Care Act 2014 · Mental Capacity Act 2005 · DoLS

Elder Abuse

Elder abuse is widespread and chronically under-reported. This guide covers definitions, types, warning signs by setting, Care Act 2014 duties, DoLS, institutional abuse, LPA misuse, and referral pathways for England-based practitioners.

1 in 6
Older people will have experienced abuse in the past year (WHO 2021 global estimate)
5%
Report it — the vast majority of elder abuse goes unreported (Comic Relief / ICM)
80%
Of perpetrators are family members or carers known to the victim (Hourglass)
£2.6bn
Annual cost of elder financial abuse alone in the UK (Age UK)

⚖️ Definition & Legal Framework

The WHO defines elder abuse 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." In England, elder abuse is addressed within the Care Act 2014 adult safeguarding framework — there is no separate elder abuse legislation.

Key threshold (Care Act 2014 s.42): The local authority duty to enquire is triggered when an older person has care and support needs, is experiencing or at risk of abuse or neglect, AND is unable to protect themselves as a result of those needs.

🔍 Types of Elder Abuse

Physical abuse
Hitting, restraining, inappropriate medication, over- or under-medicating, withholding food or fluids.
Psychological / emotional
Humiliation, threats, isolation from family and friends, verbal abuse, ignoring the person.
Financial abuse
Theft, benefit fraud, will coercion, LPA misuse, doorstep scams, romance fraud. Most reported type in adult safeguarding statistics.
Sexual abuse
Any non-consensual sexual act. Particularly affects older people with dementia who cannot consent or communicate a disclosure.
Neglect & acts of omission
Failing to provide adequate care, nutrition, medication, hygiene, or medical treatment. Can be active (deliberate) or passive (ignorance/lack of skills).
Institutional abuse
Poor practice in a care home, hospital, or day service — rigid routines, lack of choice, infantilisation, and punitive responses to challenging behaviour.

⚠️ Warning Signs by Setting

In the person's own home
  • Person appears fearful when carer or family member is present
  • Unexplained bruising, particularly in unusual locations
  • Caregiver refuses to allow visits or phone calls without supervision
  • Person expresses fear of their carer
  • Home in disrepair but family member appears comfortable
  • Bills unpaid despite adequate pension
In care homes / hospital settings
  • Unexplained falls or injuries (possible physical abuse or neglect)
  • Pressure sores not documented or treated
  • Person appears dehydrated, malnourished, or over-sedated
  • Staff deny access to family at unusual times
  • Person distressed, flinching, or afraid of specific staff members
  • Poor record-keeping or records that do not match observations

🔒 Deprivation of Liberty Safeguards (DoLS)

DoLS (Mental Capacity Act 2005, Schedule A1) provides a legal framework to authorise the deprivation of liberty of an adult who lacks mental capacity in a care home or hospital — where this is in their best interests and is the least restrictive option. Unauthorised deprivation of liberty is unlawful (Cheshire West [2014] UKSC 19).

DoLS applies when:
  • Person is in a care home or hospital
  • Lacks mental capacity to consent to their placement
  • Under continuous supervision and not free to leave
Practitioner duty:
  • Care homes and hospitals are the managing authority — apply to the LA Supervisory Body
  • Applications must be made without delay — unlawful DoL creates liability
  • LPS (Liberty Protection Safeguards) will replace DoLS when commenced

🏛️ Institutional Abuse & Care Quality Commission

Institutional abuse occurs when care provision is delivered in a way that undermines the dignity, rights, and wellbeing of the people in its care — through poor culture, inadequate staffing, rigid routines, or deliberate neglect. It can be systemic (affecting all residents) or individual (targeted at a specific person).

Signs of institutional abuse
  • Residents all woken at the same time regardless of preference
  • No choice of meals, activities, or when to go to bed
  • Staff use of demeaning language or "we" ("we're going to have a bath now")
  • Residents not addressed by their preferred name
  • Lack of privacy, dignity, or personal possessions
Raising concerns
  • Whistle-blow to the Care Quality Commission (CQC): 03000 616161
  • Refer to the local authority Safeguarding Adults Team under Care Act 2014 s.42
  • Contact local authority commissioner if LA-funded placement
  • Public Interest Disclosure Act 1998 protects whistle-blowers

Referral Pathways & Key Contacts

Adult Social Care / MASH
Local authority adult safeguarding team. Request a s.42 Care Act enquiry if the threshold is met.
Hourglass
0808 808 8141
UK's dedicated elder abuse charity. Free helpline for victims, families, and professionals.
Care Quality Commission
03000 616161
Report concerns about a registered care home or hospital. Online referral also available.
Office of the Public Guardian
0300 456 0300
Report misuse of Lasting or Enduring Power of Attorney or Court of Protection Deputy.
Police
999 immediate risk · 101 non-emergency. Financial crimes to Action Fraud: 0300 123 2040
Age UK
0800 678 1602
Free advice and guidance for older people and their families. Local Age UK branches also available.
Related resources
→ Financial Abuse hub → Self-Neglect & Hoarding → Domestic Abuse → Professional Curiosity

Statutory references: Care Act 2014 ss.42–47 · Mental Capacity Act 2005 & Schedule A1 (DoLS) · Human Rights Act 1998 · Public Interest Disclosure Act 1998 · Health and Social Care Act 2008
Case law: Cheshire West and Chester Council v P [2014] UKSC 19 (acid test for deprivation of liberty)
Statistics: WHO (2021) · Hourglass (2024) · Age UK (2024) · NHS Digital Adult Social Care Statistics 2023/24