Grades are shown as the source states them. The USPSTF grades its recommendation (an I statement means the evidence is insufficient to weigh benefits and harms). The WHO fact sheet and the systematic review are not graded. Physical warning signs of abuse are not covered: the sources that list them could not be read under their sites' terms.
Key recommendations
Elder abuse is a single or repeated act, or a failure to act, within a relationship where there is an expectation of trust, that causes harm or distress to an older person. It is a violation of human rights.
Types: physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation. The abuser is a trusted person such as a caregiver, a relationship that brings help with daily activities and an expectation of trust.
About 1 in 6 people aged 60 and over (15.7%) living in the community experienced some form of abuse in the past year. In institutions such as nursing homes, 2 in 3 staff (64.2%) report having committed abuse in the past year.
Key facts; Scope of the problemWorld Health Organization (WHO) 2024
Abuse can cause physical injury, early death, depression, cognitive decline, financial ruin and admission to a care home; in older people the consequences are especially serious and recovery may take longer.
ConsequencesWorld Health Organization (WHO) 2024
The evidence is insufficient to weigh the benefits and harms of screening older or vulnerable adults who have no signs or symptoms for caregiver abuse and neglect.
I statementRecommendation SummaryUS Preventive Services Task Force (USPSTF) 2025
Diagnosis
By type, abuse reported by older people in the community in the past year: psychological 11.6%, financial 6.8%, neglect 4.2%, physical 2.6% and sexual 0.9%. Abuse reported by staff in institutions: psychological 32.5%, neglect 12.0%, physical 9.3% and sexual 0.7%.
Risk factors for being abused: isolation, lack of social support, functional impairment, poor physical health, cognitive impairment, low socioeconomic status and a past abusive relationship.
Suggestions for Practice Regarding the I Statement: Potential Preventable BurdenUS Preventive Services Task Force (USPSTF) 2025
Risk factors for being an abuser include mental illness, substance misuse and dependence — often financial — on the older person. Ageism and cultural norms that accept violence add risk; social support reduces it.
Risk factorsWorld Health Organization (WHO) 2024
In a US national study, 12% of older adults had experienced one form of abuse and 2% several forms over their lifetime; financial exploitation (35%) and neglect (34%) were reported most often. Most abuse was by people other than partners (56%), but older adults also experience intimate partner violence (23%).
Suggestions for Practice Regarding the I Statement: Potential Preventable BurdenUS Preventive Services Task Force (USPSTF) 2025
Investigations
Screening tools exist for emergency care — for example ED Senior AID (sensitivity 94%, specificity 84% in a three-site study, taking about a minute and a half), EM-SART and ERASE — but none has been shown to improve outcomes for the people screened.
Results: ED screening for elder mistreatment; Table 3Geriatric Emergency Department Guidelines 2.0 elder mistreatment working group 2026
Tool accuracy outside emergency care is poor or uncertain: the Hwalek–Sengstock Elder Abuse Screening Test had a sensitivity of 46% and specificity of 73% in older adults attending routine dental care.
Accuracy of Screening Tests: Abuse of Older AdultsUS Preventive Services Task Force (USPSTF) 2025
Treatment
The most promising responses are interventions that relieve caregiver burden, money-management programmes for people at risk of financial exploitation, helplines and emergency shelters, and multidisciplinary teams spanning criminal justice, health, mental health, adult protective services and long-term care — though evidence for most is limited.
PreventionWorld Health Organization (WHO) 2024
Hospital-based multidisciplinary response teams, such as the Vulnerable Elder Protection Team, coordinate the medical team, social workers, adult protective services and community resources. In studies without a comparison group, discharge plans changed for 75% of patients seen, and mistreatment had resolved at 12 months in 61% of those followed up.
Results: ED intervention for elder mistreatment; Table 4Geriatric Emergency Department Guidelines 2.0 elder mistreatment working group 2026
Important geriatric considerations
Asking about abuse can itself cause harm: shame, guilt, self-blame, retaliation or abandonment by the abuser, and the labelling and stigma of a false-positive result. In video or phone consultations a caregiver may overhear the answers.
Suggestions for Practice Regarding the I Statement: Potential HarmsUS Preventive Services Task Force (USPSTF) 2025
Groups overlap: an older person with a disability may also be a vulnerable adult, and older people can experience intimate partner violence as well as abuse by caregivers.
Numbers will rise with population ageing: even at today's rates, victims would reach about 320 million by 2050 as the number of people aged 60 and over reaches 2 billion.
Scope of the problemWorld Health Organization (WHO) 2024
Drug doses
Not covered in this summary — see the original guideline.
When to refer
Reporting rules differ: in the United States they vary by state, but most states require suspected abuse of an older adult to be reported. Check the legal duties where you practise.
Suggestions for Practice Regarding the I Statement: Current PracticeUS Preventive Services Task Force (USPSTF) 2025
Red flags
Not covered in this summary — see the original guideline.
Recent updates
The 2025 USPSTF statement, replacing the 2018 one, keeps an I statement for screening older or vulnerable adults for caregiver abuse; its review found no studies of the benefits or harms of screening or early intervention in older adults.
I statementRecommendation Summary; Benefits of Early Detection and Interventions; Harms of Screening or TreatmentUS Preventive Services Task Force (USPSTF) 2025
Professional bodies differ: the American Medical Association and American Academy of Neurology recommend routinely screening all patients for abuse and neglect, and the American College of Obstetricians and Gynecologists recommends screening people aged 60 and over for signs and symptoms of mistreatment.
Recommendations of OthersUS Preventive Services Task Force (USPSTF) 2025
The 2026 systematic reviews for the Geriatric Emergency Department Guidelines 2.0 found no study that compared screened with unscreened older people, or intervention with usual care, so future guidelines will rely on indirect, lower-certainty evidence.
Discussion; ConclusionGeriatric Emergency Department Guidelines 2.0 elder mistreatment working group 2026
WHO's five priorities for 2021–2030 are to combat ageism, gather better data, develop and scale up cost-effective solutions, make the investment case, and raise funds.
WHO responseWorld Health Organization (WHO) 2024