Hidden harm: the growing threat of elder abuse in demographically shifting populations

Despite the growing global emphasis on promoting independence and community-based care in ageing policies, elder abuse remains a critical and often overlooked threat to older adults’ well-being. Defined by the World Health Organization (WHO) as a ‘single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person,’ elder abuse fundamentally undermines the health, dignity, autonomy, and security of older adults¹. Understanding elder abuse requires examining how ageing policies are framed, how older adults’ roles have changed, and how cultural norms shape perceptions of ageing. Ageing policies increasingly promote independent living, active ageing, and community-based care as strategies to manage growing older populations². Central to this vision is the concept of ‘ageing in place’, which encourages older adults to remain in their own homes through home care, assistive technologies, and local services^3,4. Many countries also pursue deinstitutionalisation, aiming to reduce reliance on residential facilities⁵. These strategies are often framed as efforts to enhance the quality of life of older people, while also being driven by cost-efficiency and economic concerns⁶. Without adequate support and safeguards, however, these shifts – while well-intended – may unintentionally foster conditions where elder abuse is more likely to occur, particularly for those who are isolated or dependent. The intersecting factors contributing to this vulnerability will be explored in the following sections.

First, there is the social status of older people. In the past, old age was recurrently viewed as a life stage characterised by dignity, purpose and respect. Indeed, in many pre-industrial and agrarian societies, older individuals were seen as figures of esteem and leadership, often occupying central roles within family, community, and governance structures. This was not merely symbolic but reflected their roles and responsibilities in society, including control over land, wealth, and intergenerational decision-making. Their authority was grounded in both economic influence and cultural status⁷. Older people were also respected for their wisdom, lived experience, and their role as custodians of historical records and moral traditions⁸. In some cultures, like African and Native American communities, older people held key leadership positions when making crucial decisions affecting the entire group⁹. Unlike in modern nuclear families, traditional households often comprised multiple generations living under one roof. In such arrangements, older adults were cared for by their children and grandchildren, in exchange for the wisdom and services they continued to provide¹⁰. Reciprocal relationships ensured social security for ageing members and emphasised the value of caregiving as a cultural norm. While this does not suggest that all older people were universally well-treated or that abuse was entirely absent, the prevailing values and societal structures offered protection from elder abuse¹¹.

The Industrial Revolution in the late 18^th and early 19^th centuries brought changes to social, economic, and familial structures, impacting older adults’ social status. Migration from rural to urban environments, housing constraints and changing labor demands resulted in the breakdown of intergenerational households and the rise of nuclear families. This transformation left older adults less integrated into daily family life. Moreover, as industrial societies increasingly prioritised economic productivity, older individuals, no longer viewed as active contributors to the labour market, were increasingly perceived as less valuable in economic and public spheres¹². This devaluation was also cultural, as youth became equated with progress and innovation¹³ and older individuals were often portrayed as dependent burdens rather than valued contributors¹⁴. As a consequence, these shifts weakened traditional roles that once protected older adults, increasing the risk of neglect and abuse.

In the decades following World War II, the expansion of welfare States across much of the Western world introduced comprehensive public pension systems. This provided unprecedented financial security for retirees, reducing poverty among older people¹⁵. However, by defining old age as a stage of economic dependency, such systems also reinforced marginalisation, relegating older adults to the periphery of productive life and framing them as passive beneficiaries rather than active participants¹⁶. The mid-20^th century also witnessed significant medical and public health improvements, contributing to longer life expectancies and better management of chronic conditions¹⁷. Yet these gains in longevity were not always matched by social inclusion, leaving many older adults to live longer lives in isolation and disengagement. In response to this, gerontological movements emerged, promoting empowerment and equal rights, resulting in a reimagining of ageing through concepts such as active ageing, lifelong learning, and intergenerational integration, shifting away from dependency models toward agency, adaptability, and engagement in later life. However, these developments are challenged by norm thinking, a tendency to apply dominant societal norms as a basis for judgment or exclusion, commonly manifested through the valorisation of youth as the default or ideal state, leaving older people feeling invisible and undervalued despite their lifelong contributions. Consequently, ageing is once more framed negatively as decline, loss, or burden¹⁸. This mindset also extends to public transportation systems, digital interfaces, and housing, which are typically structured around the needs and capacities of young, able-bodied individuals and, as a result, reinforce exclusion and dependency. The implications of norm thinking are profound, influencing everything from personal interactions to institutional policies¹⁹.

Thus, while ageing in place re-aligns with dignity and autonomy, its implementation must be accompanied by robust support systems, including workforce development and informal caregiver support. As formal care shifts towards home-based and informal arrangements, oversight decreases, and care responsibilities fall disproportionately on family members or undertrained workers, increasing the risk of abuse²⁰. Without adequate support, training, and monitoring, home settings may foster conditions where emotional, physical, or financial abuse can go unnoticed, particularly for isolated or cognitively impaired older adults. This risk is further intensified by the global shortage of professional care staff, leading to rushed care, limited time for observations or meaningful interaction, and increased caregiver stress²¹. Indeed, healthcare systems and elder care in particular face severe staff shortages, with the WHO projecting a global shortfall of 10 million health workers by 2030²². In such pressured environments, where needs are more complex, abuse can emerge not only from malicious intent but from structural neglect, where overburdened caregivers cannot simply ensure safety, dignity, and well-being. Complex care needs, reduced oversight, and systemic strain create a fertile ground for elder abuse to occur, often unnoticed and unaddressed, making it essential to understand not only its causes but also its profound, long-lasting consequences. Meert and De Donder²³ highlight systemic challenges in Flanders’ home care sector, where staff shortages, time constraints, and inadequate training contribute to rushed care, caregiver fatigue, and insufficient structural support, all of which elevate the risk of abuse, even in well-intentioned settings.

Elder abuse affects not only the individuals involved but also families, care systems, and societies at large. Indeed, it can result in serious physical harm, including bruises, fractures, permanent disability, or even premature death²⁴. However, the psychological impacts are equally severe as victims frequently suffer from depression, anxiety, chronic stress, and Post Traumatic Stress Disorder (PTSD)-like symptoms^25-27. Emotional neglect and humiliation can lead to social withdrawal, loss of trust, and suicidal ideation^28,29. Notably, abuse has been linked to a higher risk of mortality, even after accounting for other risk factors³⁰. Beyond individual suffering, elder abuse places a heavy burden on healthcare and social support systems. Victims are more likely to need emergency care, hospitalisation, or institutional placement²⁴. Financial abuse can deplete life savings, leaving older adults economically dependent and often without adequate legal recourse due to underreporting³¹. At a societal level, abuse perpetuates ageist narratives that depict older people as frail and burdensome, undermining their value and marginalising their role in society. De Donder et al³², point towards considering contextual and cross-national factors in elder abuse to develop effective prevention strategies and inform policy decisions³².

To conclude, the phenomenon of elder abuse cannot be understood merely through individual or familial failings – it is embedded in structural, cultural, and systemic shifts that have redefined how societies treat and perceive older adults. Although global ageing policies emphasise independence, autonomy, and community-based care, this ideal is often undermined by the realities of fragmented support systems, institutional under-resourcing, and persistent ageist narratives. The erosion of traditional family caregiving networks, once rooted in intergenerational co-residence and reciprocal support, has left many older adults physically and socially isolated. This isolation, especially in the absence of robust formal care alternatives, creates fertile ground for neglect, emotional abuse, and unnoticed deterioration in well-being. The ideal of ‘ageing in place’ becomes a risk factor when home-based care lacks oversight or consistency, particularly in settings where (in)formal caregivers are overburdened or untrained. Norm thinking and the devaluation of ageing have led to institutionalised ageism. This cultural backdrop normalises practices and policies that overlook older people’s needs or exclude them from design and service provision. As a result, the systemic invisibility of older adults contributes to environments in which abuse, particularly emotional or psychological, can go unnoticed and unchallenged. The medicalisation of ageing and the rise in multimorbidity have expanded the range and complexity of older adults’ needs. Yet these needs are increasingly managed within systems experiencing chronic staff shortages and care fragmentation. Under such pressures, caregivers are more prone to burnout, miscommunication, and procedural shortcuts – all of which raise the likelihood of unintentional harm, neglect, or even deliberate mistreatment, as older adults are increasingly treated as economically dependent ‘burdens’ under systems that link value to productivity. This perception can manifest as financial exploitation, restriction of autonomy, or coercive control, particularly in familial settings where older persons may be reliant on others for access to pensions, housing, or care. Although gerontological activism and inclusive ageing paradigms are on the rise, they are far from fully embedded in policy or practice. Without a broad societal commitment to intergenerational integration, inclusive design, and the dignification of old age, the risk of elder abuse will remain a systemic and persistent threat, embedded in the very structures designed to care for older populations.