We often assume that filial piety is synonymous with Chinese culture (Cheng and Chan, Reference Cheng and Chan2006; Sung, Reference Sung1998, Reference Sung2001; Hwang, Reference Hwang1999) rendering it immune to elder abuse. However, Lai (Reference Lai2011) has reminded us: “the face value of respect and care received by older people in Chinese culture should not be taken for granted.” Noting that the pervasive and pernicious global issue of elder abuse remains largely hidden and minimally studied in China (Dong et al., Reference Dong, Beck and Simon2010; Wu et al., Reference Wu2012), Li et al. (Reference Li, Chen and Peng2021) set out to examine its prevalence and mediators in a nationally representative sample of older adults living in China. Based on Western literature in relation to power inequities and social exchange, Li et al. explored hypothetical factors that might mediate the known relationship between physical frailty and elder abuse (Acierno et al., Reference Acierno2010; Lai, Reference Lai2011; Wang et al., Reference Wang, Lin, Tseng and Chang2009). Using data from the 2010 Third Survey on Chinese Women’s Social Status (SCSSW) of 3516 community-dwelling subjects, Li et al. found a past-year prevalence of elder abuse (called “elder mistreatment” in the study) of 4% of Chinese older adults, with the respective prevalence of psychological abuse and financial abuse of 3.9% and 2%. As hypothesized, physical frailty was associated with psychological vulnerability (anxiety, loneliness, and uselessness) and lower levels of housework involvement, which further correlated with increased risk of abuse. Yet contrary to hypotheses, lower financial independence predicted a lower probability of abuse.

This study is all the more salient now when the risks of elder abuse and neglect have been amplified in the face of the COVID pandemic (Benbow et al., Reference Benbow, Bhattacharyya, Kingston and Peisah2022). Notwithstanding this, any interpretation must be tempered by the recognition that the data is derived from a 2010 national survey, subsequent to which China has undergone an unprecedented transformation in its socioeconomic structure. Notwithstanding this, a recent cross-sectional study in 2020 of older people in the Hunan Province using the same elder abuse questionnaire from the SCSSW showed that the prevalence of elder abuse in China has increased since 2010 (Du and Chen, Reference Du and Chen2021). Regardless, there are lessons to be gleaned from the Li et al. study which are of global significance.

First, there are lessons to be learnt about the identification of abuse. Although Li et al. report “intentional isolation” as one of three culturally specific subtypes, isolation now has global relevance given the segregation and isolation of older adults imposed by restrictions to deal with the pandemic (Cooper, Reference Cooper2020). Vulnerable older adults are now invisible, as is their abuse (Benbow et al., Reference Benbow, Bhattacharyya, Kingston and Peisah2022). This renders solutions proposed by Li et al. such as increased screening by frontline practitioners with the many available screening scales ever more important and urgent. To aid in the identification of elder abuse, Li has elucidated risk factors with an emphasis on physical frailty, although psychological frailty conferred by dementia, depression, and other mental health conditions are also known risk factors for abuse (Du and Chen, Reference Du and Chen2021; Wu et al., Reference Wu2012). An “eyes wide-open approach” to elder abuse is needed amongst health care professionals (Peisah et al., Reference Peisah, De Mendonça Lima, Verbeek and Rabheru2021), and there is no excuse for professional ignorance (Yan, Reference Yan2014). Education across all disciplines – inclusive of allied health, nursing and medical staff – on attitudes towards and knowledge of elder abuse remains an imperative given their ideal position to recognize and address elder abuse (Yi and Hohashi, Reference Yi and Hohashi2018).

Second, there are lessons to be learnt about increased reporting of abuse by older people. Acknowledging Li et al.’s comments that stigma may be a key reason why incidents of abuse go unreported, strategies are needed to empower older adults to report abuse, or even earlier in the cycle, perceive the behavior as abuse in the first place. Chinese older adults are not unique in their perceived shame not only about being victims of elder abuse but also of disrupting harmonious family relationships with notification. Yan (Reference Yan2014) has identified several barriers impeding help-seeking behavior amongst older Chinese persons subject to abuse, such as social isolation, cultural barriers, self-blame, and lack of knowledge about how to seek help. All of these factors can be addressed and supported by frontline healthcare professionals.

Third, there are lessons to be learnt about the values of proscriptive and prescriptive societal policies and laws in addressing elder abuse. As stated above, Li et al. found lower levels of financial abuse with posited explanations being the “ironclad cultural norm” and expectation that Chinese families will provide financial support to their parents. While these ironclad norms may be protective in some ways, they may also carry their own burdens, as do prescriptive care laws. In China, the care of older people by adult children is a legal responsibility not a choice (Bu, Reference Bu2021; Du and Chen, Reference Du and Chen2021). As such, older Chinese adults mainly rely on their adult children for emotional, physical, and financial support. On the one hand, this is a laudable social norm, in many ways to be envied by Western cultures. On the other hand, in the face of erosion of traditional piety, these responsibilities may confer their own risk, bringing tension and conflict to the family, evidenced by the increased risk for elder abuse conferred by shared living situations (Wu et al., Reference Wu2012) and lower income of older persons (contrary to Li et al.’s findings) (Du and Chen, Reference Du and Chen2021). This has led to suggestions by Li et al. to encourage interventions to prevent or reduce physical frailty among older adults, and by Du and Chen (Reference Du and Chen2021) to increase the financial autonomy of older persons by increasing their income and providing more social support. This might be tested empirically by examining the potential benefits of a pilot scheme of amplified social security and welfare support on both measures of self-efficacy and abuse prevalence and detection.

We look to future studies to examine the prevalence and determinants of abuse and test some of these hypothetical solutions in the context of contemporary China with the nation’s improved economic position and willingness to protect the welfare of disadvantaged members of the society.