Elder abuse: an under-recognised phenomenon

With an estimated 167,000 older Australians experiencing some form of abuse in the past year, it is essential that community care workers know how to respond when confronted with elder abuse so they can ensure the safety of their clients, writes Dr Barbara Blundell.

Sarai works as a carer for a community care agency, visiting older people’s homes providing home help and social support. She visits Mrs Tide weekly to assist with cleaning. One day Sarai finds Mrs Tide in tears. Mrs Tide’s son, Marc, has been leaning on her for money to support his gambling habit. He tells her that she is a “terrible mother” who has never loved him when she tells him that she has no money for him and is struggling with her own bills and has threatened to damage her property if she doesn’t “cough up”. Marc has threatened to stop visiting her and bringing her grandchildren to see her.

What should Sarai do? If she is a compassionate person, she would probably listen to Mrs Tide with empathy and support, but if she had an awareness of elder abuse, then her response might be different.

Elder abuse is a pervasive but little recognised phenomenon in our ageing society. It is defined by the World Health Organisation (WHO) as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”.

There are many different definitions used both in Australia and overseas; some include abuse by family and friends, while others include paid workers, such as carers and accountants. In the Australian context, the WHO definition has been the most commonly adopted, with individual agencies making adjustments in line with their funding requirements and client groups. The most commonly recognised categories of abuse include: financial and material, emotional or psychological, physical, sexual, social and neglect.

Research estimates that elder abuse could affect an average of 5 per cent of the older population. If we translate this conservative estimate into real figures based on Australian Bureau of Statistics population data, this means that as many as 167,000 older Australians may have been abused in the past year. Financial and psychological abuse are the most commonly reported types of abuse, and often more than one type of abuse is experienced at a time.

In the example given above, Mrs Tide was experiencing financial abuse coupled with psychological abuse. Also, abuse may occur as part of a process rather than a one-off event. What starts with Marc ‘borrowing’ $200 until pay day and not paying it back could escalate into him requesting money on a frequent basis and making threats to intimidate his mother in to giving him the money when she shows hesitation or reluctance. Marc might also try to socially isolate her from other family, friends and service providers so that no one finds out about the abuse, cancelling services and activities for her as she “doesn’t have the money.”

It is vital that staff working with older people are aware of the issue of elder abuse and know how to respond to it in order to ensure the safety of their clients. The staff of organisations working with older people are at the coalface; they are the ones most likely to come across elder abuse through their contact with older people in the community, and are uniquely placed to raise awareness of the issue and tell older people who they can contact for assistance.

A hidden issue

In common with domestic violence and child abuse, elder abuse is often a hidden issue, not recognised by the older person or others around them, and not reported or responded to appropriately.

There are many reasons for under-reporting, including a sense of shame and/or fear of retaliation by the family member. There may also be a fear of changes to living arrangements – if the abuser is a carer, taking action may mean that the care is no longer given and the older person may have to move into a residential care facility.

Often the older person wants the abuse to stop, but they do not want the police and courts to get involved – it is often a family member after all.  The older person might be very isolated and dependent and have no knowledge of elder abuse and who to contact for help.

There are some federal compulsory reporting requirements for physical and sexual abuse occurring in residential aged care facilities, but responses to elder abuse in the community vary from state to state and from metropolitan to rural and remote areas. There is no systemic recording or reporting of concerns across the sector.

Small non-government organisations in some states are funded to deal with elder abuse and they may collect data, but all have different systems and there is no collation of data across agencies and government organisations. Unfortunately there is no consistency in responses across jurisdictions: no legislation, and no mandatory standards or guidelines in relation to elder abuse within the community care sector.

It is a jigsaw puzzle of service responses that may be hard for the average helping professional to navigate, let alone a vulnerable older person.

Policies and protocols

Several jurisdictions have developed their own protocols and policy guidelines to inform and assist service providers in developing service responses to elder abuse, and elder abuse training is also offered, but these are both voluntary and not mandated. It is also not known how many community care organisations have developed specific elder abuse policies and procedures.

There is a more robust system of protections in place for people without decision-making capacity under guardianship and administration legislation in various jurisdictions. There are fewer protections in place for older people with capacity. Elder abuse hotlines have also been put into place in a number of areas, but often they are only able to provide information and referral.  Some states have additional elder abuse advocacy services, but no direct mandate to assist in a situation of elder abuse without permission from the older person involved if they have decision-making capacity.

The older person has the right to decide and direct the advocacy effort, and for them it often comes down to a choice between choosing a legal intervention and doing nothing.

In Mrs Tide’s situation, she could probably either decide to press charges against her son for the financial abuse and for making threats and using intimidation, but it would probably come down to her word against his, and any prosecution would have a great deal of difficulty in gathering the evidence needed.

If Sarai has received elder abuse awareness training and her organisation had a policy and procedure in place, she might know to follow the procedure, report the situation back to her supervisor and/or provide Mrs Tide with the contact details of the local elder abuse organisation. If she did not, she might listen sympathetically and provide a shoulder for Mrs Tide to cry on and nothing further might happen.

Elder abuse is not really on most people’s radars to the same extent as domestic violence and child abuse. Service responses and preventative measures are in their infancy – 20 to 30 years behind the more recognised forms of abuse.

It is the final frontier in looking at abuse across the lifespan. There is a growing clamour from stakeholder organisations for a united national approach. It will require a heightening of awareness in the community and strong political will to put this issue firmly on the national agenda.

Dr Barbara Blundell is a social worker and lecturer in the School of Occupational Therapy and Social Work at Curtin University. 

For a six-step approach to responding to elder abuse, see the Elder Abuse Protocol: Guidelines for Action

For an extended version of this article read ‘More than a shoulder to cry on’, Community Care Review magazine (January 2015)

Elder abuse resources

Related coverage: From GPs to hairdressers: community workers need elder abuse training

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