The purpose of the present study was to explore the profile of concerned persons, their experience and wishes in seeking help for the victim, and the impact on them of the abusive situation and the help-seeking process. Concerned persons were primarily female family members, often helping a parent who was being abused by another family member, very frequently the concerned person’s sibling. The concerned persons’ experience of seeking help was overall negative, and barriers to help-seeking primarily related to formal services. They also experienced barriers related to the perpetrator’s behavior and challenges when the victim did not agree with seeking action. Finally, the impact on concerned persons was varied and wide-ranging in severity, affecting their mental and physical health, financial status, and relationship with the victim.
Concerned Persons’ Profile
The familial relationship between concerned persons and alleged perpetrators is likely to create many challenges in seeking help, but also for professionals interacting with family members when there is suspected abuse. The finding that concerned persons are primarily children of victims reporting abuse perpetrated by a sibling adds to the literature on EA dynamics. Even though family members are often the most common perpetrators of EA (Dow et al., 2020; Weissberger et al., 2020), they are also the most common advocates for the victim. Given that most enquiries to the helpline over a year were made by concerned person, the requirement for sensitive management of and response to EA concerns is emphasized.
Barriers and Facilitators to Help-Seeking
The present study has expanded knowledge on barriers and facilitators to seeking help in EA, by focusing on concerned persons’ perspectives and experiences. Barriers most commonly related to formal services, likely due to the context of the helpline. Given that the helpline is primarily a source of advice, often including the recommendation to contact other services (Action on Elder Abuse, 2008), helpline staff are likely to explore enquirers’ previous attempts to seek help, in order to know where to signpost enquirers. Barriers related to fear (e.g., of repercussions) were also common, consistent with previous research where third parties involved in EA cases were afraid of retaliation for reporting the abuse (Storey & Perka, 2018). These worries do not seem to be unwarranted, as some concerned persons in the study had experienced retaliation from services or individual perpetrators. Barriers related to the social network were also common, and several concerned persons did not have the support of other relatives or friends, which may have prompted feelings of responsibility over the abuse (Moschella et al., 2018).
Barriers related to services and a new theme of barriers related to the victim’s behavior not only highlight the perspective of concerned persons, but, at the same time, offer an insight into the struggles of services to respond to EA and address third-party concerns. Safeguarding generally requires the victim’s consent when the victim has mental capacity, prior to assessment and intervention (Department of Health and Social Care, 2020). However, the victim’s view may differ with the views of concerned persons, who may be particularly reluctant to intervene when other family members are involved (Dow et al., 2020), all of which might mean professionals are unable to assess the allegations. Professionals need to be mindful that concerned persons, even if informed of legislation, will still struggle with seeing a loved one being hurt.
In terms of triggers and facilitators leading to help-seeking, concerned persons sought help out of concern for the victim’s safety and also following an escalation of abuse. This is consistent with previous findings for EA victims (Fraga Dominguez et al., 2021a) and may be related to feelings of responsibility over the victim’s wellbeing (Moschella et al., 2018). It is important to understand ways of supporting concerned persons to make earlier disclosures, to avoid further harm. Nonetheless, it is possible that, by waiting to report, concerned persons are merely respecting the victims’ wishes not to involve services.
Sources and Goals of Help-Seeking and Responses from Sources of Help
In terms of concerned persons’ help-seeking patterns, they had primarily sought help from formal services, generally receiving negative responses and achieving little success in stopping the abuse. There could be an overestimation of negative experiences with services, given that those enquirers with less success are probably more likely to contact the helpline. However, these experiences are still important in shaping practice and understanding how services can provide a better response. The number of concerned person enquirers is relatively high (n = 1352) and only covers one year of data from the helpline, suggesting there are many family members, friends, neighbors, and acquaintances who may be struggling to support EA victims and interact with services. Concerned persons also confronted the perpetrator, and almost a quarter were met with negative consequences for themselves or the victim, such as increased abuse. The findings suggest that confrontation is rarely successful and may put concerned persons and victims at risk of further harm. Thus, it is not an advisable or safe way of resolving abuse. However, confronting the perpetrator may be something that concerned persons prefer if they want to privately address a family matter, or where the victim does not support formal intervention (Dow et al., 2020; Mackay, 2017). For this reason, in order to reduce risk, confrontation needs to be explored and discussed actively by professionals when they interact with concerned persons. Professionals need to make concerned persons aware of the risks of confrontation for victims and concerned persons, and evaluate safer alternatives, which may require formal services’ involvement. Breckman et al. (2017) recommended that services for concerned persons should include education about EA and ways of being effectively involved without harm to themselves.
At the moment of enquiring from the helpline, most concerned persons wanted general advice about how to proceed, or specific advice in their interaction with services. This is consistent with the purpose of the charity’s helpline. However, some needed general knowledge about EA, relevant legislation, and the rights of older people. These findings suggest there is still a need for more population awareness about EA and related laws and policies (Breckman et al., 2017; Fraga Dominguez et al., 2021a; Mackay, 2017). Long-term, concerned persons expressed wishes in several areas (specific help, the victim’s housing and living arrangements, and the outcomes of disclosure), indicating that there is a need to explore these varied wishes in their interaction with services. Nonetheless, because of the use of secondary data, only a small number of cases had data available regarding wishes, and thus future studies should gather primary data to investigate concerned persons’ goals and needs.
Impact of Abuse and Help-Seeking on Concerned Persons
The current study findings expand previous research by identifying some of the ways in which concerned persons are impacted (Breckman et al., 2017; Kilaberia & Stum, 2020). The impact of abuse and help-seeking on concerned persons ranged widely in severity, but it was clear that, for some, it was not mere concern that they were experiencing, but more severe impact to their mental health, as well as victimization by the perpetrator. Abuse by the perpetrator was sometimes severe, including a threat of homicide, physical assault, and false allegations. These findings can be considered in light of recent suggestions that concerned persons may need to be framed as secondary victims (Kilaberia & Stum, 2020). Another major impact of the abuse for the concerned person was the loss of their ability to see the victim, due to the perpetrator’s control or restrictions placed by them. This impact is likely to cause particular anguish in concerned persons, who were frequently family members supporting a parent and blocked by a sibling from seeing the victim. In addition to what the concerned persons described to the helpline, their involvement in supporting the victim probably did not stop there. Many concerned persons were advised by the helpline on how to proceed further or on new routes to explore, such as contacting adult safeguarding or legal services.
Previous research found that helping an EA victim was associated with more distress than only knowing about the abuse (Breckman et al., 2017). In the present study, in most cases it was not possible to determine that the impact on the concerned person was a result of seeking help on behalf of the victim rather than the result of knowing about the abuse itself and the perpetrator’s abusive behaviors. However, given that many concerned persons reported seeking help before, it is likely that some of the described impact was associated with seeking help. Therefore, there might have been an underestimation of the impact that was caused by seeking help and not simply by the abuse or knowledge about the abuse. Nevertheless, these two types of impact, from knowledge about the abuse itself and seeking help, may sometimes be intertwined. For example, a perpetrator who may be isolating the victim from a family member may increase their isolation once they notice that the family member is aware of the abuse and trying to seek help. In this example, the concerned person would be affected both by the abuse itself and by the consequences of trying to support the older adult.
Notably, in some cases, the concerned person making the enquiry was not the only one impacted, and another third party (usually another family member) was also suffering from a similar impact as a result of the abuse and/or supporting the victim. This highlights the reach of EA, which we know severely affects victims (Yunus et al., 2019) and emphasizes the need to support concerned persons. Because the current study used secondary data, gathered at a particular point in time, it is possible that many more enquirers and other third parties experienced impact that they simply did not report or that was not recorded, so there could be an under-estimation of the impact experienced. Importantly, there are ways of supporting this group of people, some of which are already being implemented. For example, the New York City Elder Abuse Center (NYC EAC) launched a helpline specifically targeted at concerned persons (Elman et al., 2020; NYC EAC, 2018), considering their specific needs and how they may be impacted by the experience of witnessing abuse or supporting an older adult who is abused (Breckman et al., 2017). It may also be necessary to involve concerned persons in intervention planning (Sylaska & Edwards, 2014) and explore how they are perceived by services.
Implications for Practice and Policy
Practitioners—particularly from social services, police, and legal advice—should be mindful when interacting with a victim’s family members and friends. Concerns by family members—the majority of concerned persons—should be taken seriously; however, given that the perpetrator is likely to be a family member as well, this can be confusing for practitioners. In fact, they may have difficulties establishing who is trying to help and who is harming the victim. In those cases, interviewing the victim alone will be paramount, and so will be seeking corroborating evidence from multiple sources and services. Such a protocol will ensure that victims and concerned persons are protected from the perpetrator. Importantly, the fact that EA perpetrators, victims, and reporters may all be related, stresses the importance of considering family dynamics by policy makers (Dow et al., 2020).
Concerned persons need support, and the negative response they receive from services can make them feel despondent and hopeless. Specific helplines for them, or helplines and services that understand their unique experiences and needs, are necessary (Elman et al., 2020). Professionals should not ignore those concerned persons and should remain in touch and listen carefully to their concerns. If concerned persons are supported in remaining close to victims, they might be able to notice when the situation escalates or when there is an emergency and services must intervene (Mackay, 2017). They may also be the first ones to know when victims reach a threshold and decide that they support intervention. The New York City Elder Abuse Center’s (NYC EAC) helpline for concerned persons (Elman et al., 2020; NYC EAC, 2018) can be used as an example of supporting this population, and future research on service efficacy should be considered when modelling initiatives. Although a specific helpline may not always be appropriate or cost-effective, the experience of the helpline can be used in order to inform the work of existing EA helplines and services that will often be interacting with concerned persons. Finally, further education for concerned persons may be helpful, so that they are aware of relevant legislation and are able to understand how to best manage these cases. For example, focusing on the risk of confrontation, and also emphasizing the need to respect victims’ wishes and the legislation around mental capacity and intervention by services (Mackay, 2017).
This study is limited in several ways, primarily because it represents a biased sample of EA cases. First, there is likely a bias towards those experiencing more negative responses in their interaction with services because those may be more likely to continue seeking redress and more willing to enquire from a helpline. However, as highlighted earlier in the discussion, even without knowing the representativeness of these experiences with respect to concerned persons in the general population, the experiences reported in this sample should not be ignored. Importantly, the characteristics of the sample in terms of EA types and victim-perpetrator relationship were consistent with previous research (Joosten et al., 2020; Weissberger et al., 2020).
Second, there are limitations relating to the diversity of the sample in the study. There was no information for the enquirers relating to important areas such as race/ethnicity, socioeconomic backgrounds, and sexual or gender minorities, meaning that it is not possible to understand how representative the sample is of the diversity of the UK population. Recording these characteristics in future samples, with a consideration of intersectionality, will be essential in understanding the different barriers to service access that may be faced by different groups in the population.
Third, the source of data (e.g., the organization) may affect the data obtained, in that Hourglass’ campaigning work and organizational characteristics may attract specific enquiries. Nevertheless, this helpline was chosen due to its strengths (i.e., representativeness, national recognition, and special focus on EA; Podnieks et al., 2010). Finally, the EA cases are not substantiated and are based on self-reporting by helpline enquirers at a particular point in time. Nevertheless, because the aim of the study was to understand enquirers’ perspectives of seeking help, their perceptions are of utmost importance.
The present study aimed to explore the profile of family members, friends, neighbors, and acquaintances of EA victims (“concerned persons”), their help-seeking experience, and the impact of knowing about abuse and/or seeking help on behalf of the victim. Concerned persons were primarily the victims’ female family members, who experienced many barriers at different levels, but particularly in relation to formal services. Seeking help on behalf of the victim came at a great cost, particularly psychologically. The study provides support for the need to continue investigating the experience of concerned persons. Additionally, it suggests that practitioners may need to provide tailored support to these concerned persons, given that they are in an ideal position to assist victims, and connect victims with formal services, but may not be able to do so without appropriate assistance.