Millions of adult children care for parents, even after abuse

The nation’s caregiving system runs on a promise that is often taken for granted: family will step in. But for millions of adult children, that promise collides with a past shaped by abuse, neglect or abandonment, forcing them into care roles they are expected to fill without paid help, respite or trauma-informed support.

AARP and the National Alliance for Caregiving reported in 2025 that 63 million Americans, nearly 1 in 4 adults, provided ongoing care in the past year, up 20 million from 2015. AARP has also said that unpaid family caregiving was worth about $600 billion in 2021. Those numbers capture the scale of a labor force that is essential to keeping older adults at home, yet remains largely invisible in policy design.

That gap matters most when caregiving is complicated by harm. The Centers for Disease Control and Prevention defines abuse of older adults as intentional harm or failure to act by a caregiver or other trusted person, and says an older adult is someone 60 or older. The United States Department of Justice says elder abuse can include physical abuse, psychological abuse, financial exploitation, neglect, abandonment and sexual abuse, with trauma that can damage physical health, psychological health, social relationships and finances. The policy framework recognizes the danger, but it does not fully confront the reality that some adult children are being asked to care for parents who were themselves abusive.

Researchers in England and Wales have described abuse of parents by adult children as “filial abuse,” a little-understood form of domestic violence. A Conversation article said the first study of its kind there began in September 2018. A systematic review of violence against parents by adult children found 39 relevant empirical contributions published in English between 1990 and 2023, underscoring how thin the evidence base still is for a problem that cuts across family life, aging and trauma.

That scarcity of data has consequences in Washington and beyond. The Elder Abuse Prevention and Prosecution Act was signed on October 18, 2017, reflecting ongoing concern over collection, intervention and enforcement. Yet the care system still leans on unpaid relatives while federal elder-abuse materials continue to flag caregiver stress, isolation and psychological health as risk factors. For adults who must decide whether to help a parent, refuse help or try to do both while carrying old wounds, the system leaves the hardest questions unanswered.