Prevalence of elder abuse
Little is known about the national prevalence of elder abuse in Australia. While several prevalence studies have been conducted in other countries, a prevalence study is yet to be conducted in Australia. The available evidence is limited and does not provide a clear understanding of the prevalence of elder abuse in Australia. However, data collected through advocacy organisations, related population studies (e.g. ABS Personal Safety Survey), criminal justice agencies and other administration data provide some insight into its incidence and dynamics (Kaspiew et al., 2016).
Evidence relating to the prevalence of elder abuse is further limited by a lack of studies in institutional care settings and the likely under-representation of adults with disability or cognitive impairment in population studies more generally (Chesterman & Bedson, 2017; Pillemer et al., 2016; Yon et al., 2018).
Internationally, a recent meta-analysis of elder abuse prevalence studies estimated that 15.7% of older adults (60 years and older) in community settings had experienced some form of abuse in the past 12 months (Yon, Mikton, Gassoumis, & Wilber, 2017). This estimated figure represents the combination of one or more subtypes of abuse experienced by older people. Prevalence rates for particular subtypes of abuse were lower and ranged between 0.9% and 11.6% depending on type:
- sexual abuse (0.9%)
- physical abuse (2.6%)
- neglect (4.2%)
- financial abuse (6.8%)
- psychological abuse (11.6%).
The study found that the prevalence of elder abuse varied by region of the world, with high-income countries reporting lower prevalence than low-income countries. Overall, it revealed very little difference between males and females in combined prevalence rates, though it did support other findings that show older women are more likely to be victims of intimate partner violence than older men.
These estimates are, however, limited by some significant methodological issues. This includes variations in how elder abuse is defined and measured across studies and the under-representation of people with disability or cognitive impairment (e.g. dementia) in the studies. The prevalence of elder abuse for older adults with disability and cognitive impairment is likely to be comparatively higher than for the general population (Yon et al., 2018).
Institutional care settings
There is very limited data to accurately estimate the prevalence of elder abuse in institutional care settings (Castle, Ferguson-Rome, & Teresi, 2015; Yon et al., 2018). Based on the few rigorous studies conducted, Yon and colleagues (2018) estimate that elder abuse is likely to be more prevalent in institutional care settings than in community-based settings. Table 2 presents summary results of a systematic review of prevalence studies of elder abuse in institutional care settings from various countries around the world (none of which were conducted in Australia).
Notes: aAdjusted for publication bias.
Source: Yon et al. (2018)
Due the small number of studies available, differences in definitions used and the range of different contexts in which they were conducted, these results should be read with caution. Even so, the results show a general consistency in prevalence rates for each abuse type reported by older adults and staff. Psychological abuse is the most prevalent form of abuse reported by both older people and staff, estimated to affect between 32.5% and 33.4% of all older people in institutional care settings.
With no national prevalence data of elder abuse available in Australia, researchers have looked to international studies to provide an insight in to how prevalent it might be in Australia. As Kaspiew and colleagues observe (2016, p. 26), 'if international indications provide any guidance, it is likely that between 2% and 14% of older Australians experience elder abuse in any given year' (see also Lacey et al., 2017). While this estimate provides an indication of its potential prevalence in Australia, it should be treated with some caution because it may not reflect the Australian experience.
Incidence of elder abuse in Australia
While there is no prevalence data available in Australia, there is some data relating to the incidence and dynamics of elder abuse in Australia. Based on analysis of the ABS 2012 Personal Safety Survey (PSS), it was found that older women aged 55 years and older were less likely to experience cohabiting partner violence - physical assault, physical threat, sexual assault or sexual threat - compared to a younger cohort (aged 25-34 years) in the past 12 months; 0.4% of all older women aged 55 years and older compared to 3% of women aged 25-34 years (Kaspiew et al., 2016). Based on the Australian Longitudinal Study of Women's Health, around 8% of older women reported some form of abuse when surveyed in 2008 (aged 82-87 years) and 2011 (aged 85-90 years), with slightly lower rates of abuse reported at a younger age (70-81 years). The study also revealed that 20% of women aged 70-75 years and 85-90 years experienced neglect (Kaspiew et al., 2016).
A more recent analysis of ABS datasets examined the incidence of abuse of people aged 55 years and older (Hill & Katz, 2019). It found that, in 2016, 1.7% of older people aged 55 years and older experienced physical violence (either physical assault or threat) in the past 12 months, with slightly more older men experiencing physical violence than older women. Although not directly comparable due to the use of a different dataset and definition of physical abuse, this analysis found higher rates of physical abuse among older Aboriginal and Torres Strait Islander people aged 45 years and over in 2014/15, with 16.4% reporting an experience of physical abuse (including threats of violence) in the past 12 months. According to PSS data collected during 2005, 2012 and 2016, between 0.1% and 0.4% of women aged 55 years and older reported experiencing sexual violence in the past 12 months (limited sample sizes and low prevalence rates prevented analysis of sexual violence for older men). Analysis of PSS data also revealed that older women experienced higher rates of emotional abuse by a partner in the last 12 months than older men: 2.5-3.2% of women aged 55 years and older compared to 1.0-2.6% of men the same age (Hill & Katz, 2019).
Data collected by state- and territory-based advocacy organisations reveal further details about the proportion of abuse types and victim/perpetrator characteristics reported to helplines. That is, it provides some insights about the characteristics of elder abuse incidents reported to advocacy organisations but not about their prevalence at a population level. In its 2015/16 national elder abuse report, Advocare Incorporated (2016) compiled administration data collected by 12 advocacy organisations around Australia. Of the 2,717 advocacy cases and 12,993 information calls received during 2015/16, financial abuse (38%) and psychological abuse (36%) were the most frequently reported, followed by neglect (14%), physical abuse (9%), social abuse (6%) and sexual abuse (0.3%). Sons or daughters (including stepsons and daughters) were the most frequently reported perpetrators (60%), other perpetrators included friends and neighbours, parents, spouses, siblings, grandchildren, and nieces and nephews.
Similar findings are reported by other state-based advocacy organisations, such as Seniors Rights Victoria (SVR), Aged Rights Advocacy Service (ARAS) in South Australia, the Elder Abuse Prevention Unit (EAPU) in Queensland and the NSW Elder Abuse Helpline and Resource Unit of New South Wales. Helpline data collected by these agencies reveal consistent patterns of financial and psychological abuse as the most frequently reported types of abuse. Older women are the most frequently reported victims of abuse overall, and sons and daughters were the most frequently reported perpetrators (Joosten, Dow, & Blakey, 2015; Lacey et al., 2017; NSW Elder Abuse Helpline and Resource Unit, 2015; Spike, 2015).
Impacts of elder abuse
The abuse of older people negatively impacts the victims in a range of ways. In a general sense, elder abuse has the common effect of reducing an older person's quality of life (Jackson & Hafemeister, 2016). The main effects of elder abuse can include (Acierno, Hernandez-Tejada, Anetzberger, Loew, & Muzzy, 2017; ALRC, 2017; Dong, Chen, Chang, & Simon, 2013; Jackson & Hafemeister, 2016):
- psychological distress and emotional difficulties (e.g. depression, fear, chronic stress)
- disruptions in social and family relationships
- compromised health
- physical injury and hospitalisation
- premature mortality
- restrictions on, or elimination of, autonomy
- changes in living arrangement
- loss of assets and finances.
As in other areas of elder abuse research, there is relatively little evidence about the various effects of elder abuse; not only on victims but also on family members (Hamby et al., 2016). The impact of abuse, like the abuse itself, can often go undetected and is difficult to quantify (Roberto, 2016). In one of the few studies that have investigated the long-term impacts of elder abuse, Acierno and colleagues (2017) found that victims of elder abuse experienced higher rates of depression, post-traumatic stress disorder, anxiety and poor health compared to non-victims, with these effects enduring over long periods of time (see also Roberto, 2016).
In response to the relative lack of evidence on the impacts of elder abuse, Hamby and colleagues (2016) have argued that future research should incorporate a wider view of potential impacts of elder abuse that includes subjective, financial, family and spiritual wellbeing.