Elder abuse in the UK: out of the shadows and on to the agenda

Correspondence to: C Stephens [email protected]

Elder abuse is a major public health problem, facing one in six older people globally (defined as aged 60 and older).¹² Older people with dementia are at much higher risk,³ and the disease is predicted to affect over a million people in the UK by 2025.⁴

In 2021, a report by the House of Lords described abuse of older people, particularly those with dementia, as complex, poorly measured, and hidden.⁵ Physical abuse includes violence, but psychological and financial abuse is recorded as the most common form of harm, including manipulation of older people to obtain assets through marriage, wills, and abuse of lasting powers of attorney.⁶ Controlling and coercive behaviour by perpetrators and social isolation of victims make elder abuse difficult to detect or tackle.⁷ The UK General Medical Council recommends that health professionals should be familiar with different types of abuse in order to identify patients at risk, noting that many abuses are now criminal offences.⁸

UK policy changes—and challenges

Since the previous editorial on this subject in The BMJ in 2011,⁹ UK legislation has substantially changed. New domestic abuse crimes have been introduced, including forced marriage (2014)¹⁰ and coercive and controlling behaviour (2015).¹¹ The Domestic Abuse Act 2021 introduced a statutory definition of domestic abuse in UK law for the first time.¹² The Forced Marriage Unit was established in 2005 to protect victims coerced into marriage, and the Office of the Public Guardian was established in 2007 to protect people from abuse of powers of attorney. In health and social care, adult safeguarding guidance and multiagency safeguarding teams now exist.⁸ Together, these have great potential to prevent abuse or intervene when it occurs.

We do not yet know whether these changes have led to more action against abuse. This is because basic data on the scale of elder abuse in the UK are lacking, creating “systematic invisibility.”¹³ For example, the Crime Survey for England and Wales excluded respondents older than 59 until 2017 (it still excludes people older than 74) and does not survey group residences, thereby excluding elderly...