills.

This study brings together existing research on discriminatory abuse to argue that it is time to revive this understanding of abuse and develop safeguarding practice with adults who have protected characteristics.