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Purpose: Elder mistreatment (EM) is a complex, universal health and social problem predominantly studied in the indigenous (white) populations of Western countries. This has led to consideration of dominant explanations as universal, potentially masking crucial cultural and ethnic differences. This study aims to fill the gap in elder mistreatment literature for the Pakistani community, offering unique perspectives to inform culturally sensitive policy recommendations. Design/methodology/approach: A qualitative approach, anchored in the philosophical basis of constructivist grounded theory, was used to investigate understandings of EM among Pakistanis in Sheffield, UK. This involved two gender-based focus groups (male = 1; female = 1) and 22 in-depth individual interviews, engaging a diverse participant pool, including older people, family caregivers and community stakeholders. Findings: This study reveals diverse understandings of elder mistreatment (EM) among Pakistani adults, varying across age and gender groups, with distinguished key forms identified. Reporting EM is crucial, but victims face complex decision-making, hindered by societal and individual barriers, including moral and cultural dilemmas. Access to formal support is limited, emphasising the need for targeted interventions. Originality/value: To the best of the authors' knowledge, this study is the first to delve into the perspectives of Pakistanis on elder mistreatment. It emphasises the importance of policymakers and service providers integrating considerations of race, ethnicity, culture and gender to develop inclusive services, as indicated by the study's findings. [ABSTRACT FROM AUTHOR]