Neglect and abuse of older adults

Abuse of older adults is a common and increasing worldwide phenomenon as populations live longer.

Many different forms of abuse exist, including neglect; physical, psychological, sexual, or financial abuse; and self-neglect.

The key to diagnosis is maintaining a high index of suspicion with every patient encounter with older adults.

Certain patient and carer characteristics can help identify high risk for abuse.

Knowledge of local reporting procedures is advisable, as these may differ between countries and states.

Management requires a multi-disciplinary approach and includes immediate care, long-term assessment and care, education, and prevention.

There is increasing consensus on the key components that constitute abuse and neglect of older adults (also known as elder abuse), and on the types of mistreatment involved. Presently, there is no globally accepted definition of abuse of older adults, which makes it difficult for researchers to study, determine trends, and evaluate benefits of interventions.

According to the Centers for Disease Control and Prevention (CDC): 'Older person abuse is an intentional act or failure to act that causes or creates a risk of harm to an older adult. An older adult is someone aged 60 years or older.'[1]Centers for Disease Control and Prevention. About abuse of older persons. Nov 2024 [internet publication]. https://www.cdc.gov/elder-abuse/about

The World Health Organization states: 'The abuse of older people is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.'[2]World Health Organization. Abuse of older people. 2024 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people WHO: abuse of older people factsheet Opens in new window

Older adult abuse is often considered to be perpetrated by a caregiver or trusted individual. The widespread use of technology and increased geographical separation of families have also heightened older adults' risk of victimisation through fraudulent schemes by strangers. Financial fraud is one of the fastest growing forms of older adult abuse. Guardianship, meant to protect older adults unable to care for themselves, has also been inappropriately used to victimise older adults with assets.