Most societies pride themselves on the way that they provide care and respect for elderly people. Yet in all societies, there are elderly people who do not have access to family supports and who may not receive the social care they require. For example, Janice Reid has written about the role of elderly people in aboriginal societies (the Yolngu people) in Northern Australia:

The treatment and status of the elderly is probably no more uniform in Aboriginal society than it is in Western societies. Differences between the fortunes of individual elders largely reflect their personalities and their differential location in the economic, political and social structures. Some old Yolngu today have been able to take advantage of the direction of social change to enhance their status and material security; others have been bypassed or marginalized by the forces of modernization and seen their fortunes dwindle with their age…[A major theme] relating to the care of the aged seems to be the importance of having someone willing to take on a caring role. ‘Big men’ have young wives or caring children; many women have their children or co-wives, but aged widows, widowers or bachelors may have had no-one to nurse them at the end [2].

The same is likely to be true of most other societies—elderly people who have built up stores of social capital in their lives, through families, friendship and other social structures around them, are likely to do well as they age and be supported and respected in the ageing process. People who have become isolated in their lives—whose families have died or lost contact, who have been heavy drinkers or experienced mental illness or whose families are unable to manage for some reason—are not likely to have good social resources as they grow older.

Trajectories of ageing are greatly mediated by cultural differences. For example, in India, the notion of kinship stipulates that it is the duty of a child—particularly a male child—to provide support for parents in their old age, traditionally in the form of co-residence. About 60% of elderly men, and 25% of elderly women live with their spouse, children and grandchildren; 12% of men and 45% of women live in the same situation but without their spouse. About 2% of elderly men and 10% of elderly women live alone [3].

Living with children and grandchildren gives older people social and financial support, as well as providing them with a social role. These advantages are missing for those who live alone but also for those who live only with their spouse (20% of elderly men and 11% of elderly females in India) [3]. The difficulty that comes from elderly couples living separately to their families is not something that is discussed greatly in the West, where couples living alone are seen as almost the ideal living arrangement for the elderly.

To escape from the experience of abuse is one of the reasons why elderly people may want live alone. Elder abuse is both a consequence of the increasing powerlessness of some elderly people as they age and is a reflection of wider experiences of family abuse in most societies, including such forms of abuse as child and spousal abuse.

Elder abuse is sometimes divided into:

Of course, one form of abuse can easily lead to another, such as when an elderly person is asked for money, refuses and then is pushed over or physically abused.

Elder abuse is unfortunately common. In a study of elderly people in New York, the past-year prevalence of elder emotional abuse was 1.9%, of physical abuse was 1.8% and of neglect was 1.8%, with an aggregate prevalence of 4.6%. Emotional and physical abuse were associated with being separated or divorced, living in a lower-income household, functional impairment and younger age. Neglect was associated with poor health, being separated or divorced, living below the poverty line and younger age [4]. In a community-based study in urban Chennai of 400 community-dwelling older adults, the prevalence of mistreatment was found to be 14%. Chronic verbal abuse was the most common followed by financial abuse, physical abuse and neglect. A significantly higher number of women faced abuse as compared with men, adult children, daughters-in-law, spouses, and sons-in-law were the prominent perpetrators [5].

The leading risk factor for dementia is increased age. As elderly people age, their risks of dementia rise, and as societies throughout the world age, the prevalence of dementia will continue to rise. In the Asia-Pacific region, the number of people with dementia is predicted to increase from 23 million in 2015 to almost 71 million by 2050. That means that by 2050, more than half of the people with dementia worldwide (135 million) will live in this region [9].