The focus of Chapter 6 is the abuse, mistreatment and neglect of older people. It is a cross-cutting issue that spans settings and contexts and is self-evidently damaging to well-being and to physical and mental health (Milne et al, 2013). Prevalence and incidence of abuse will be discussed first before reviewing what is known about its causes, nature and impact. It is important to note that mental ill health intersects with abuse and mistreatment in at least two overarching ways: older people with mental illness, especially dementia, are at heightened risk of abuse; and older people who are victims of abuse are at risk of poorer mental health.

Prevalence and incidence of abuse and neglect of older people

Due to the fact that abuse of older people occurs ‘behind closed doors’ and often goes unreported, accurate statistics about its prevalence and incidence are difficult to obtain. Current estimates suggest that between 2 per cent and 10 per cent of older people suffer ‘some form of abuse’. Randomised, community-based epidemiological studies have reported annual rates of between 2 per cent and 4 per cent in the United States, Canada and Europe (Sethi et al, 2011). The 2007 UK Study of Abuse and Neglect of Older People identified that 8.6 per cent of older people (those aged 66 years or over) living in the community experienced some form of ‘mistreatment’ (O’Keefe et al, 2007). ‘Mistreatment’ was defined as physical, psychological, sexual or financial abuse or neglect. The survey identified that the prevalence of mistreatment increased with declining health of the victim; it also noted the particular vulnerability of very elderly people who have complex comorbid health conditions (O’Keefe et al, 2007). Action on Elder Abuse (a charity) estimates that at least 500,000 older people are abused each year in the UK (2004). Data drawn from ‘adult safeguarding systems’ suggest that older women make up the vast majority of victims (Milne et al, 2013).

Studies focusing on older people dependent on family carers report that approximately a quarter have experienced significant psychological abuse and a fifth neglect (Hirsch and Vollhardt, 2008; Association of Directors of Adult Social Services, 2011). In studies with well-defined target populations, 11 to 20 per cent of family carers reported physically abusing the relative they support and 37 to 55 per cent reported verbally abusing or neglecting them (Cooper et al, 2008).