The media’s portrayal of vulnerable elder people as ‘perpetrators of assaults’ shows us just how far we still have to go.
Dr James Woods is a registrar in Geriatric and General (Internal) Medicine in South East Scotland. He tweets at @jmwoods87
Earlier this week BBC Radio 5 Live ran a piece with corresponding BBC website article reporting on figures obtained from an NHS Protect report on physical assaults against NHS staff in England. The headline and corresponding analysis focused on patients over 75 years old as the most frequent ‘perpetrators of assaults’ against NHS staff. If you care about the healthcare needs of older people and want to see them treated with dignity and respect (which if you are reading this blog you probably do) then this makes for distressing reading.
Emotive language does these vulnerable people a huge disservice. Not only are they referred to as ‘perpetrators of abuse’ (a hugely pejorative title) in the headline but their actions were repeatedly described as ‘lashing out.’
Anyone who works closely with older people in hospitals will know that a huge proportion of these ‘assaults’ will have been committed by patients with delirium or possibly behavioural and psychological symptoms of dementia. Even the NHS Protect report makes it clear that 73.3% of all violence in the acute sector was unintentional and attributed to ‘medical reasons prevailing at the time.’
Whilst the BBC analysis does mention dementia as a significant factor, the role of delirium is conspicuous by its absence from the discussion. We are told about ‘frustration’ and occasionally ‘confusion’ but nothing more substantive. No real focus on the distress and fear that often underlies the aggression of a patient suffering from delirium.
At one concerning point we heard from a nurse that somebody who is older and suffering from a urinary tract infection can experience: “severe changes in their behaviour through imbalances in their electrolytes.” That is neither an accurate nor helpful statement but is indicative of the standard of coverage that this issue currently attracts in the mainstream media.
Two groups absent from this debate were geriatricians and older people themselves. We heard two really tough accounts from relatives but none from patients. The presenters didn’t even bother to mention them when asking for callers. Their absence from the discussion is of course complex, as mentioned this is a vulnerable group with high rates of underlying dementia. I am sure however there were those who have suffered the distress and trauma of acute delirium, and who wanted to speak up but were scared to do so. They may have wanted to recount their story, but were shamed into silence, possibly by the coverage, made to feel like a criminal rather than the victim. It is for this reason that we must stand up and challenge this sort of coverage, we must be a voice for our patients (past, present and future). We must educate the media so we can inform and reassure the public.
So let’s go out and engage people. Use tools to spread the word like the valuable #Icanpreventdelirium video https://www.youtube.com/watch?v=BPfZgBmcQB8&feature=youtu.be by Mani Krishnan (@psychinformatic)
or the #ThinkDelirium information leaflet from Healthcare Improvement Scotland.
In doing so hopefully we will not only make a difference to the lives of many of our patients and their families but might even prevent some of these ‘assaults’ from taking place.