When care becomes control: Abuse in plain sight
- Feb 28
- 6 min read
Updated: May 11
When care becomes control is not confined to age. When someone becomes dependent, isolated, or easier to manage, harm can take hold quietly.
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When vulnerability replaces age
In the UK, elder abuse is defined as a single or repeated act, or a failure to act, within a relationship of trust that causes harm or distress. It can include physical violence, emotional control, sexual harm, financial exploitation, and neglect.
The difficulty with the term “elder” is that it suggests age is the defining factor. In practice, the common thread is vulnerability.
Abuse of this kind can affect anyone who depends on others for care, safety, or daily needs. That includes older people, but also younger adults with complex disabilities, those living with illness or injury, and anyone whose independence has been reduced.
When the definition is tied too closely to age, it becomes easier to overlook the same patterns elsewhere. The behaviour does not change. Only the label does.
Why we’re still not talking about it
According to the charity Hourglass, an estimated 2.6 million older people in the UK experience some form of abuse every year. It is a figure large enough to sit alongside the populations of major cities, yet it rarely enters mainstream discussion or sustained policy focus.
The financial impact alone is significant. Hourglass estimates the annual cost at £16.6 billion, compared with around £307 million invested in addressing it. The imbalance is difficult to ignore.
As Hourglass themselves put it:
“Normally a £16 billion issue of violence and neglect would be at the forefront of policy and public attention… but the abuse of older people and the needs of older victims and survivors continue to be last in line.”
This pattern is not new. During the COVID-19 pandemic, care home residents were left particularly exposed. Patients were discharged into homes without testing, protective equipment was limited, and the risks were widely known. When criticism followed, the response was subdued and largely administrative.
These moments highlight a broader question about visibility and priority. When harm affects people who are less visible in public life, it can remain on the margins for longer than it should.
The financial fallout
When people think of abuse, they often imagine bruises or raised voices. One of the most damaging and least reported forms is financial abuse, taking place behind closed doors every day.
Financial abuse is the misuse of someone’s money, property, or assets. According to Age UK, this can include theft and fraud, pressure around wills, manipulation of power of attorney, or restricting access to funds. It may not always appear criminal, but it is. Those responsible are rarely strangers. Over 60 percent of reported cases involve a family member.
Hourglass estimates that more than £53 million has been stolen or misappropriated from older people in the UK in just three years, based on reported cases alone. The average loss per individual is £87,000.
These are not minor oversights. They are sustained acts of exploitation, often unfolding over months or years. This is not about phishing emails or fraudulent calls. It is about bank cards handed over in good faith, PIN numbers shared “just in case”, accounts quietly depleted, and decisions made under pressure.
Abuse rarely begins with cruelty. It often starts with a favour, a promise, or a suggestion: “Let me help.” Over time, that help can shift into control.
Financial abuse is difficult to spot because it leaves little visible trace. There are no obvious signs. Instead, it may appear as a shrinking balance, an unexplained bill, or spending that does not fit the circumstances.
This is exploitation, often hidden behind familiarity and kept quiet by silence.
Abuse takes many forms
Elder abuse is not always a raised fist or a stolen bank card. It can be quiet, circumstantial, and sometimes carried out by people who never expected to cross that line.
Psychological abuse can take the form of persistent belittling, manipulation, or isolation. This may include limiting access to phones, controlling contact with others, or speaking over someone as though they are no longer present.
Neglect can stem from disregard, but it is often more complex. Many older people live with dementia, reduced mobility, or incontinence, all of which require consistent, hands-on care. When carers are unsupported, exhausted, or untrained, pressure builds and patience can wear thin.
In that space, people may be left unwashed, underfed, or dismissed in ways that erode dignity. The outcome remains neglect, even where it did not begin with intent to harm.
This is not limited to home settings. Institutional environments can present similar risks. Rushed care, unanswered call bells, rough handling, or being spoken to as a task rather than a person can all contribute to a loss of dignity.
Abuse is not always about intent. Sometimes it is about erosion.
Sexual abuse remains one of the least acknowledged forms. In NHS hospitals in England, 274 allegations of sexual assault against older people were recorded between 2021 and 2024, according to updated findings by independent researcher Amanda Warburton Wynn in partnership with Hourglass. Over a third of these cases were not reported to the police.
There is a persistent assumption that older people are somehow beyond vulnerability. That belief allows harm to remain hidden.
Discriminatory abuse is also often overlooked. Whether rooted in age, disability, race, or a combination of these, the outcome is the same: a person is treated as less, less credible, less deserving of care.
It is easy to imagine abuse as deliberate harm carried out by individuals. In reality, it can also emerge from systems, pressures, and environments that reduce people to tasks rather than individuals.
A cultural blind spot
Abuse of older people does not only happen behind closed doors. It is shaped by a wider cultural lens that makes it easier to overlook or minimise.
In early 2025, a study led by Dr Jennifer Storey and supported by Hourglass found that one in four university students did not recognise behaviours such as violence, theft, or non-consensual sexual advances against older people as abuse. Some viewed taking money or valuables without consent as acceptable, or not serious enough to be considered harmful.
When people are unsure whether something qualifies as abuse, they are less likely to question it or report it. That uncertainty creates space for exploitation to continue unnoticed.
Assumptions play a part. Older people may be seen as naturally generous, less concerned with money, or simply set in their ways. Changes in their circumstances can be explained away rather than examined.
Ageism does not always appear as hostility. It can sit within quieter attitudes that reduce how seriously someone is taken. Over time, that shift in perception makes it harder to recognise when harm is taking place.
Dr Storey’s study also found that stronger ageist attitudes were linked to a lower likelihood of recognising abusive behaviour. This is not simply individual bias. It reflects a broader pattern in how age is understood.
When harm is not recognised, it is less likely to be addressed.
What becomes visible when we look
There is no single pattern to follow, but there are often changes that do not quite sit right. A shift in behaviour. A financial situation that does not add up. Someone who was once connected becoming harder to reach. New relationships that seem to limit contact rather than support it.
These moments are easy to explain away. They can be framed as personality, habit, or coincidence. That is often how they remain unnoticed.
Acting on concern is not always straightforward. It can be difficult to question a situation, particularly when it involves family or when the boundaries of responsibility are unclear. There is often hesitation, and sometimes a quiet decision to step back.
Yet in situations where someone cannot easily speak for themselves, the absence of attention can allow harm to continue without interruption.
Taking concern seriously
If someone appears to be in immediate danger, emergency services remain the first point of contact.
In less urgent situations, there are several routes for raising concern. Local councils have Adult Safeguarding teams, usually accessed through Adult Social Care. The police non-emergency line can also be used where there is reason to believe a crime may have taken place. Organisations such as Age UK and Hourglass provide confidential advice and can help people understand what to do next.
When concerns are raised, it can help to share what is known about the situation. This might include who is involved, where they are, and what has prompted the concern.
Situations are not always straightforward. Some people may not want others to step in. They may feel embarrassed, worried about consequences, or concerned about losing support. These responses are not unusual, and they can make decisions harder.
Acting on concern does not always lead to a clear outcome, and it may not be acknowledged in the moment. Safeguarding is not about recognition. It is about ensuring that concerns do not go unnoticed, and that responsibility can be shared with those in a position to act.
Where to get help
If you’re worried about someone, or you need advice yourself, the following organisations offer confidential support:
Hourglass
0808 808 8141 (Free 24/7 helpline)
Age UK
0800 055 6112 (8am–7pm, every day of the year)