This paper highlights the critical issues to consider in the development of a practice and policy response. These issues are intended to inform the discussions within and between the aged care, elder abuse and domestic violence sectors. The analysis considers the role that the social construction of older people, women and carers has had on the responses to abuse and violence where dementia is a factor. This poses questions as to the rationale for the invisibility of these issues within the elder abuse and domestic violence perspectives. It alo examines the implications of viewing this abuse and violence as a symptom of disease without reference to the historical or psychosocial context of the relationship. Finally the lack of a consistent theoretical framework for understanding dementia and abuse is identified as the foundation for the development of a response that maximises the health, well being and safety of all involved.