Challenges in Identifying Abuse in Dementia Care

1. Introduction:

According to Dementia guide of National Health Service (NHS), dementia is the broad category of cerebral disorders that leads to gradual as well as long-term decrease of remembering and thinking ability affecting the daily functioning of individual (NHS, 2019). Based on the key dementia statistics of UK, there are currently 850,000 people with dementia in the UK. The World Health Organisation report shows that the number of dementia people in the UK is predicted to be increased to more than 1 million by 2025 (www.alzheimers.org.uk, 2019). This research proposal is going to conduct the research on the topic, “key challenges that are faced in order to identify the abuse and neglect with a dementia patient in UK care homes”. From the evidence-based sources, it is clear that more than, 40,000 people under 65, suffering from dementia in the UK, are exposed to the high level of discrimination, abuse and neglect by their carers and health professionals. There are different types of abuse that dementia patient can face in the care homes such as physical, mental, emotional and sexual abuse (Benbow et al. 2017). This research proposal is going to analyse these abuses and neglects faced by dementia patient in UK based care homes and the challenges that are associated with identifying these abuses. This research paper will first discuss the background and rationale of the selected research topic, in which it will discuss the statistical information about dementia patient and their experience of abuses and neglect in the UK. Second, this research paper will describe the aims and objectives of conducting this research in order to highlight the targets that the research paper will achieve after completing the research process. Third, this research will describe the entire methodology in order to mention the entire method in which the entire research would be conducted. Forth the research paper will discuss the ethical considerations that will be followed in order to conduct this research. Fifth, the research paper will mention the bias and limitations that the researcher can face in order to complete the entire research. Finally, this research paper will describe the expected outcomes and the project timeline of this research.

2. Background and rationale of the research:

From the recent WHO report on dementia in the UK, it is seen that around 850,000 people in Britain suffer from dementia, of which 400,000 are treated in the care homes. Alzheimer’s Society has figured out that, most of the patients with dementia in the UK based care homes endure the poor as well as unacceptable practices. As stated by Kupeli et al. (2016), professionals of National Health Service and Department of Health, England, face severe challenges in order to find out unacceptable and illogical practices in care homes that pose an adverse impact on the mental and physical health of dementia patient. Evidence suggests there are several reasons behind these challenges in order to determine the abuse and neglect experienced by dementia patient in UK care homes. One of the most important reasons is poor mental and physical condition of the patient. According to Pickard and Fazel (2013), as the dementia patients have poor remembering and thinking ability they can’t report to the higher authority about the misbehaviour, discrimination and abuse they face each day in care homes. Based on the report from Alzheimer’s Society, out of 739 care workers surveyed in the UK, more than 38% of the staffs do not have proper training and professional knowledge about how to take care of a dementia patient. another survey conducted by the Alzheimer’s Society shows that, out of 1227 dementia patients in UK care homes, only 2% reported that they have properly trained staffs and carers who are efficient in managing and accessing patient's needs. Neglect and abuse to dementia patient can be apparently seen in the case of Terrified Gladys Wright, the lady aged 79 suffering from dementia. She has been admitted to a care home in England, The Granary (www.mirror.co.uk, 2019). Three carers were caught under CCTV camera while they were abusing the older lady (Terrified Gladys Wright). In this case study, it has been seen that the lady suffering from dementia was exposed to high rate of physical, emotional and psychological abuse by the carers, which were not revealed in front of the care home authority and the health professional for long times due to lack of proof and proper information. According to Hollinrake (2016), although UK government has developed the Dementia Care Policy (2013), in order to identify the several issues regarding health and welfare of dementia patient in care homes, still it is highly challenging for the professionals to find out the mistreatment and torture that majority of the dementia patient face during the process of their treatment and care. Recent statistical analysis shows that in UK based care homes, more than 70% of the older adults suffering from dementia are exposed to mistreatment and abuse. Due to reveal of several abuse and neglect cases in care homes with a dementia patient, more than 64% of the UK people think that care homes are a place in which mental patent suffer from the high level of abusive behaviour as well as the as torture rather than getting proper healthcare facilities. On the contrary Hester et al. (2015) argued that in today's medical world have several high-class cares and treatment facilities for a dementia patient, in the medical team. Health professional and in-charge of the care homes always check the overall activities of carers in order to eliminate challenges of abuse and neglects. For example, the UK government has set Dementia Action Alliance and Commissioning for Quality and Innovation (CQUIN) for assuring that dementia patient in the community and care homes would be treated with proper respect and dignity. In order to deal with challenges determining the abuse and neglect with a dementia patient, UK government has set the National Dementia Care Policy (2013), in which care authority would ensure that all antipsychotic drugs that are provided to the dementia patient would be checked on a regular basis by the health professional and the care manager.

A recent report from Alzheimer’s Society on dementia patient in the UK cares homes shows that one of the major challenges that professional face in order to determine whether the patient has passed through any abuse, is aggressive behaviour of the patient due to poor mental health. As stead by Makimoto et al. (2015), in most of the cases, dementia patient reacts adversely and aggressively on queries made by professional about their health condition or usefulness of their treatment. Moreover, most of the dementia patients get violent while they are asked about any kind of abuse and misbehaviour they face. According to Jiwa et al. (2014), under Mental Capacity Act and Care patient with dementia, needs to be empowered by providing psychotherapies and anti-psychotic drugs so that they can remember and inform properly about the mistreatment and abuse they face in care homes. On the contrary, Goergen and Beaulieu (2017) argued that challenges in order to identify these neglect and abuse arise due to the continuous threats that are imposed by the caregivers and the professional on the dementia patient for compelling them to do not disclose the mistreatment and abuse. the investigation by NHS England unearthed the hallowing condition of a 64 years old patient suffering from dementia in a care home in England. In this case study, the patient had suffered the mistreatment, abuse, mental, emotional torture by the carers for long periods. The reason behind the inability to determine the distress faced by the patient is that the patient is being threatened continually by the carers for not disclosing the torture and abuse. According to Speroni et al. (2014), NHS professional and local healthcare authority in the UK care home huge challenges in involving the dementia patient and their families for conducting proper information regarding the use of their treatment in care homes. This is due to not only the poor mental health of dementia patient for which they can't provide proper information about their treatment but also the for support from the families who do not want to reveal any information about the patient due to protect their social status. As stated by Gove et al. (2017), in order to deal with the challenges in determining neglect and abuse in care homes with a dementia patient, professional can focus on collecting accurate medical database regarding the daily treatment process of the dementia patient. Based on NHS guidelines, Patient Generated Health Data (PGHD)is an important Health Information Technology that assists the medical investigators to gather and record the accurate medical database. By gathering and evaluating Patient Generated Health Data (PGHD) it is possible for health investigators and a care manager to get proper information regarding medication, treatment, and current psychological and physical status of a patient. On the contrary Pillemer et al. (2016) argued that in order to identify the abuse and neglect with the patient it is not sufficient to gather medical database as there are full chances of data manipulation, rather the investigators use CCTV camera and strong surveillance system in the care homes. Through using CCTV cameras, it was possible in an abovementioned case study to find out the mistreatment of the three carers on 78-year-old lady, Terrified Gladys Wright. Moreover, in the Bupa Care Home in England, the NHS professionals were successful in identifying the abuse and neglect by collecting and evaluating the CCTV footage of the patient’s room (www.thesun.co.uk, 2019).

From the above-mentioned review of literature, it can be stated that there are severe challenges in identifying the abuse and neglect that are faced by dementia patient in UK care homes. A report by NHS England shows that more than 540,000 older adults suffering from dementia and mental illness are exposed to long term physical and mental abuse by their caregivers. Although the UK government has taken several policies in order to eliminate chances of this abuse and mistreatment on dementia patient in care homes. It is important to investigate the proper implementation of these policies by all care homes in the UK. Moreover, Medical Health Records is important for health investigators and NHS professionals in order to investigate the regular healthcare service, therapies and overall treatment process for meeting the health needs of patients with mental illness.

3. Aims and objectives of the study:

This research aims to identify the changes that are associated with determining the abuse, neglect and mistreatment faced by dementia patient in care homes in the UK. This research also aims to determine the effective strategies that can be used to combat the challenges in order t fund out the mistreatment of a dementia patient in UK care homes.

Research Objectives:

To identify types of abuse and neglect faced by dementia patient in care homes in the UK

To determine the challenges for identifying the abuse and neglect experience by a dementia patient

To analyse the strategies in order to eliminate the risk of abuse and mistreatment of a dementia patient in UK based care homes

To recommend the proper strategies for determining the cases of abuse and neglect with the dementia patients

Research Questions:

What types of abuse and neglect faced by dementia patient in care homes in the UK?

What are the challenges for identifying the abuse and neglect experienced by dementia patient?

What are the strategies in order to eliminate the risk of abuse and mistreatment of a dementia patient in UK based care homes?

What are the strategies for determining the cases of abuse and neglect with dementia patients?

4. Methodology:

The research methodology is one of the most important processes in order to represent the overall methods which the researcher has applied to conduct the research. In this methodology section, the researcher will mention the overall step-by-step process in which the entire research will proceed. In the methodology section, research will discuss the method outline, research design, philosophy, approach, data collection methods, data analysis process, sampling method, population and sampling size.

Research philosophy:

Research philosophy is of different types such as interpretivism, epistemology, ontology, realism and positivism. In this researcher will use the positivism research process. The positivism research method is useful for conducting primary research in which the researcher is able to use the relevant models and theories in order to collect the proper database regarding the research topic. On the other hand, ontology is based on objectivism, subjectivism and reality. Interpretivism is based on analysing the result and objectives without evaluating the current database and models. On the other hand, realism is associated with using the scientific database and theories rather than using relevant theories and models.

Research approach:

There are two types of research approaches such as inductive and deductive. In order to conduct this research researcher will use the deductive approach, which is based on using the existing theories and models. On the other hand, inductive research is no selected by the researcher as it deals with developing new theories and hypothesis in order to meet research objectives.

Research design:

There are three types of research designs such as exploratory, explanatory and descriptive. In this research, the researcher will use a descriptive research design, which assists the researcher to analyse and describe all collected database in a proper manner in order to make a proper interpretation of the research objectives and outcomes. On the other hand, the exploratory design is unable to discuss the clear research objectives and aims. The explanatory research design is generally used in conducting the e\secondary research process. In which the research need to describe and analyse the theoretical database.

Research type:

There are two types of researches such as qualitative and quantitative research method. In this research, the researcher is going to conduct both qualitative and quantitative research methods. In qualitative research methods, research focuses on collecting the theoretical database by asking interview questioners to the professionals. In the case of conducting quantitative research process, the researcher collects numerical information by conducting the survey. In order to collect information, about the challenges faced by professional’s in order to identify the abuse and neglect of dementia patients in care homes, research will use a survey of 50 respondents. Through the survey process close ended questioned would be provided to each respondent in order to collect their response. In the case of conducting the qualitative methods, here the researcher will conduct an interview of 5mental health professionals of care homes in the UK.

Data collection method:

The data collection method is of two types such as primary data collection process and secondary data collection process. In this research, research will use the primary data collection process. In order to conduct the primary data collection process, the researcher will directly approach the participants through survey and interview in order to collect accurate data from them. On the other hand, the secondary data collection methods are associated with the process of collecting database indirectly through using the online magazines, articles, newspapers and other secondary sources such as government reports. Here researcher will use the primary data collection process for maintaining the accuracy by recording the real experience of a dementia patient in UK care homes. In the primary data analysis process, the researcher will use both the survey and interview in order to gain the quantitative and qualitative database respectively. Here the researcher will also evaluate each response collected from respondents and the mental health professional in order to reduce the chances of manipulation of data.

Data analysis:

Here the researcher will use the primary data analysis, in which, both the qualitative and quantitative database would be analysed by using graphs and charts. In order to conduct the quantitative information that will be collected from the selected dementia patients from the different UK based care homes, the researcher will put all numerical data into tables and measure the percentage and probability values. Then the researcher will use graphs for representing the percentage in order to analyse the probability values. In order to analyse the qualitative database that would be collected from the mental health professionals, the researcher would analyse the response by using practical example and relevant sources.

Sampling method:

Random sampling method will be used in order to select participants in this research. The researcher will select 50 dementia patients and 5 mental health professionals from different care homes in England. Survey and interview will be conducted for the patients and managers respectively in order to collect relevant database. Close-ended questions would be prepared for the survey process and open-ended question are for the interview process.

5. Ethical considerations:

In order to conduct any research, the researcher needs to follow as well as implement all the ethical aspects, for maintaining transparency of research. For this research, the researcher will take full confirmation from each selected participant before their joining into the research process. Moreover, the researcher will also ensure that all the database that would be collected from participants during the survey and interview would be strictly used for this research but not for any commercial purpose. The researcher will also ensure that confidentially and privacy of database will be maintained in a proper manner under the Data Protection Act (1998). Before starting this research will also assure that all participants voluntarily participate in this process and nobody is forced to attend this research process. The researcher will ensure that the overall research process would represent the transparency and bias-free framework. All the participants will be treated with proper respect and dignity and there would not be any kind of discrimination and bias. In addition to this research will also ensure there are no chances of data manipulation. Data manipulation is based on providing and using a vague and fake database by making unauthorised changes in collected information in order to interfere with the research outcomes. Therefore, it is important for the research to ensure that the entire databases that are collected directly from the respondents would be accessed only by the authorised people. For maintaining transparency of this research will take proper approval from the concerned care homes in the UK, from which the dementia patient is selected for conducting the survey process. Similarly, prior permission and approval will be taken from the mental health professionals and care home authority of UK based care homes in which the interview would be conducted.

6. Biases and limitations:

In conducting this research, the researcher will ensure that the overall process is bias-free and transparent. All the selected participants will be dealt with proper dignity and respect in order to collect the relevant database. The researcher will ensure that respondents would not be discriminated based on their religion, caste, race, ethnicity, gender and sex. In order to eliminate the chances of bias, the researcher will provide similar questions to each participant for maintaining transparency in the overall data collection process. Moreover, the researcher will also ensure that no partiality and illegal privileges would be provided to a special group of participants. The random sampling process will be used for conducting this research in order to eliminate the chances of bias and discrimination, In order to conduct this research, the researcher will face different limitation such less time, insufficient fund and lack of accessing the huge amount of database. The fund that is allocated for this research is not sufficient to collect database from a large geographical area. Moreover, due to insufficient fund, the researcher will be unable to involve more participants in this research as it can enhance the maintenance cost. Due to time shortage researcher would not be able to conduct more research into other geographical regions in the UK rather than focusing on only a few care homes n England. Time shortage will also pose stress on the researcher for completing this research process within the deadline, which makes it difficult for the researcher to conduct further evaluation analysis of the research outcomes. As research will collect debase of the patient and mental health professionals of a few care homes in the UK, it can reduce the probability of getting an accurate and relevant database. On the other hand, time shortage will make the researcher spend more time on analysing the statistical database in a proper manner, which can enhance the chances of getting flaunt data.

7. Expected outcome(s) / results

An expected outcome of this research is to meet all the research objectives and the research questions by analysing and evaluating the collected database. After completing this research, the researcher will be able to find out the actual challenges that are faced by professionals in order to determine neglect and abuse in the dementia care unit in the UK. Moreover, with the completion of this research, the researcher will be able to answer why it is a challenge to determine the mistreatment of dementia patient admitted in care homes in the UK. This research will also provide comprehensive knowledge of types of abuse in dementia care units in the UK. Moreover, it will also recommend the proper strategies that would be developed and implemented by the healthcare authority in order to determine the mistreatment and abuse and to eliminate chances of further abuse of dementia patients in care homes.

Reference list:

Benbow, S.M., Benbow, S.M., Kingston, P. and Kingston, P., 2017. Spontaneous concerns about risk and abuse reported by people with dementia and their carers. The Journal of Adult Protection, 19(2), pp.92-99.

Clarke, Caroline, Darren Lumbard, Suzanne Sambrook, and K. Kerr. "What does recovery mean to a forensic mental health patient? A systematic review and narrative synthesis of the qualitative literature." The Journal of Forensic Psychiatry & Psychology 27, no. 1 (2016): 38-54.

Cooper, C., Barber, J., Griffin, M., Rapaport, P. and Livingston, G., 2016. The effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial. International Psychogeriatrics, 28(6), pp.881-887.

Gan, C.L., O'Sullivan, M.J., Metzler-Baddeley, C. and Halpin, S., 2017. Association of imaging abnormalities of the subcallosal septal area with Alzheimer's disease and mild cognitive impairment. Clinical radiology, 72(11), pp.915-922.

Gove, D., Diaz-Ponce, A., Georges, J., Moniz-Cook, E., Mountain, G., Chattat, R., Øksnebjerg, L. and European Working Group of People with Dementia, 2017. Alzheimer Europe's position on involving people with dementia in research through PPI (patient and public involvement). Aging & mental health, pp.1-7.

Hepworth, I. and McGowan, L., 2013. Do mental health professionals inquire about childhood sexual abuse during routine mental health assessment in acute mental health settings? A substantive literature review. Journal of psychiatric and mental health nursing, 20(6), pp.473-483.

Hester, M., Ferrari, G., Jones, S.K., Williamson, E., Bacchus, L.J., Peters, T.J. and Feder, G., 2015. Occurrence and impact of negative behaviour, including domestic violence and abuse, in men attending UK primary care health clinics: a cross-sectional survey. BMJ Open, 5(5), p.e007141.

Imfeld, P., Brauchli Pernus, Y.B., Jick, S.S. and Meier, C.R., 2013. Epidemiology, co-morbidities, and medication use of patients with Alzheimer's disease or vascular dementia in the UK. Journal of Alzheimer's disease, 35(3), pp.565-573.

Jiwa, M., Nichols, P., Magin, P., Pagey, G., Meng, X., Parsons, R. and Pillai, V., 2014. Management of behavioural change in patients presenting with a diagnosis of dementia: a video vignette study with Australian general practitioners. BMJ open, 4(9), p.e006054.

Kupeli, N., Leavey, G., Harrington, J., Lord, K., King, M., Nazareth, I., Moore, K., Sampson, E.L. and Jones, L., 2016. What are the barriers to care integration for those at the advanced stages of dementia living in care homes in the UK? Health care professional perspective. Dementia, p.1471301216636302.

Makimoto, K., Kang, H.S., Yamakawa, M. and Konno, R., 2015. An integrated literature review on sexuality of elderly nursing home residents with dementia. International journal of nursing practice, 21(S2), pp.80-90.

McCausland, B., Knight, L., Page, L. and Trevillion, K., 2016. A systematic review of the prevalence and odds of domestic abuse victimization among people with dementia. International review of psychiatry, 28(5), pp.475-484.

Melchiorre, M.G., Di Rosa, M., Barbabella, F., Barbini, N., Lattanzio, F. and Chiatti, C., 2017. Validation of the Italian Version of the Caregiver Abuse Screen among Family Caregivers of Older People with Alzheimer’s Disease. BioMed Research International, 2017.

Melchiorre, M.G., Di Rosa, M., Barbabella, F., Barbini, N., Lattanzio, F. and Chiatti, C., 2017. Validation of the Italian Version of the Caregiver Abuse Screen among Family Caregivers of Older People with Alzheimer’s Disease. BioMed Research International, 2017.

Parsons, C., McCann, L., Passmore, P. and Hughes, C., 2015. Background No studies have been conducted in the UK context to date that categorise medications in terms of appropriateness for patients with advanced dementia, or that examine medication use in these vulnerable patients. Objectives The objectives of this study were to categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia;... Drugs & Aging, 32(1), pp.67-77.Cooper, C. and Livingston, G., 2014. Mental health/psychiatric issues in elder abuse and neglect. Clinics in geriatric medicine, 30(4), pp.839-850.

Parsons, C., McCann, L., Passmore, P. and Hughes, C., 2015. Background No studies have been conducted in the UK context to date that categorise medications in terms of appropriateness for patients with advanced dementia, or that examine medication use in these vulnerable patients. Objectives The objectives of this study were to categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia;... Drugs & Aging, 32(1), pp.67-77.

Peisah, C., Bhatia, S., Macnab, J. and Brodaty, H., 2016. Knowledge translation regarding financial abuse and dementia for the banking sector: the development and testing of an education tool. International journal of geriatric psychiatry, 31(7), pp.702-707.

Pickard, H. and Fazel, S., 2013. Substance abuse as a risk factor for violence in mental illness: some implications for forensic psychiatric practice and clinical ethics. Current opinion in psychiatry, 26(4), p.349.

Speroni, K.G., Fitch, T., Dawson, E., Dugan, L. and Atherton, M., 2014. Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of emergency nursing, 40(3), pp.218-228.

Twomey, C.D., Baldwin, D.S., Hopfe, M. and Cieza, A., 2015. A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK. BMJ open, 5(7), p.e007575.

Samsi, K., Manthorpe, J. and Chandaria, K., 2014. Risks of financial abuse of older people with dementia: findings from a survey of UK voluntary sector dementia community services staff. The Journal of Adult Protection, 16(3), pp.180-192.