Abuse, mistreatment and neglect

Between 2% and 10% of all older people are estimated to be victims of abuse. Isolation, frailty, dementia and dependency are all risk factors. Abuse and mistreatment occur in all contexts - family members are often implicated in domestic settings and paid workers in care settings. Whatever its aetiology abuse, in all its guises, has profoundly negative mental health consequences, including depression, anxiety, learned helplessness and post-traumatic stress disorder. These are pronounced in situations where exposure to abuse has been long term. At present all ‘types’ of abuse - domestic abuse, sexual violence, institutional abuse, abuse by a relative -are managed under the institutional umbrella of ‘safeguarding’. This model not only uncouples abuse from its (often) lifecourse roots but tends to foreground age as its defining dimension. Most policy related literature does not refer to frailty, socioeconomic disadvantage, gender, or issues of power. As power lies at the very heart of abuse of older people in all contexts this is a profound oversight. Policy and practice responses struggle to accommodate the complex causes of abuse, structural issues, or the perspective of the older person. They also fail to engage with a discourse of rights and social justice.