A total Indifference to Our Dignity: Older People's Understanding of Elder Abuse

Findings show that the current definitions of elder abuse, which centre on the actions or inactions of a person or persons where there is an expectation of trust, ignore wider societal issues like the withdrawal of respect and recognition. This serves to place older people in vulnerable positions.
Standard typologies of abuse were recognised by participants, although sexual abuse was not commonly mentioned except when prompted. However, what also emerged was a new concept of ‘personhood abuse’. This refers to societal attitudes; how these affect a person’s confidence, autonomy and agency resulting in an inability to say no or to stand up for oneself against abusive
acts, words and pressures possibly from fear of negative repercussions such as withdrawal of contact and/or care. Many ways were identified to support older people and reduce the opportunity for abusive actions to occur. They centred on community-based and peer supports through ‘having someone to talk
to’ and being aware of their rights. Continued involvement in community based activity which keeps people active and participating in society, such as community transport and clubs, supported people’s access to amenities and opportunities for engagement and were identified as ways to
prevent abuse from happening. Enhanced status, resources and support therefore need to be given to these types of community activities to prevent abuse occurring in the first place. These types of supports can enable older people to share their concerns in an everyday setting and to gain informal support and confidence; seeking more formal interventions when necessary.

Older people's views of support services in response to elder abuse in communities across Ireland

Purpose – This paper seeks to present findings from the first all-Ireland study that consulted older people on their perceptions of interventions and services to support people experiencing abuse.

Design/methodology/approach – Utilising a grounded theory approach, 58 people aged 65 years and over took part in focus groups across Ireland. Four peer-researchers were also trained to assist in recruitment, data collection, analysis, and dissemination.

Findings – Participants identified preventative community-based approaches and peer supports as important mechanisms to support people experiencing, and being at risk of, elder abuse. Choices regarding care provision and housing, as well as opportunities for engagement in community activities where they can discuss issues with others, were identified as ways to prevent abuse.

Originality/value – The development of elder abuse services has traditionally been defined from the perspective of policy makers and professionals. This study looked at the perspective of the end-users of such services for the first time. The research also gave an active role to older people in the research process. The policy implication of the findings from this research is that enhanced attention and resources should be directed to community activities that enable older people to share their concerns informally thereby gaining confidence to seek more formal interventions when necessary.

Older People's Conceptualisation of Elder and neglect

Purpose

To be effective, definitions of elder abuse should be informed by the perspectives of older people themselves.

Methods

This qualitative study used data from eight focus groups involving 58 people aged over 65 years in both urban and rural settings across Northern Ireland and the Republic of Ireland. Following training, four older people assisted in facilitation and analysis as ‘peer-researchers'.

Findings

Increasing lack of respect within society was experienced as abusive. The vulnerability of older people to abuse was perceived as relating to the need for help and support, where standing up for themselves might have repercussions for the person's health or safety. Emotional abusiveness was viewed as underpinning all forms of abuse, and as influencing its experienced severity. Respondents' views as to whether an action was abusive required an understanding of intent; some actions that professionals might view as abusive were regarded as acceptable if they were in the older person's best interests.

Implications

Preventing abuse requires a wide-ranging approach including re-building respect for older people within society. Procedures to prevent elder abuse need to take into account the emotional impact of family relationships and intent, not just a description of behaviours that have occurred.

Conceptualising elder abuse across local and global contexts: Implications for Policy and Professional Practice on the island of Ireland.

Social policy and professional practice across the island of Ireland is dominated by the WHO (2002) definition of elder abuse and national and professional interpretations of what constitutes elder abuse. Top down, generalist knowledge of the abuse of older people have facilitated paternalistic and protectionist policies and services designed to protect older vulnerable adults across the Republic of Ireland (ROI) and Northern Ireland (NI). However a qualitative study involving 58 older people in six focus groups held across Ireland highlights an alternative understanding of elder abuse grounded in the subjective experiences of older people across urban and rural communities on the island. Indigenous ways of knowing offer a broader and more inclusive understanding of the experience of elder abuse (Lafferty 2012; Dow and Joosten 2012) together with opportunities for the prevention of ageism and the empowering of older people across the jurisdictions.

Complex PTSD, interpersonal trauma and relational consequences: Findings from a treatment-receiving Northern Irish sample

Background:
The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences.

Methods:
Eighty one treatment-receiving participants with a history of exposure to the ‘Troubles’ in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness.

Results:
DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity).

Limitations:
Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings.

Conclusions:
Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.

Future Directions in Treating Cough

Cough is a common and troublesome symptom that can be difficult to treat. New therapeutic options that are safe and more effective than those currently available are needed. In this article, the authors offer opinion on future directions in the treatment of cough, with a particular emphasis on the clinical syndrome associated with cough reflex hypersensitivity. In addition, the article provides an overview of some of the diagnostic technologies and promising drug targets likely to emerge from current clinical and scientific endeavor.

Anger, aggression, and self-harm in PTSD and complex PTSD

This study examined the contribution of complex posttraumatic stress disorder (PTSD) diagnosis and symptomatology to the difficulties of anger, aggression, and self-harm in a Northern Ireland clinical community sample. A "current complex PTSD" (CCPTSD) group (n = 11) was compared with a "current PTSD" group (n = 31) on self-report measures of these variables. The CCPTSD group demonstrated significantly higher levels of physical aggression and selfharm than the PTSD group. The complex PTSD symptom of 'alterations in self-perception' was a significant predictor of aggression and history of self-harm, suggesting the potential role of posttraumatic shame and self-loathing in PTSD theoretical models of these destructive behaviors. Social desirability was a notable confounding influence in the assessment of anger, aggression, and self-harm in traumatised individuals.

Serum erythropoietin levels in paroxysmal nocturnal haemoglobinuria: Implications for therapy

In order to assess the rationale and possible indications for the use of recombinant erythropoietin in paroxysmal nocturnal haemoglobinuria (PNH), we have measured endogenous erythropoietin (Epo) levels in 18 patients with PNH and in 44 patients with iron deficiency anaemia (IDA), In both groups of patients we found a significant inverse correlation between Epo and haemoglobin (Hb). However, the mean Epo level was significantly higher in the PNH group (385 mU/ml) than in the IDA group (136 mU/ml), The range of Epo levels at any given Hb was greater in the PNH group than in the IDA group. There was a significant positive correlation between Epo and absolute reticulocyte count, Since Epo administration is unlikely to benefit patients with high levels of endogenous Epo, we conclude that in the majority of patients with PNH there is no indication for treatment with Epo.

Erythropoietin production:evidence for multiple oxygen sensing pathways

The production of erythropoietin (Epo), the glycoprotein hormone which controls red blood cell formation, is regulated by feedback mechanisms sensing tissue oxygenation. The mechanism of the putative oxygen sensor has yet to be elucidated. There is evidence that at least two pathways participate in hypoxia signal transduction. One appears to involve a specific haem protein, and a second implicates reactive oxygen species (ROS). Iron catalyses the generation of intracellular ROS and therefore alters the cellular redox state. We have investigated the effect of modulating intracellular iron content on Epo production in Hep 3B cells. Iron chelation stimulates Epo production at 20% O2 and enhances Epo production at 1% O2, but it has no additive effect on cobalt-induced Epo production. Excess molar iron inhibited Epo production in response to hypoxia, desferrioxamine (DFO) and cobalt chloride and inhibited the DFO-enhancing effect of hypoxia-induced Epo production. We found that sulphydryl oxidising agents exert a differential inhibitory effect on hypoxia-induced versus DFO-induced Epo production, providing further evidence that multiple pathways of oxygen sensing exist.

Older people and legal advice – the need for joined up and creative approaches

This paper reports the findings from research conducted with older people in Northern
Ireland which investigated whether their needs for legal information and advice were
being met. One of the unique aspects of the research involved investigating the
potential of the internet as a possible source for advising older people in relation to
legal problems. The findings suggest that online legal information may frequently assist
older people in identifying potential answers to their legal questions, but may not be an
adequate substitute for personal communication and advice. The research also
highlights the need for professionals to work together to meet the needs of older
persons for legal advice and to safeguard their interests. Such ‘joined up’ approaches
are particularly important, for example at the point of dementia diagnosis, where
information sharing between health and social care professionals may significantly
promote the legal and welfare interests of older people at a vulnerable point in their
lives. This paper therefore turns to work by university-based legal clinics in the United
States, such as the Elder Law Clinic at Pennsylvania State University, where social
work or healthcare professionals, lawyers and law students collaborate to support older
people in their search for resolution of legal problems.