CHAPTER 8 Old People at Risk

This chapter explores the related concepts of risk and abuse and their implications for assessment; it also considers issues which arise concerning old people who live in the community and those who live in residential and nursing care. During the course of this discussion, some reference will be made to the available research. However, as we shall see, risk is a multifaceted concept; the research which bears upon it is diverse, coming from many different fields:-medical, technological and social- and the quality and volume is variable. From the point of view of readers of this book, research on abuse as an aspect of risk is likely to be most useful. Although there is a paucity of well-founded empirical research compared, for example, with child abuse, there has been a significant growth in the last decade. In Britain, we are indebted to McCreadie (1995) who has comprehensively summarised and discussed the available evidence on elder abuse in all its forms. Reference in this chapter will frequently be made to McCreadie's work. There are, however, two other distinct dimensions of risk, self-neglect and environmental risk, which are also of significance to workers in this field. These merit a similar review of research, which would need to draw together a wide range of material from many different disciplines. Unfor-tunately, these reviews have not yet been undertaken. Both 'risk ' and 'abuse ' are complex and contested concepts. Risk is inherent in life itself, a necessary component in the exercise of personal autonomy. In childhood, in any given society, there is a fair degree of agreement about acceptable degrees of risk, with subtle gradations as children grow towards maturity. This is much more difficult to achieve in relation to old people, for tw