Elder abuse: the least visible form of violence

“I just bumped into the wardrobe, that’s all.”

Ana visited her mother on the first Sunday of the month, as she always did. On her mother’s forearm she noticed a dark mark the size of a palm. Her mother quickly pulled her sleeve down over it and started talking about the neighbour. Ana’s brother, who has been living with their mother since last year, was “out running errands” that day. Later, looking for sugar in the kitchen, Ana found a bank statement in a drawer. The pension had been withdrawn on the third day of the month. The whole amount, all at once.

Ana drove home with a feeling she couldn’t name. She wasn’t sure anything was happening. But she was sure something wasn’t right. And she didn’t know whether she even had the right to ask.

That feeling — that something isn’t right, but you have no proof, no name for it and no permission — is almost the rule when it comes to the abuse of older people. That is why I am writing about it. Not because I am a specialist in violence; I am not. But because this is a form of violence that all of us, professionals included, overlook most often.

What counts as elder abuse

The World Health Organization describes elder abuse as a single or repeated act — or a lack of appropriate action — occurring within a relationship where there is an expectation of trust, which causes harm or distress to an older person. Two parts of this definition matter most.

The first is the relationship of trust. We are not talking about a thief in the street or a phone scammer, even though both are serious problems. We are talking about people who ought to be on the older person’s side: adult children, grandchildren, partners, relatives, carers, staff in a care home. The violence comes from exactly where care should come from.

The second is the lack of action. Abuse is not only what someone does, but also what they fail to do after taking on the task: not buying the medication, not helping with washing, leaving a person lying in bed. For older people who increasingly depend on others, neglect is often the quietest and the most dangerous form.

If you are interested in how violence in close relationships takes hold and keeps going, the knowledge base has a short explanation of violence in a relationship. With older people the same mechanisms of power and control apply — they are simply joined by physical frailty, illness and dependence.

How common it is — and how much we don’t see

In 2017 Yongjie Yon and colleagues pooled the results of dozens of studies from countries around the world. They found that in the past year roughly one in six people aged 60 or over living at home had experienced some form of abuse — 15.7 per cent in their analysis. Psychological abuse was the most common, followed by financial abuse and neglect.

One in six. That means that in a block of flats with fifty older residents, there are probably several people whom someone close is threatening, taking money from or leaving without help. And we mostly know nothing about them.

How little comes to light was shown by a large study in New York State (2011). The researchers compared the number of cases people described themselves in a survey with the number of cases known to services and agencies over the same period. For every case that reached any service, around twenty-four remained unknown. The figure applies to one American state and cannot simply be transferred to Slovenia. But it says something researchers describe everywhere: elder abuse is hidden almost by definition.

This is not just a question of statistics. As early as 1998, Mark Lachs and colleagues found that older people for whom services had confirmed abuse or neglect had significantly higher mortality in the following years than their peers — even after accounting for illness and other risk factors. Elder abuse is not a “family matter”. It is a health risk.

Five faces that intertwine

When we say violence, most people think of a blow. With older people, physical abuse is serious, but it is not the most common. More often it is something barely visible from the outside.

Psychological abuse is often the first to appear and the last to be recognised: teasing that becomes daily, threats of a care home, silence as punishment, a ban on visitors. Financial abuse is particularly widespread, because older people are often the only ones in the family with a regular income and a home of their own. I have written more about how control is established through money in Economic abuse: when money becomes control. That piece is mostly about partners, but the pattern is the same: whoever holds the money holds the decisions.

With older people, financial abuse likes to hide behind care. “I’m only helping her with the bills.” Sometimes that is true. The difference lies in whether the older person still has insight and a say — or whether both have been taken away. How money, love and control intertwine in families even when there is no abuse is something I describe in Money as love and control: parents and adult children.

Why the people who suffer stay silent

When people hear about elder abuse, they often ask: why don’t they say anything? Why doesn’t Mum tell anyone what is going on? The answer lies in who the abuser is. If a stranger hits you, you report him. If you are being humiliated by the son you gave birth to, reporting it is also an admission that is almost impossible to put into words.

(a composite, not a real person)
“Mum, where’s your pension money?”
“Marko took it to pay my bills.”
“Mum, the bills haven’t been paid. The last reminder is on the table.”
“Please don’t say anything to him. He’s going through a hard time. And where would I go if he got angry?”

This short conversation holds almost everything that keeps elder abuse hidden. Loyalty: Marko isn’t abusive, Marko is going through a hard time. Fear: where would I go. Dependence: perhaps Mum can no longer get to the shop, the doctor or up the stairs by herself. And beneath it all, shame — that this is happening to her, that she raised him like this, that it is even possible. There is a separate entry on the shame that silences people in the knowledge base under shame.

Then come things that are not psychological at all, but purely practical. An older person who is lonely has no one to tell — and the abuser often isolates them further. An older person with dementia or confusion struggles to connect events, and people around them believe them less. And many signs of abuse — bruises, weight loss, confusion, withdrawal — are easily put down to age itself. “Well, she’s old, she’s frail, she forgets.”

I describe the same mechanism in Depression in older people: when we mistake it for age itself. Age becomes the explanation for everything. And once age explains everything, nobody asks what is really going on.

It isn’t always the “exhausted carer”

For a long time there was an explanation that sounds almost compassionate: elder abuse is committed by exhausted carers who lose their temper. The older person is difficult, caring is hard, and eventually you can’t take it any more.

Research has significantly corrected this picture. As early as 1989, Karl Pillemer and David Finkelhor compared older people who were being abused with those who were not. They found that what made the difference was not so much how demanding the older person was, but the characteristics of the abuser: problems with alcohol or drugs, mental health difficulties, weaker social ties — and above all the abuser’s dependence on the victim. Often it is the adult child who lives in Mum’s house, spends Dad’s pension and has no life of their own. Later reviews, including the one by Lachs and Pillemer in 2015, have largely confirmed this picture.

Why does this matter? Because the exhausted-carer explanation points towards the wrong solution: more respite, a little rest, and things will improve. For an exhausted carer, respite really is essential — I write about that below. But when an adult child holds power over a parent and lives off them, respite changes nothing. What is needed is protection.

This does not mean that caring for an ageing parent is easy. It isn’t. What the role brings and where its limits lie is described in the knowledge base under caring for an ageing parent. It only means that exhaustion is not an excuse, and that it is not the only road to abuse.

When violence grows old along with the couple

There is another group we easily overlook: older couples in which violence has been present for decades. The woman whose husband has been humiliating her since their wedding is now eighty. The violence did not end when they retired — fewer people simply see it. The children have left, work no longer exists, her friends have died. Sometimes the violence even gets worse when one partner falls ill and becomes dependent on the other.

These people often do not use the word violence. They grew up at a time when nobody talked about it, and that was just how things were. “He’s always been like that, it’s just worse now.” And the people around them do not see an older couple as a possible setting for violence — they see two old people looking after each other.

The same applies here as with younger couples: when one partner is abusing the other, couples therapy is not an appropriate form of help. Joint sessions can put the victim in danger and create the impression that both are responsible for the violence. The safety of the person experiencing violence comes first.

Signs that should make you pause

The following list is not a tool for working out whether abuse is happening, and it does not tell you how dangerous a situation is. It only tells you when it makes sense to stop and look more closely — or to ask someone who knows about this to take a look.

• Injuries that don’t match the explanation, or injuries at different stages of healing.
• The older person is noticeably more frightened, quiet or withdrawn when a particular person is present.
• Someone always answers for them or won’t leave them alone with you.
• Money disappears, bills go unpaid, new signatures, powers of attorney or changes of ownership appear.
• Neglect that isn’t like them: hunger, unwashed clothes, missing medication, glasses or hearing aid.
• Visits are less and less welcome, the phone goes unanswered, meetings are cancelled.

Important: none of these signs proves abuse on its own. Older people fall, become confused because of illness, spend their money as they see fit. Which is exactly why it is so much easier to look away.

Exercise: a private conversation when you are worried

If you recognise a feeling like Ana’s, the most important step is often very simple: to ask the older person — in private, calmly and without pressure. This exercise is not an interrogation and does not assess danger. It is a way of opening a door they may one day be able to walk through.

1. Write down what you saw, not what you think. Not “my brother is abusing her”, but “bruise on forearm, whole pension withdrawn, Mum withdrew when he came in”. Concrete notes calm you down and help later if you call someone for support.
2. Find a moment when you are alone together. A walk, a drive to the doctor, a coffee away from home. Never raise the subject in front of the person you suspect, and don’t confront them on your own — that can put the older person in greater danger.
3. Start with yourself and an open question. “You were very quiet last time. I’m worried about you. How are things at home at the moment?” Don’t ask “Is Marko hitting you?” — to a question like that, the answer is almost always no.
4. Listen, don’t fix. If they tell you something difficult, don’t rush in with suggestions and don’t attack the abuser, however tempting it is. Say: “Thank you for telling me. It’s not your fault. You’re not alone.”
5. Agree on a next step — or simply that you can talk again. An older person has the right to make decisions about their own life. If they don’t want to take action, tell them they can come back to the conversation at any time, and leave them the phone numbers. But if they are in immediate danger or can no longer look after themselves, don’t wait for their permission — call 112 or 113 (in Slovenia).

Many people avoid that first conversation because they are afraid of being wrong. Being wrong can be uncomfortable, but it can be put right. Silence in the face of abuse, on the other hand, often has consequences that cannot.

Where this doesn’t apply: the limits of this piece

Because the subject is heavy, it is important to say what this piece does not claim.

Not every conflict is abuse. Adult children and parents argue, get angry with each other, say hurtful things. The difference between a difficult relationship and abuse lies in a pattern of power, fear and control — not in the fact that things sometimes get loud. When a relationship hurts but there is no abuse, the answer is often elsewhere, perhaps in the question I explore in Adult children and parents: can the relationship still be repaired?

Sometimes it is the older person who is aggressive. Dementia can bring outbursts, blows, accusations. A carer who experiences this is not the abuser — they need support, professional help and often a medical assessment of the older person. It is a different situation, even if it can be just as dangerous and just as exhausting.

An exhausted carer needs help before anything happens. If you are caring for a parent and notice that you are becoming rough, that you shout, or that you feel the pull to leave them on their own, it does not mean you are a bad person. It means you are past your limit. That is the time to look for relief — home help, other family members, your own GP, the local social work centre. And to talk to someone about it before something happens that you would be ashamed of.

Autonomy is not neglect. An older person who has full capacity is allowed to live differently from how their children would like: in an untidy flat, making different decisions about money, without help they refuse. Care that takes away every decision can itself become a form of control.

And finally: this piece does not replace professional judgement. It cannot assess how dangerous a situation you know about is. The people I list below can.

Sometimes, behind not asking, there is also grief. Watching a parent who is no longer who they were is a loss in itself. I write about how painful it is to grieve for someone who is still alive in Grieving someone who is still alive: dementia, addiction, estrangement. But when you sense fear alongside that grief, it is time to act.

Where to find help in Slovenia

In Slovenia, violence between family members — including between adult children and parents, and between older partners — is covered by the Family Violence Prevention Act (Zakon o preprečevanju nasilja v družini). This means the same routes are open to you as for other forms of family violence:

• 112 (in Slovenia) — emergency medical help, when someone is injured or in danger.
• 113 (in Slovenia) — the police, when violence is happening or there is an immediate threat.
• The social work centre (center za socialno delo) where the older person lives — it accepts reports and arranges support, including when the older person cannot look after themselves.
• The older person’s GP — who can assess injuries, health and capacity to make decisions, and involve other services.
• SOS helpline for women and children victims of violence: 080 11 55 (in Slovenia) — anonymous and free, also for older women experiencing violence.
• Mental health crisis line (Klic v duševni stiski): 01 520 99 00 (in Slovenia, daily from 7 pm to 7 am) and Samaritan helpline (Samarijan): 116 123 (in Slovenia, 24 hours) — if you need to talk yourself, as a victim, a relative or a carer.

I have described these routes in more detail in Where to get help with abuse in Slovenia: a map for the first step.

And therapy? Psychotherapy does not replace protection. Once safety is in place, though, it can have its role: for the older person working through what they have experienced; for the adult child carrying the guilt of not seeing it sooner; for the carer who has lost themselves. In relational family therapy, the approach I am training in as a therapist in training under supervision, it often becomes clear that the patterns of power and dependence revealed in old age took shape in the family much earlier. Understanding them does not mean excusing them — it means not passing them on.

What to remember

• Elder abuse is common: according to a large international analysis, roughly one in six people over 60 experience it in a single year, and most of it goes unreported.
• It is most often committed by people the older person trusts — children, partners, carers — and it is most often psychological or financial, not physical.
• Carer exhaustion is not the only explanation: what often decides it is the abuser’s dependence on the victim, their home and their money.
• If you are worried, ask in private, calmly, and without confronting the abuser. In immediate danger, call 112 or 113 (in Slovenia).
• Psychotherapy does not replace protection; when one partner abuses the other, couples therapy is not an appropriate form of help.