Notre recherche visait à mettre en lumière les pratiques bientraitantes des préposées aux bénéficiaires en milieux d’hébergement pour aînés au Québec. L’objet de l’article est de faire ressortir la dichotomie entre les définitions de la bientraitance et son opérationnalisation. Dans la première partie, la notion de bientraitance dans le cadre de deux politiques gouvernementales québécoises est présentée. Ensuite, il est question du travail des préposées aux bénéficiaires en tant que vectrices de cette bientraitance dans la pratique. La troisième partie présente les résultats de notre recherche qui viennent soulever trois constats remettant en cause l’applicabilité des politiques publiques en cette matière : l’absence de reconnaissance d’un métier par définition bientraitant; les injonctions normatives à l’encontre du sens attribué à la bientraitance, et les obstacles organisationnels et sociopolitiques à la bientraitance. Ces constats sont réexaminés à la lumière des écrits dans la discussion, laquelle ouvre sur la notion de maltraitance organisationnelle.

The term ‘obstetric violence’ has been used to describe the mistreatment, disrespect and abuse or dehumanized care of women during childbirth by health care providers. This is a review of the existing literature in India on violence against women during childbirth. The review used the typology of Bohren et al. (2015). An internet search of PubMed, Google Scholar and JSTOR was conducted using the terms ‘obstetric violence’, ‘mistreatment’, ‘disrespect and abuse’ and ‘dehumanized care’. Studies based on empirical research on women’s experiences during childbirth in health facilities in India were included in the review. The search yielded sixteen studies: one case study, two ethnographic studies, two mixed-methods studies, three cross-sectional qualitative studies, seven cross-sectional quantitative studies and one longitudinal quantitative study. The studies were analysed using the seven categories of mistreatment outlined by Bohren et al. (2015): 1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. An additional category of ‘harmful traditional practices and beliefs’ emerged from the Indian literature, which was also included in the review. Although geographically limited, the selected research highlighted varying prevalences of the different forms of ‘obstetric violence’ in both public and private birth facilities in India. ‘Obstetric violence’ in India was found to be associated with socio-demographic factors, with women of lower social standing experiencing greater levels of mistreatment. In response to this normalized public health issue, a multi-pronged, rights-based framework is proposed that addresses the social, political and structural contexts of ‘obstetric violence’ in India.

The hidden nature of older adult mistreatment renders its detection in the domestic setting particularly challenging. A validated screening instrument that can provide a systematic assessment of risk factors can facilitate this detection. One such instrument, the “expanded Indicators of Abuse” tool, has been previously validated in the Hebrew language in a hospital setting. The present study has contributed to the validation of the “e-IOA” in an English-speaking community setting in Ontario, Canada. It consisted of two phases: (a) a content validity review and adaptation of the instrument by experts throughout Ontario, and (b) an inter-rater reliability assessment by home visiting nurses. The adaptation, the “Mistreatment of Older Adult Risk Factors” tool, offers a comprehensive tool for screening in the home setting. This instrument is significant to professional practice as practitioners working with older adults will be better equipped to assess for risk of mistreatment.

This article reviews developments in the field of elder abuse and neglect since the publication of Elder Abuse and Neglect in Canada (1991). The arguments made here are twofold: first, we have no idea of the size and nature of the problem of abuse and neglect in the community or in institutions; second, we do not know how to solve these problems or their attendant issues that have been masked by rhetoric and the recycling of information for the past 20 years. It is time to move forward from the “awareness phase”. What we must tackle in the future is as obvious now as 20 years ago. Our knowledge is incomplete (i.e., our glass remains half full) because we lack the type of investigations we most urgently need: prevalence studies in the community and institutions, serious theory development, and random clinical trials to test our interventions both socially and legally.

This paper critically reflects upon policy and research definitions of elder mistreatment in light of the findings of the United Kingdom Study of Abuse and Neglect of Older People that was commissioned by Comic Relief with co-funding from the Department of Health. The study uniquely comprised a national survey and follow-up qualitative research with survey respondents. This paper focuses on the findings of the qualitative component. One focus is the idea of ‘expectation of trust’, with an argument being made that the concept needs clarification for different types of relationships. It is particularly important to distinguish between trust in affective relationships and ‘positions of trust’ (as of paid carers), and to articulate the concept in terms that engage with older people's experiences and that are meaningful for different relationship categories. The qualitative research also found that ascriptions of neglect and abuse tend to be over-inclusive, in some instances to avoid identifying institutional and service failures. We also question the role and relevance of the use of chronological age in the notion of ‘elder abuse’. Given that ‘abuse’, ‘neglect’ and ‘expectation of trust’ are ill-defined and contested concepts, we recommend that although consistent definitions are important, especially for research into the epidemiology and aetiology of the syndrome and for informed policy discussion, they will unavoidably be provisional and pragmatic.

This study has explored how family members of care recipients define and sustain claims of mistreatment in old-age care. Twenty-one informants were recruited from an association of relatives of care recipients in Sweden. Using argumentation analysis, four warrants about mistreatment were identified from the qualitative interview data: they referred to physical harm, psychological harm, social-care deficiencies and identity subversion. The first three categories are similar to those recognised in previous research on elder mistreatment, but the fourth, which is described in detail in the article, is less familiar: elder mistreatment as the violation of an older person's identity. The family members backed their claims about staff members' violation of a care recipient's persona or identity by using arguments that drew on their unique knowledge of the care recipient's appearance, daily routines and preferred activities. They also described their attempts to protect the dignity and identity of a care recipient, their fears of abuse, and actual cases of conflict and retribution by care staff. They consistently positioned themselves as guardians of identity through their claims of mistreatment. The study provides important knowledge about family members' moral view of elder mistreatment, which may enhance the understanding of conflicts between formal care providers and family members.

A system to assist daily identification of radiotherapy patients and to prevent accidental exposures to mis-indentified patients was developed. The fingerprint-based biometric system was chosen because of its high sensitivity in identification and suitability for hospital use. In a 6-month survey, 85.7% of the daily treatment fractions were identified successfully; 5.5% of the unsuccessful identifications were overridden by the staff and the remaining 8.8% were due to poor-quality fingerprints. No false identifications occurred so that patient was identified as a different person. During the past 2.5 years and 47,000 treatment fractions, the system has been well accepted by the patients and radiation technologists and misidentified patients have not been treated since the installation.

Large surveys of the general population's perceptions of the neglect and mistreatment of older people are few. This article provides evidence about the public's awareness of ‘elder abuse’ at a time of considerable media and political interest in the subject in many countries. It presents the findings of a survey of 1,000 adults' knowledge of the neglect and mistreatment of older people in the UK. Descriptive and multivariate analyses were used to examine: variations in the perception of the existence of neglect or mistreatment of older people, the perceived relative prevalence of knowing an older person who had been subject to such experiences, the type and place of such experiences and knowledge of sources of help in such circumstances. The key findings are that older people believed that there is less neglect and mistreatment of older people than younger people, that women perceived more than men, and that there were regional variations in these perceptions. One-quarter said they knew an older person who had experienced neglect or mistreatment, and such reports were most likely among the middle aged and women. The most frequently reported locations of abuse were care homes and hospitals, and the most commonly reported form was inadequate or insufficient personal care. Most people said they would contact social services or paid carers if they encountered neglect or mistreatment. The findings are discussed in the light of increased policy attention to the safeguarding of vulnerable adults, and the implications for research, practice and campaigning organisations are considered.