This is a complete extract of Chapter 5 of Silver Book (Quality care for older people with urgent & emergency care needs, published 2012) with updated links.


Abuse of older people is common. It may occur in many settings: private homes, care homes and hospitals (including Emergency Departments). Safeguarding is a range of activity aimed at upholding an adult’s fundamental right to be safe. It is of particular importance for people who, because of their situation or circumstances, are unable to keep themselves safe. The Mental Capacity Act introduced a new criminal offence of or wilfully neglecting a person without capacity.

Studies from around the world suggest that one in four vulnerable older people are at risk of abuse, however only a small proportion of this is currently detected. In the UK of a sample of people aged 66 or over living in private households between 2.6% and 4% of respondents reported that they had experienced “mistreatment” by a family member, close friend or care worker during the previous year. This equates to a figure of between 227,000 and 342,000 people aged 66 or across the UK.

Nature of abuse

Five types of abuse are recognised:

  1. Physical abuse, including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions
  2. Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks
  3. Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits
  4. Sexual abuse, including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting
  5. Neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating

Key points

  • All EDs have arrangements with local social services, police and other agencies about how to notify concerns about the abuse of vulnerable people.
  • All EDs understand the role of Safeguarding of Adults Boards and have training to ensure all clinicians and others working with older people, not only know what safeguarding is and what abuse looks like, but are clear what to do about it and who is responsible for what

See Appendix 7 of Silver Book for more information.

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Further background information (updated from Silver Book links):

Action on Elder Abuse website has a range of resources available:

Skills for Care Briefing: Care Act implications for safeguarding adults