Safeguarding Older Adults - with Sarah Lonbay

For our spring conference on Adult Safeguarding, Sarah Lonbay joins us to talk about her research on identifying and responding to domestic abuse in older populations, the key challenges and complexities. 

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ExChange Wales
This episode contains descriptions of abuse. Listener discretion is advised.
 
 Jeremy Dixon
Hello and welcome to The Exchange Podcast. My name is Jeremy Dixon, and today I'm going to be interviewing Professor Sarah Lonbay from Sunderland University. I'm going to be talking to her about her research on older adult abuse. And it focuses particularly on the issue of domestic violence. There are a few times when we talk about specific issues of domestic violence.
 
 Just so you've got that warning in advance. But Sarah does also talk about some ways in which social workers can support people who are experiencing this type of abuse in some very helpful ways.
 
 ExChange Wales
Welcome to the Exchange Wales Podcast, a series that explores research and practice sharing, evidence and care experience to build better social care in Wales and beyond.
 
 Jeremy Dixon
Hello and welcome to The Exchange Podcast. Today's guest is Professor Sarah Lonbay. Sarah is Professor of Social Sciences and Social Care at Sunderland University, and she's also a research fellow in the Multi Morbidity, aging and Frailty theme of the National Institute of Health Research Applied Research collaboration for North East and North Cumbria. So it's really great to have you with us, Sarah.
 
 And we're going to talk today about some of the research you've done focused on adult safeguarding. And I'd read one of your papers, which we're going to talk about, which was in the European Journal of Social Work. So the title of that paper is Identifying and Responding to Domestic Abuse in Older Populations: Key Challenges and Complexities. And this is a paper you've written with Caroline Southall, but you've also done some other research in the area.
 
 So I think we're also going to talk about some of the research which is ongoing, which it also looks at the area of elder abuse. So I was wondering to begin with if you could tell us a bit about what led you to start researching this area?
 
 Sarah Lonbay
Yeah, absolutely. So really, it came from two areas that sort of merge this particular project that I did with Carole.
 
 So on the one hand, I've been involved in research about adult safeguarding and looking specifically at the experiences of older people for quite some time, particularly, I'm interested in how we think about abuse in adulthood. Who we notice, who gets overlooked and particularly interested in abuse in adulthood, where people also have care and support needs. So people who would come within the remit of our adult safeguarding systems in the UK, and on the other hand, I've done a lot of reading and teaching about abuse and it is very clear, particularly in domestic abuse, that sort of typical victims are often perceived as younger women within the domestic abuse remit.
 
 And that there is a gap in terms of older people being recognised and in fact, older people being really quite invisible within the domestic abuse landscape. So the first piece of work that I did with Carol Southwell, who's at Northumbria University, she sits on the local safeguarding adults board. And they started to recognise that there were some cases coming through, within the region really and nationally that were starting to see cases in domestic homicide reviews that didn't fit, that sort of typical victim that people might expect to see when it comes to cases of domestic abuse and that actually older people were being affected.
 
 Often people in long standing marriages sometimes being abused by adult children as well, not just partners. And sometimes with complicating, kind of caregiving dynamics in the mix as well. Or perhaps, dementia and things like that. So the boards were quite keen, to kind of find out what's going on in this area. They weren't really sure if it was getting recognised properly, if it was getting picked up in practice.
 
 So what was happening when these cases, were being spotted and how were people responding and were we responding in the right kinds of ways when it was, a case of domestic abuse specifically and for older people. So we've looked at the literature and it kind of confirmed concerns about the invisibility of this within both research and practice.
 
 So we do know that lots of people, lots of older people experience domestic abuse. But they're not coming through into kind of practice areas or it's not been recognised or picked up in the way that they might want it to. So that's sort of how we came about it, they approached Carol initially and said, we're really keen to explore this area, recognise that there are some concerns, about this not being recognised or responded to, and could we do some work around this?
 
 So Carol came to me because she knew I had an interest and had done research in this area before. And between us we did a small qualitative study, which is the one that you just mentioned that was published in the European Journal of Social Work, where we looked at, a multi-disciplinary sample of practitioners, and we spoke to a couple of older women who had also experienced domestic abuse to just try and get a sense of what's actually happening.
 
 Is it on people's radar, and if it is, how are they identifying it? How are they responding to it? And also from the perspective of the older victim survivors that we spoke to, what does help and support look like from their side? So we specifically spoke to two older women who were in receipt of services, who have disclosed their experiences and received some support to understand well, what does that look and feel like from their side?
 
 And are they're getting what they feel they need?
 
 Jeremy Dixon
Sure. So if I can just come in and ask a question about how the Safeguarding Adults Board works. So, I mean, some of our listeners will be very familiar with how, what safeguarding guidance boards do, but I guess some people might not really have heard of this phrase.
 
 So what kind of work do they do and what part they play in safeguarding?
 
 Sarah Lonbay
Yeah. So every, area in England has the safeguarding adults board. So they've been in place for quite a long time. So when we had, safeguarding adults in England only came under a statutory framework with the Care Act in 2014. So prior to that, there was policy guidance called No Secrets, which mandated or suggested multi-agency committees in each area.
 
 But it wasn't a sort of statutory requirement at that stage. So by the time we got to the Care Act, most places had them and the Care Act made it mandatory. But they are multi-agency boards. And they have a remit to oversee adult safeguarding policy and practice in that area. So they'll managed safeguarding teams and they have input from health, police, social work, voluntary sector housing, kind of all the key people that you would expect.
 
 And members of the board are typically at, a level where they can enact change in their own organisation. So talking about more senior people being part of this board, so they will kind of, oversee what happens in that local area around workforce development, around the statistics and the data that's routinely collected, all kinds of work that happens in the area around safeguarding.

Jeremy Dixon
Yeah. So the board that approached your colleagues, was there a particular, set of cases that sparked their interest in this issue of domestic violence and older adults?

Sarah Lonbay
Yeah, there were a couple of cases, regionally, there was a domestic homicide, in the North East around the time when this work first happened, so that was what they were particularly concerned about.
 
 Sarah Lonbay
It wasn't in the area, but it was on their radar, that they'd sort of noticed these things and it made them think, well, hang on, do we really know what's happening here? And is it on practitioners radar to look out for cases of domestic abuse when it's in the older population because as I sort of suggested earlier it’s quite a hidden area of abuse.
 
 Sarah Lonbay
 I think it's becoming less so since I started doing the work. There's been a lot more attention paid to it.
 
 Jeremy Dixon
Yeah. So you mentioned it being a hidden area of abuse. And I mean, that's quite interesting to me because, I've written a bit about the history of adult safeguarding, and I guess one of the first forms of abuse it was kind of talked about was kind of elder abuse.
 
 But was it the case then that people were talking about elder abuse, but just not domestic violence in older adults? And when did kind of domestic violence start to get recognised as an issue for this group, do you think?
 
 Sarah Lonbay
Yeah, that's a really good question. Obviously, elder abuse has been recognised for quite a long time as you say, it was one of the first policy documents that we had in the UK was specifically about the abuse of older people, but I think it's been quite often focused around older people with care and support needs.
 
 Sarah Lonbay
And I think that's where this distinction is coming through now that people are recognising that actually even when there aren’t care and support needs, there’s very often or there can be abuse within relationships. And these are particular relationships, so when we talk about domestic abuse, so within the UK, the domestic abuse act defines that as personal relationships, basically, so that’s partners, ex-partners, family members.
 
 Whereas when we think about elder abuse more broadly, that might include paid carers, for example, or other people, that could be the perpetrators of abuse. So it's looking at a particular relationship between the victim survivor and the perpetrator. So it's not that it wasn't happening and suddenly it's happening, I think partly where cases were getting picked up if there are care and support needs,
 
 it was being put through a particular group of adult safeguarding. And actually perhaps cases where older people didn't have those needs or didn't come into contact with the services in the same way, that's where it was hidden more in some respects, because that, it wasn't getting recognised. And there was this perception that actually it stops us [...]
 
 It's only an issue that affects younger women. You know, we don't necessarily talk that much about sexual violence, for example, in older age. And we don't always like to kind of think about physical violence between older people as well. We assume, I don't know what we think that happens. That it just stops at 65. But of course, you know, it doesn't.
 
 It can continue. If it's been within the relationship, it's not going to suddenly stop because that relationship, the people reach a certain age. And of course, it can arise in later life as well, with different kind of dynamics within the relationship too.
 
 Jeremy Dixon
Yeah. No, that's interesting. So I mean, I guess, for what you're saying, it might be the case that people who are, eligible for safeguarding under the Care Act or, you know, similar safeguarding legislation in other countries, such as the Social Services and Wellbeing Act in Wales, they might have been getting referred more often, whereas other adults, maybe not so much because of these maybe stereotypical beliefs about domestic violence in older, older people.
 
 Sarah Lonbay
Yeah. And I think within that there's another complexity around, even in cases where perhaps that would fall within the remit of those sort of formal safeguarding procedures. Sometimes even then, the historical domestic abuse is not necessarily picked up or recognised that there might be assumptions that actually what's happening as a result of a caregiving dynamic, rather than actually seeing that this is a pattern of abuse that’s happened across the life course.
 
 Jeremy Dixon
Right, so people might assume that it's because of carer stress rather than it’s happened for the last 30 years or something.
 
 Sarah Lonbay
Yeah, exactly. And I think sometimes that doesn't get realised or recognised.
 
 Jeremy Dixon
Yeah. I mean, one of the things that was interesting that you spoke about in your paper was that there's kind of different definitions of, abuse used by the World Health organisation and also by UK domestic abuse legislation and safeguarding legislation.
  

So does that cause particular problems do you think or are there kind of tensions there?
 
 Sarah Lonbay
I think there are, particularly as a researcher I think there are, because, you know, this is what we found. You mentioned some of the work that we've been doing. One of them was a qualitative, systematic review. And I think, when we’re thinking about definitions and how different organisations or legislative acts define abuse, where there are differences in how it's defined and conceptualised, that influences what researchers look at and what they include within the parameters, their research that can affect prevalence data.
 
 And I think our UK definition under the Domestic Abuse Act is broader than the World Health organisation definition. So they focus on intimate partner violence. And some of the literature that Carol and I and another colleague Emma Aggar at Sunderland helped us with this systematic review. We found that some of the literature did just focus on intimate partner violence in terms of older people, and some of it did broaden out and look at adult children who are often perpetrators as well in later life. And our UK definition would include other family members such as children, so adult sons in particular. We did find examples where siblings were the perpetrators as well. So I think there's more complexity with older people in that sense as well. Because if you're talking about younger people, they're not going to have adult children who are potentially the perpetrators, whereas in later life that's far more likely to be the case.
 
 Jeremy Dixon
Yeah. Okay. So one thing I want to ask you about was around the kind of effect of gender. So in the paper you highlight various issues about the explanations of domestic abuse. And you talk about feminist researchers pointing out that gender is a very important factor. But you also say that gender is often overlooked, under care and safeguarding, where the focus is on adults at risk, of abuse and neglect.
 
 So I wonder if you can say a bit more about what these concerns about gender are, and what are the problems with the way domestic abuse is framed within the Care Act in your view?
 
 Sarah Lonbay
Yeah. So the reason that I think that's important is because there's been a lot of work on domestic abuse, and particularly from a feminist perspective.
  

And I think that perspective really highlights that these aren’t isolated incidents where someone's become overwhelmed and, done something. This is about gendered power and control and within the domestic abuse kind of remit or within that literature, that perspective is well documented and well discussed and it underpins a lot of service intervention as well. That perspective is very grounded in prevalence in the data as well, which does demonstrate that women are largely the largest group of victim survivors and men are more often the perpetrators.
 
 So there is a gendered dynamic to abuse which persists across the life course. So if we think about domestic abuse being perpetrated mostly by men against women when it comes to the Care Act and the framing of abuse under the Care Act, and within that kind of statutory framework, it's more of a welfare discourse anyway. But it focuses much more on the deficit of the person and the individual.
 
 So it's someone who can't protect themselves because their care and support needs. And it's framed around that kind of inherent vulnerability because of age or disability. So I think then that gendered lens is lost and it becomes looking at it as more of an individual case, rather than looking at those larger systems that perpetuate that inequality, that power and control framing that feminist scholars bring into the discussion.
 
 So I think the issue then also becomes about how we then respond to it. So within that sort of feminist framing of domestic abuse, a lot of work, would be done, I'm going to talk about women, I do, obviously of course, recognise that many men are also victims of domestic abuse. But in this, now I'm going to talk about this.
 
 So a lot of the work that's done with women who have experienced domestic abuse within that kind of framing would be more about empowerment and kind of recognising those controlling dynamics that might have been within the relationship, those kinds of things. Whereas within the safeguarding remit, it can be more about establishing care needs and kind of thinking about that, those kinds of aspects.
 
 And I'm not saying that we need one and not the other, but I think if we completely ignore the gender and ignore the domestic abuse, and we're missing something for those people.
 
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Jeremy Dixon
So there's a danger in a sense that those conversations about, control from a gender perspective, you know, men's control of women get left out of the conversation or,
 
 Sarah Lonbay
Yeah.
 
 Jeremy Dixon
get kind of reframed,
 
 Sarah Lonbay
They get reframed as something, yeah-
 
 Jeremy Dixon
as a kind of issue of somebody, I don't know, needing support because of their mental health problem or learning disability or being an older adult.
 
 Sarah Lonbay
Yeah. Or like you said before because of carers stress. And again, we miss those patterns and those dynamics in the relationship. And I think coercive and controlling behaviour is quite difficult for people as a concept anyway or, you know, it's not well recognised or well understood. And I think particularly for older people, that dynamic of thinking about the gendered aspects of it are really important because we're talking I mean, this is going to change, you know, this is not something that's static, but we're talking about a group of older people who grew up at a time when domestic abuse is not talked about.
 
 It was not a public issue. It was a private family matter. It was often accepted as something that happened within relationships. And it wasn't on people's radar. And, at a time when patriarchal norms and kind of gender based roles were much more normalised within relationships and much more accepted within relationships. So we're talking about an older population that have normalised some things that might now be described as domestic abuse, particularly around, non physical violence.
 
 So the third study that we did that I haven't mentioned yet was a critical discourse analysis where we looked in depth at three women's accounts, three older women’s accounts of their domestic abuse
 
 Jeremy Dixon
Sure.
 
 Sarah Lonbay
and looked at, the patterns across the life course. So just in very kind of easy to understand terms, what we were interested in was the language that was used by the women.
 
 So how are they talking about and describing their experiences and making sense of them? So we looked at particularly the words and the phrases and how they talked about themselves and other people, within their stories and, you know, became very clear through those conversations and through that analysis how much that early experiences shaped their later help seeking an understanding of domestic abuse.
 
 So all of them, and this is true in the literature as well, which has picked up some of this stuff that we explored in more depth within that study that coercive and controlling behaviour isn't necessarily recognised by older people as domestic abuse. When all three of the women that we spoke to within that study had had those experiences but couldn't frame them in that way, they didn't have the kind of conscious awareness of what that was.
 
 So for them domestic abuse was just physical. So and all of their relationships did escalate into physical violence as well. But there were these early, early signs. It started with more psychological controlling behaviour. And they described things like, well, you know, I knew it wasn't right, but I didn't think there was anything wrong because I would have just expected to be hit.
 
 So, I've kind of gone off on a tangent from your gender question here.
 
 Jeremy Dixon
That’s okay. No, it's really interesting. So I mean, so it sounds like people who you spoke to would say abuse is just physical abuse rather than recognising at an early stage. So was it always the case that they just saw it was abuse at the kind of physical abuse stage or were they some early signs of recognition maybe?
 
 Sarah Lonbay
When it wasn't physical, it was more described as a feeling of unease and feeling like, well, I didn't really think this was right, but I didn't think, I didn't frame it as anything significantly wrong.
 
 And I didn't think that it was domestic abuse. And really, for these women that didn't frame as domestic abuse and they didn't use that language until they'd had quite close interactions with professionals who reframed their experiences with them, validated their experiences, and then they started to use that language of domestic abuse. So what we saw in that study was actually we called it a coded language of abuse, where the women used a lot of mitigated and, distancing language.
  

So really downplaying their experiences. So they would say things to me because I did the interviews and I would say things like, oh, you know, he was a bit nasty. And then through the conversation when they were sharing details of what had actually happened, it was really quite serious, really quite horrific examples of abuse.
 
 Jeremy Dixon
So what kind of things were they actually referring to when they were saying words like nasty or quite generic words like that?
 
 Sarah Lonbay
Yeah. So without kind of going into too much detail about the individual stories, there were some examples of, really severe sexual violence within the relationships, some very dangerous, physical abuse being described to me as well, being pinned by the throat and, and things like that. So,
 
 Jeremy Dixon
Right.
 
 Sarah Lonbay
they were describing quite horrific and serious incidents, but using very minimising language.
 
 Jeremy Dixon
So if you heard in general conversation you might mistake it for maybe, I don't know, verbal aggression or
 
 Sarah Lonbay
Yeah, exactly.
 
 Jeremy Dixon
or something of that nature.
 
 Sarah Lonbay
Yeah. And that's one of the things we really wanted to pull out. And we want to do some more work around this because, you know, if they were to go to their GP and say, you know, my husband's a bit mean sometimes, but actually they're talking about something really serious, those kinds of disclosures could easily be missed.
 
 Obviously this was a small sample, but the work that we did with the systematic review, language use came up quite a lot in the studies in terms of people suggesting that older people might not use the language that you expect, to disclose their experience, but there isn't really any in-depth information about what that language really looks like.
 
 So this was a sort of starting point for looking at that in more depth. We did this study to see, you know, do we need to look at this more closely? And I think from what we found, we definitely do, because I think there is a real risk that disclosures could be missed.
 
 Jeremy Dixon
Yeah. So this brings us on quite nicely, I guess, to the paper that you wrote, because in that paper you do interview some older adults, but I think you are largely talking about professionals, views about responding to domestic abuse.
 
 So can I ask about how did you go about kind of exploring this issue with the professionals, and the women you spoke to? So, you know, what kind of agencies where you kind of drawing from and what questions do you want to ask them?
 
 Sarah Lonbay
Yeah. So, I have to cast my mind back a bit first because actually, we did the work quite a while back, but we wanted, to just get a snapshot, really, of what was happening.
 
 Because at the time, as I mentioned before, it's received a lot more attention now. So there's more work being done in this area and there's more, things being published and talked about. But at the time, we couldn't really find many papers that had really looked at this as an issue. So we wanted to take a multidisciplinary sample and include the views of older people who had experienced domestic abuse as well.
 
 So we spoke to some health practitioners, social work, we connected with the VCSE sector, which is a voluntary community and social enterprise sector, because a lot of domestic abuse support is delivered by the voluntary sector. So we spoke to, some voluntary agencies and a women's refuge, couple of people from women's refuges as well, to sort of just get a broad perspective on what people were aware of, what kind of cases were they seeing, how were they identifying it?
  

And if they did identify domestic abuse in this population, what were they doing with those cases? Where were those cases going and what was happening to the older people? What kinds of support was available for them? And we explored that from the perspective of the two older women who took part in terms of, we didn't, we wanted to obviously be very sensitive with them about, their engagement in their research, we were very clear that we weren't there to speak to them about their experiences of abuse, although they did choose to share those with us as well.
 
 But we were interested in from the point of disclosing what kind of help did you get? What did that feel like for you? Was it a good fit? Was it what you wanted, needed, those kinds of questions. And I suppose you might ask me this as a follow on question but what we found was that the provisions were really quite poor for older people.
 
 Jeremy Dixon
Right. I guess before I get to the kind of provision bit I was wanting to ask how people identified the abuse or neglect, so were there particular things that services were looking for or things that they were missing? And we've talked about some of the kind of suppositions that people have but what were the participants you were speaking saying about that, were they, did they have particularly kind of red flags or things that we're looking for?
 
 Sarah Lonbay
Yeah. They didn't, we didn't really get a sense that there were I think, a lot of the people that came forward were sort of in, in safeguarding roles. So they were quite finely tuned to that. I think what we found was that, abuse and neglect were often identified, but not necessarily being framed as domestic abuse, even when there were cases of domestic abuse.
 
 Jeremy Dixon
Yeah.
 
 Sarah Lonbay
So I think the identification of abuse more broadly, people in health and social care roles are quite well trained and safeguarding, and they seem to be quite confident that they would recognise those cases, but that they wouldn't necessarily think about them in terms of domestic abuse, that their kind of go to would be like, this is adult safeguarding because it's an older person.
 
 Jeremy Dixon
Yeah. So it could have, aligned with some of the things you're talking about before from the literature that people could have missing or framing it as a care and support issue rather than as a domestic violence
 
 Sarah Lonbay
Yeah.
 
 Jeremy Dixon
issue and some of those gender dynamics may be getting missed as well.
 
 Sarah Lonbay
Yeah. That seems to be the more typical kind of way that it would happen. Yeah.
 
 Jeremy Dixon
Yeah. I mean, one of the things you talked about was about the complexity of the abuse in later life.
 
 Sarah Lonbay
Yeah.
 
 Jeremy Dixon
What kind of complexities were people thinking of when they were kind of making that statement?
 
 Sarah Lonbay
Yeah, I think that the complexities in later life are to do with the perpetrators partly so,
 
 Jeremy Dixon
Yeah,
 
 Sarah Lonbay
the fact that, you know, as I sort of mentioned earlier, there can be perpetrators at different generations, that could be a partner, could be a child, it could be a sibling.
 
 Sarah Lonbay
So the abuse could potentially be intergenerational. There can be multiple perpetrators for older people. There may be more likely to be caregiving dynamics in the relationship. And that can really complicate and sometimes obscure what's really happening as well. Particularly if the cared for person is, someone who has been an abuser throughout the relationship. That's not always recognised.
 
 So caregiving dynamics can complicate, I mentioned as well about the sort of historical context for abuse in later life, and kind of how older people themselves might frame it or see it or understand it can be quite complicated, because of how they've been brought up and the lessons that they've learned through their lives as well.
 
 Jeremy Dixon
Yeah, I mean, you mentioned the service responses weren't great. So,
 
 Sarah Lonbay
Yeah.
 
 Jeremy Dixon
Who was saying that? Was that the professionals or the service users or both groups of people?
 
 Sarah Lonbay
It was both. Definitely both. Yeah. And I think one of the I mean, there were quite a few different issues that got raised. So, there were issues around the risk assessment tools that are used, not really being fit for purpose when it comes to older people.
 
 So they ask questions about children and things that aren’t really relevant when you're over 65. One of the biggest challenges is around housing provision.
 
 Jeremy Dixon
Yeah.
 
 Sarah Lonbay
And this came up quite strongly in the systematic review as well, because in terms of disclosure and help seeking, a big barrier for older people can sometimes be around the home. And the fear of institutionalisation, which actually the literature suggests sometimes that fear is as well founded.
 
 And one of our participants, social worker we spoke to also suggested that when she said sometimes that is the only option is to put someone into a care home because there's nowhere else for them to go. So there doesn't seem to be any adequate housing support for older women who might, or older victim survivors, not just women who won't choose to leave home because of domestic abuse.
 
 The home is often a site of - how do I describe it - kind of a site of, unsafety, but it's also a place where they've perhaps lived for a long time and, and built memories and raised families. So to leave that space can be very challenging. And that kind of fear of institutionalisation is sometimes used by perpetrators as well.
 
 Who will threaten them with, well, if you leave me, you’ll have to go into a care home and things like that so there's a lot of issues around housing and what that looks like. And for the two older women, in the first study that we spoke to, talked about how, when they had, one of them in particular spoke about a refuge that she'd moved into, but she just didn't feel comfortable there, she was the only older person.
 
 It was lots of younger women with their children, and she felt like she almost ended up taking on a mothering role to them, which then superseded her own kind of needs,
 
 Jeremy Dixon
Right.
 
 Sarah Lonbay
in that space. And it was noisy, and it just wasn't where she wanted to be. And the people that we spoke to who ran the refuge sort of echoed that and said, you know, that the older people that they support, it's not necessarily a space that they want to be in or that sometimes even they feel like, well, I'm taking a space away from someone younger who needs it more than me.
 
 Yeah. So that is, that is problematic. And if there are any care and support needs, the refuges are not set up to manage or support people who have any additional needs either. So, there's lots of issues around that too.
 
 Jeremy Dixon
So as a last question I guess, what kind of things can practitioners do to try and improve the outcomes for the people who they're working with?
 
 You know, when they see these problems in practice?
 
 Sarah Lonbay
Yeah. Good question. I think something that comes up time and time again and, not just in this research, but in the other research I've done around adult safeguarding is professional curiosity. And I think it's such an obvious thing, and I think it comes up a lot in kind of recommendations and social work practice, but it's really important for practitioners to feel confident, to probe with sensitivity, to ask further questions and to feel confident around exploring someone's, experiences.
 
 And particularly in relation to kind of listening to red flag language or not dismissing where someone might be trying to disclose, but perhaps not using the language that they might expect to hear. So really having the confidence to to delve a little deeper and making space for that as well, because I think quite often we're a bit more well-versed in maybe routinely asking those kinds of questions when it's younger people, but not when it's older people.
 
 So thinking about that in terms of practice, I think again, another very clear message that comes up is around the need to really respect that person and listen to their views and their choices and give them control over what happens, because that fear of choice and control being taken away can be quite a large barrier to disclosure as well.
 
 We're talking about people who have lived a full life. They're over 65. They perhaps have been an abusive relationship for a long period of time. So they have a story of resistance and survival, and they have coping mechanisms, and they've had lots of different ways, potentially, where they've learned how to keep themselves safe. And I think we need to listen to those stories and not just focus on what's wrong here, what the deficits are and what we need to address.
 
 Because although that's important, prioritising their experiences and their views and what they want to do moving forward is really important. And if that doesn't happen, people will just disengage from services.
 
 Jeremy Dixon
Yeah.
 
 Sarah Lonbay
And then they're not getting any help at all. So I think those are my two kind of key messages for practitioners.
 
 Jeremy Dixon
Yeah. Well thank you so much for coming to speak to us today. And it's really challenging but interesting research. So thanks for sharing the paper that you've written and the other ongoing research, and we look forward to hearing about the research that you continue to do in this area in the not too distant future.
 
 Sarah Lonbay
Great, well, thank you very much for having me as a guest. It's been good.
 
 ExChange Wales
Thank you for tuning in to this episode of the Exchange Wales Podcast. At Exchange Wales, we connect researchers, practitioners and people with lived experience to share evidence, practice and insights that shape social care. Our work spans children's and adult social care, and we're also exploring the growing role of artificial intelligence in the sector. If you'd like to learn more or get involved, please visit exchangewales.org