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Education And Debate

Caring for Older People: Elder abuse

BMJ 1996; 313 doi: (Published 31 August 1996) Cite this as: BMJ 1996;313:548
  1. Mark Bradley, senior registrara
  1. a Department of Geriatrics/General Medicine, Seacroft Hospital, Leeds LS14 6UH

    Elder abuse takes many forms and occurs in a variety of settings; it is both under-recognised and under-reported. Despite a lack of statutory guidelines or legislation, effective management is possible. More could be done to recognise abuse, and healthcare workers need to be vigilant, paying attention to both the circumstances in which abuse occurs and its warning signs.

    Elder abuse may be physical, sexual, psychological, or financial. It may be intentional, unintentional, or the result of neglect. It causes harm to the older person either temporarily or over a period of time. Abuse occurs in many forms and a variety of settings. The often quoted stereotype of a highly dependent white woman over the age of 75 who is being physically abused by her son or daughter is only a small aspect of this problem.

    The scale of the problem is not known as there is no accepted way of recording cases. Attention is increasingly being focused on elder abuse, largely because of the influence of the Community Care Act. Many cases, however, go unreported.


    There are many reasons why older people are abused. The most common include deteriorating family relationships, caregivers who have been abused themselves, social isolation, psychopathology of the abuser, and imbalance of power between abused and abuser. Caring for a sick, dependent elderly person is a challenge for even the most capable person. When caregivers to older people have little support from within the community they may suffer intolerable strain and this may lead to elder abuse. Disturbed sleep, difficult behaviour, and faecal incontinence often result in severe strain on the caregiver and may set the scene for abuse. Many caregivers express feelings of frustration, despair, and worry and of not being cared for themselves. They often feel that the situation is beyond their control. Difficult …

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