Elder abuse and neglect: recognising it and where to report concerns in the UK

Abuse of an older person is harm that is done to them, or that they are put at risk of, by someone else. That can be someone they know, rely on or trust, such as a relative, a paid carer, a friend or a member of staff, though it can also come from others. GOV.UK gives examples including neglect, pressuring someone to give away money or property, psychological abuse such as threats, harassment or forcing someone to live somewhere they do not want to, physical abuse such as violence, and sexual abuse.

Neglect is a form of abuse that can be an act or a failure to act. SCIE describes neglect and acts of omission as failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, or personal or medical care, along with failing to give medication as prescribed and preventing access to glasses, hearing aids or dentures. It treats self-neglect as a separate category, meaning a lack of self-care to an extent that it threatens personal health and safety.

The words elder abuse are not used in every service. SCIE frames this work as safeguarding adults, and its guidance is written for people who come into contact with people with care and support needs.

SCIE sets out types of abuse and examples of behaviour in each. The lists are not exhaustive and people may experience more than one type at the same time.

SCIE stresses that evidence of one indicator should not be taken on its own as proof that abuse is happening, but it should alert you to look further. Many of the signs it lists can also have innocent explanations, such as illness, medication or frailty, which is why a safeguarding concern is a request for assessment, not an accusation.

• Physical: injuries with no explanation or inconsistent with the account given, bruising, cuts, burns, frequent injuries or unexplained falls, signs of malnutrition.

• Neglect: a dirty or unhygienic environment, poor personal hygiene, pressure sores or ulcers, unexplained weight loss, untreated injuries and medical problems, accumulation of untaken medication.

• Psychological: withdrawal or a change in psychological state, insomnia, low self-esteem, tearfulness or anger, an air of silence when a particular person is present.

• Financial: missing possessions, unexplained withdrawals or lack of money, a lasting power of attorney being obtained after the person has lost capacity, unusual interest in the person's assets by family or others.

• Behavioural: changed behaviour in the presence of a particular person, reluctance to be alone with someone, fear of receiving help with personal care.

GOV.UK sets out where to take a concern. If you are reporting a crime that is in progress, or someone is in immediate danger, call 999. If you think a crime has been committed, contact the local police. If you think someone is at risk or is being abused, contact the local council.

For a particular setting, GOV.UK says to contact the local council if you are concerned that someone is not being treated properly in a care home or is being mistreated by a home carer. For concerns about NHS hospital or clinic care, contact the manager of the hospital or clinic. GOV.UK also names Hourglass (Safer Ageing) as a helpline for discussing concerns and getting advice.

If the person is a patient you know through a health or care role, follow your organisation's safeguarding policy as well. For anyone with a concern, it is reasonable to write down what you saw and when, without confronting the person you suspect.

Abuse and neglect can show up in healthcare settings as injuries, malnutrition, dehydration, pressure sores, untreated illness, missed appointments, medicines not taken as prescribed, anxiety, low mood or withdrawal. SCIE lists several of these among its signs and indicators, and also lists failure to seek medical treatment or frequent changes of GP among the signs and indicators of physical abuse.

This is why GPs, district nurses, hospital teams and pharmacists are asked to be alert to it. If an older person tells you something worrying, take them seriously, listen, and let them say what they would want to happen where they are able to. SCIE notes that signs of abuse can be difficult to detect, so reporting a concern is more important than being certain.

Abuse can happen in any setting, including NHS, council-funded, independent and private care, and in a person's own home. GOV.UK's advice is to contact the local council about care homes and home carers, and the manager of an NHS hospital or clinic about NHS care.