Elder abuse and neglect !

Harm or neglect of an older person by someone they trust, such as a relative or caregiver. It is common, hidden and often first seen by health staff.

Updated 2026-11-01

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What it is

A single or repeated act, or a failure to act, within a relationship of trust that causes harm or distress to an older person. It includes physical, psychological, sexual and financial abuse, and neglect or abandonment by a caregiver or institution.

Who gets it

According to WHO, about one in six people aged 60 and over living in the community suffered some form of abuse in the past year, psychological abuse being the most frequent, and rates are higher in nursing homes. Most cases are never reported. In Colombia and Latin America, abuse usually happens inside the family, often linked to economic dependence, caregiver overload and abandonment; Colombian law protects older adults and treats abandonment as a form of family violence.

Causes

Physical abuse: hitting, pushing, burns or inappropriate restraint (physical or chemical)
Psychological or emotional abuse: threats, humiliation, isolation or intimidation
Financial exploitation: taking money, property or pensions, or forcing changes to documents
Sexual abuse: any non-consensual sexual contact, including with a person unable to consent
Neglect or abandonment: failure to provide food, water, hygiene, medication, safety or medical care

Risk factors

Functional dependence, disability or poor physical health in the older person
Dementia or other cognitive impairment
Social isolation and low income
Caregiver stress, burnout, mental illness or substance misuse
Abuser who depends on the victim, often financially
Shared housing with family conflict, and ageism in the community
Institutions with too few or poorly trained staff

Pathophysiology

It is a social and relational problem rather than a disease process. Dependence on others, cognitive decline and isolation make the older person vulnerable and less able to report harm. Frailty, thin skin, fragile bones and slow healing make even minor violence or neglect produce serious injuries, malnutrition, dehydration, pressure injuries and medical decompensation.

Classification

By type: physical, psychological, sexual, financial and neglect (active or passive)
By setting: domestic (family, home caregiver) or institutional (care homes, hospitals)
Self-neglect, in which the older person fails to meet their own basic needs, is usually studied alongside

Symptoms and signs

Bruises of different ages, especially on the inner arms, trunk, face or in a grip pattern
Injuries that do not match the explanation given, or a delay in seeking care
Untreated or deep pressure injuries, poor hygiene, soiled clothing
Weight loss, malnutrition and dehydration without a medical explanation
Fear, withdrawal, agitation or depression, especially in the presence of the caregiver
Missed appointments, missing medicines or glasses, hearing aids or dentures
Sudden changes in bank accounts, wills or property

Diagnosis

Clinical: Suspicion from the history and examination. The older person is interviewed alone and the skin is examined completely (including back, sacrum and heels). Injuries are documented with their location, size, colour and photographs. Cognition and the capacity to make decisions are assessed. Screening questions or tools (such as the Elder Abuse Suspicion Index) can be used in primary care.
Tests: Tests support the assessment of injuries and neglect: blood count, electrolytes, kidney function, albumin and nutritional markers, and medication or drug levels when chemical restraint or over-sedation is suspected.
Imaging: X-rays or CT when a fracture or head injury is suspected; multiple fractures at different stages of healing raise suspicion.

Differential diagnosis

Senile purpura and easy bruising from anticoagulants, antiplatelets or glucocorticoids
Accidental falls in a frail person
Pressure injuries despite good care in a very immobile patient
Weight loss from cancer, depression, dementia or other illness
Pathological fractures from osteoporosis or metastases

Goal of treatment

Ensure the immediate safety of the older person, treat injuries and medical consequences, respect their autonomy and decision-making capacity, and activate the legal and social protection network.

Treatment

Acute: Immediate protection when life is at risk: hospital admission or a safe place, and treatment of injuries, dehydration and infections.
Conservative: Report to the competent authorities as required by local law (in Colombia, family commissioners, police or the health and social protection network); clear documentation in the medical record.
Conservative: Interdisciplinary work with social work, psychology and geriatrics: safety plan, support for overloaded caregivers, respite care and, when needed, a change of caregiver or residence.
Follow-up: Follow-up of nutrition, skin, medicines and mood; repeat home or institutional visits to confirm that the situation has improved.

Complications

Fractures, head injury and death
Pressure injuries, malnutrition and dehydration
Depression, anxiety and loss of trust
Loss of money, property or housing
More hospital admissions, earlier institutionalisation and higher mortality

Prognosis

Abuse rarely stops without outside intervention. Victims have higher mortality and more hospital admissions than other older adults; early detection and a coordinated social and legal response improve safety.

Prevention

Education of families and caregivers, and support for caregiver burden
Routine questions about safety in geriatric visits
Adequate staffing, training and supervision in care homes
Community programmes against ageism and social isolation

Test yourself

Think of the answer, then tap the question to see it.

According to WHO, what is the most frequent type of abuse reported by older adults living in the community?

Psychological (emotional) abuse, followed by financial abuse and neglect.

Which bruise patterns raise suspicion of physical abuse in an older adult?

Bruises on the inner arms, trunk, face or ears, grip-shaped marks, bruises of different ages, and injuries that do not match the explanation.

How should an older adult with suspected abuse be interviewed?

Alone, without the caregiver present, with a full skin examination and careful documentation of the findings.

Which finding on the skin is a classic sign of neglect in a bedbound older person?

Untreated or advanced pressure injuries, especially over the sacrum and heels, with poor hygiene.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Abuse of older people (World Health Organization, 2024); Elder Abuse (MedlinePlus (U.S. National Library of Medicine), 2025).

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Representative model, for educational purposes only.

Skin highlighted on the Durgical 3D model