Guardianship in the elderly and the Community Care Act: more of the same?

Guardianship has been used in increasing numbers of elderly mentally disordered Scots in the past decade. During this time, the Community Care Act (CCA) encouraging the provision of care for individuals in their home has been enacted. This study aimed to see if the increased use of guardianship could be due to the use of orders to maintain at-risk elderly people in their homes.

A retrospective survey of all new guardianship orders in people aged 65 or over, comparing those in the two years before the CCA with those in the two years after. Cases were identified using the Mental Welfare Commission (MWC) database. MWC records for the individuals placed on guardianship were examined for data on demographics, social circumstances and perceived risks, together with duration and outcome of orders. Hospital case records were examined for diagnostic information.

All individuals aged 65 or over placed on guardianship under the Mental Health (Scotland) Act 1984 between 1st April 1991 and 31st March 1995.

85 new guardianship orders were identified, 22 before and 63 after CCA. Most were female (82% before and 85% after) and suffered from organic mental disorders (82% before and 84% after). The modal duration of orders for both groups was six months with a trend towards longer orders being noted in the after CCA group. The majority of orders resulted in the placement of the individual in nursing or residential home care (82% before and after CCA).

The increased use of guardianship in elderly mentally disordered individuals is not explained by the use of orders to maintain them at home. It is likelier that the process of social work assessment required by the CCA highlights more cases where guardianship could be used.