Independent Nurse Consultant for Older People, London, UK, Honorary Senior Research Fellow, City University, London, UK and Consultant Editor to the Journal of Dementia CareConsultant Nurse Older People (Safeguarding Adults) at West Sussex Primary Care Trust, UK and Visiting Fellow, University of Brighton, UK.
Int J Older People Nurs. 2009 Jun;4(2):120-31. doi: 10.1111/j.1748-3743.2009.00165.x.
Older people, and particularly those of advanced age, become increasingly vulnerable to the consequences of abuse or neglect and, since the birth of specialist services for older people, researchers and clinicians have sought to understand the reasons for this. Multi-agency work across the UK is developing innovative strategies, protocols and tools to support investigation into situations of possible neglect in formal care settings. Emerging within this work has been a dilemma concerning which terminology should be used to most accurately describe care in specific situations, for example should care be described as 'inadequate' or 'poor', or as 'neglect'. One key element in this decision is the consequence, or consequences, of the care for the vulnerable person, i.e. its impact on the individual. Because of the complex changes which accompany ageing, and particularly older age, this is not straightforward. Is a person's health deteriorating as a consequence of ageing or disease? Are factors such as mental state or motivation impacting on their health? Is this the trajectory that their health would naturally follow? Or is the deterioration a direct consequence of the care that they have, or have not, been given? And, if so, to what degree? Identifying ways of addressing these questions could support the development of a lexicon of terms and definitions which could be used to accurately define specific categories of neglect in specific circumstances. This paper describes the practice based dilemmas that prompted this work. It briefly sets a historical context for contemporary understandings of the mechanisms that render older people particularly vulnerable to the effects of neglect. Some perspectives on defining neglect are offered. The paper then outlines the findings of a literature review and concepts analysis of the term frailty. It offers a new definition of frailty and explains the theoretical approach within which this nests. The paper concludes with a discussion on the implications of frailty as a consequence of care or neglect for older people.
老年人，尤其是高龄老年人，越来越容易受到虐待或忽视的后果的影响，自专门的老年人服务机构成立以来，研究人员和临床医生一直在努力理解其中的原因。 英国各地的多机构合作正在制定创新战略、协议和工具，以支持对正规护理环境中可能存在的忽视情况进行调查。在这项工作中出现了一个困境，即应该使用哪种术语来最准确地描述特定情况下的护理，例如，护理应该被描述为“不足”还是“差”，或者是“忽视”。这个决定的一个关键因素是护理对弱势人群的后果，即对个人的影响。由于衰老，特别是高龄带来的复杂变化，这并不简单。一个人的健康状况是由于衰老还是疾病恶化？他们的健康是否受到精神状态或动机等因素的影响？这是他们健康的自然发展轨迹吗？还是他们的健康状况恶化是由于他们得到或没有得到的护理直接导致的？如果是，那么程度如何？确定解决这些问题的方法可以支持制定术语和定义词汇表，以便在特定情况下准确定义特定类别的忽视。 本文描述了促使这项工作开展的基于实践的困境。它简要介绍了当代对导致老年人特别容易受到忽视影响的机制的理解的历史背景。提供了一些关于定义忽视的观点。然后，本文概述了对术语脆弱性的文献回顾和概念分析的结果。它提供了脆弱性的新定义，并解释了其所属的理论方法。本文最后讨论了由于护理或忽视导致老年人脆弱性的后果的含义。
