The abuse and mistreatment of LGBTIQA+ older people

Background

The abuse and mistreatment of older people is a serious social, human rights, health and justice issue in Australia. This research project, commissioned by the Attorney-General’s Department, focuses on the abuse and mistreatment of lesbian, gay, bisexual, transgender, intersex, queer and/or asexual (LGBTIQA+) older people. It builds on our knowledge of the nature and prevalence of abuse and mistreatment in the National Elder Abuse Prevalence Study (Qu et al., 2021, ‘National Prevalence Study’) commissioned by the Australian Attorney- General’s Department.

The National Prevalence study showed that 15% (14.8%) of older people living independently reported an experience of at least 1 of 5 types of abuse in the 12 months before the survey. Psychological abuse was the most common type (12%), followed by neglect (3%), financial abuse (2%), physical abuse (2%) and sexual abuse (1%). Some people experienced more than one type of abuse (4%), and the most common combination was psychological abuse and neglect.

The research gap

Following the National Prevalence Study, more specific research was required to better understand the nature and quantum of abuse and mistreatment of LGBTIQA+ older people in Australia. This research contributes to our understanding of LGBTIQA+ older people’s specific experiences of abuse and to inform measures to address barriers to accessing services, programs and initiatives that address their specific needs. There is some research with LGBTIQA+ people on their experiences of abuse and mistreatment over their lifetime from Australia and comparable overseas jurisdictions. However, there is no national research providing both quantitative and qualitative insights on this issue from LGBTIQA+ younger and older people in Australia.

Research design

This research project has been designed to address this gap and comprises:

• two concurrent national surveys (n = 335) of both younger (18–64 years; 18–49 years for Aboriginal and Torres Strait Islander) LGBTIQA+ people and older (65 years+; 50 years+ for Aboriginal and Torres Strait Islander) LGBTIQA+ people. The survey of participants in each state and territory collects quantitative and qualitative data about the experience and use of abuse and mistreatment as well as its drivers and context, together with help seeking and protective behaviours and experience of services. The geographical spread of participants included 72% residing in major cities, 19% in inner regional and 9% in outer regional, remote or very remote Australia.
• focus groups (9 in total with n = 32) and interviews (n = 10) with LGBTIQA+ older people providing more in-depth qualitative insights on the experiences of abuse and mistreatment; experience of services; and interventions, services, training or supports required. The geographical spread of participants included 52% residing in major cities, 33% in inner regional, 12% in outer regional and 3% remote. Included among the participants were (n = 4) participants identifying as Aboriginal. Further information about the focus group and interview sample is included at section 1.5.3 and Appendices A5 and A6.
• a desktop review of empirical research literature conducted in Australia and international jurisdictions prior to this study that is relevant to the abuse and mistreatment of LGBTIQA+ older people from Australia and selected international jurisdictions.

Research aim and questions

The research aim and questions guiding the research presented in this report were designed to improve the understanding of:

• the types of abuse and mistreatment experienced by LGBTIQA+ older people
• the drivers and context for this abuse and mistreatment
• who experiences this abuse and mistreatment and its effects on them
• who is abusing or mistreating LGBTIQA+ older people
• help seeking and protective behaviours of LGBTIQA+ older people
• experiences of service responses by LGBTIQA+ older people.

It also includes case studies from the perspectives of LGBTIQA+ older people.

Importantly, the findings from this research may be used to inform the development and implementation of the 5-year action plans and future initiatives that sit under the new National Plan to End the Abuse and Mistreatment of Older People 2025–2035.

The definition of abuse and mistreatment applied in this project is the working definition for research that was developed for the National Prevalence Study.1 This definition is:

a single or repeated act or failure to act, including threats, that results in harm or distress to an older person. These occur where there is an expectation of trust and/or where there is a power imbalance between the party responsible and the older person.

The extended scope of this definition facilitates the exploration of additional types of abuse and mistreatment that may be experienced by particular groups such as LGBTIQA+ older people, and captures systemic issues and discrimination, which were included in this project as an additional type of abuse and mistreatment.

Comparability with the National Prevalence Study

Where applicable, data collected from this LGBTIQA+ study has been referenced in relation to data collected in the earlier AIFS National Prevalence Study.

• The National Prevalence Study findings were based on a representative sample of 7,000 community-dwelling people aged 65 years or older, and data were collected via Computer Assisted Telephone Interviewing (CATI). The findings for this current study are based on data collected via an opt-in, online survey instrument and, as such, it is not a nationally representative sample of LGBTIQA+ people. In the absence of relevant census data, a sampling frame for the different groups of people included in the LGBTIQA+ acronym is not presently available in Australia.
• The National Prevalence Study’s CATI data collection and longer interview time allowed a list of indicators to be collected to ascertain and categorise, for example, psychological/emotional abuse, whereas for the current study a single question about experiences of emotional abuse was collected.

Due to these differences in design and methodology, findings from the current study and the National Prevalence Study are not directly comparable. Nevertheless, in most cases, the same or similar survey items have been used in both studies, and the National Prevalence Study results referenced in this report help to place the current findings in the context of the experiences of the wider Australian population. It also helps to inform our understanding of the prevalence, characteristics and drivers of the experience of abuse and mistreatment of LGBTIQA+ older people and how these are similar or different to the experiences of older Australians more generally. 

In the analysis that follows, estimated proportions from the LGBTIQA+ study are reported alongside the estimated proportions from the National Prevalence Study for key survey questions asked in each study. The differences in sample sizes between the 2 projects should be kept in mind when interpreting the data/ responses. Where statistical significance is observed in this report, it is important to emphasise that this relates to statistically significant differences within the LGBTIQA+ surveys.

Overview of findings

Forms of abuse and mistreatment experienced by LGBTIQA+ older people

More than one-in-three (36%) LGBTIQA+ older people participating in the survey reported an experience of at least 1 of the 6 identified types of abuse and mistreatment in the 12 months preceding the survey.

The most common forms of abuse and mistreatment experienced by LGBTIQA+ older people aged 55 years or older were:

• psychological/emotional abuse (23%)
• discrimination (specified in the survey as including homophobia, biphobia, transphobia, endosexism and/or being deliberately misgendered in public and private contexts – 17%) and
• financial abuse (9%).

Largely consistent findings were identified in survey data collected from LGBTIQA+ younger people, with 30% of LGBTIQA+ younger survey participants reporting at least one observance/concern in the 6 categories of abuse and mistreatment of an LGBTIQA+ older person that they knew.

When the analysis is restricted to the 5 abuse types examined in the National Prevalence Study, a greater proportion of LGBTIQA+ older people reported experiencing abuse and mistreatment (21%–27%) compared to older people in the broader population, with 15% (14.8%) of people aged 65 years or older in the National Prevalence Study.

65 years or older in the National Prevalence Study

• Psychological/emotional abuse and financial abuse are reported in higher proportions by LGBTIQA+ older people. Physical abuse and neglect are similarly reported by participants in the current study and the National Prevalence Study.
• LGBTIQA+ older people commonly experience multiple forms of abuse and mistreatment to a substantially higher degree than for participants in the National Prevalence Study (11% cf., 4%).¹

Together, the quantitative and qualitative data suggest the pervasiveness and widespread nature of discrimination that spans personal, community and institutional levels, and its intersection with ageism as well as homophobia and sexism. The data also highlight how LGBTIQA+ older people are experiencing discrimination within relationships of trust, as well as more generally.

Although the data indicates non-LGBTIQA+ people more commonly engaged in abuse or mistreatment of LGBTIQA+ older people (69%), lateral violence was highlighted by some gay and lesbian older people and transgender and/or gender diverse older people (20%).

This lateral violence may take a variety of forms including physical and psychological/emotional abuse or discrimination, including within LGBTIQA+ organisations.

Most older participants in the survey, focus groups and interviews who described personal experiences of lateral violence, described their exclusion from LGBTIQA+ events, advocacy efforts and spaces. For example:

• Some transgender and/or gender diverse older people described experiencing psychological abuse and discrimination from LGBTIQA+ people and organisations based on a range of reasons, including age, disability as well as transphobia.
• Some lesbian participants described not being permitted to advocate for and seek cisgender women-only spaces as a form of abuse and mistreatment. Some other LGBTIQA+ participants identified this behaviour as discriminatory against transgender and/or gender diverse women.

Systemic abuse experienced across the life course and into older age was identified by some participants in the form of:

• unequal access to services or the absence of support to access services
• heteronormative interactions with government and healthcare structures
• government and social services that do not accommodate the health and medical needs of transgender and/or gender diverse people, and the health, service and medical needs of older lesbian women and some older gay men, including those with HIV.

Societal and community factors in the drivers and context of abuse and mistreatment of LGBTIQA+ older people

When compared to participants in the National Prevalence Study, a greater proportion of participants in both LGBTIQA+ surveys perceived abuse and mistreatment to be common and to be ignored in society. Participants in the LGBTIQA+ surveys were also substantially less likely to hold views that could be considered as condoning abuse and mistreatment.

Specifically, awareness and understanding of the experience of psychological abuse and neglect, as well as sexual abuse, were more strongly identified among participants in this project than in the National Prevalence Study, although awareness of physical and financial abuse was equally well represented in both studies.

These data suggest that awareness and understanding of abuse and mistreatment of older people may have improved since the National Prevalence Study in 2020, building upon improvements in awareness and attitudes found in the Evaluation of the National Plan Community Survey (McEwen et al., 2024).

LGBTIQA+ people may also have a stronger awareness and understanding of abuse and mistreatment compared to the broader community. This greater awareness and understanding may, in part, reflect greater lived experience of abuse and mistreatment, including over the life course, for LGBTIQA+ people.

Factors relevant to the drivers and dynamics of abuse and mistreatment of older people identified by participants include:

• ageist and abuse-condoning attitudes
• changes in social norms
• increasing diversity of cultural and religious beliefs that may not be accepting of LGBTIQA+ people
• bias and stereotyping in the Australian community (including within LGBTIQA+ communities)

Ageist attitudes and assumptions including those that people make about the perceived vulnerability of older people and about their wealth and other resources and how they should be used, were also identified as contributing to abuse and mistreatment of older people.

Factors identified in the data as compounding the experience of abuse and mistreatment of LGBTIQA+ older people include:

• financial and housing precarity
• isolation (including over the life course)
• experiences of disability and cognitive decline.

Individual and relationship factors for people who use abuse and mistreatment of LGBTIQA+ older people

Overall, men and women were equally likely to be identified by survey participants as engaging in abuse and mistreatment of LGBTIQA+ older people (43%), with a further 4% of participants reporting abuse undertaken by people who would describe their gender as non-binary.

However, some differences were identified in relation to abuse types.

Men were more likely to be identified in the survey as engaging in financial abuse and emotional abuse and women were more likely to be identified as engaging in discrimination.

Heterosexual people were more likely to be identified in the survey as engaging in abuse or mistreatment of LGBTIQA+ older people.

• Just over two-thirds (69%) of people engaging in abuse or mistreatment were identified by those experiencing abuse to be heterosexual, 16% as gay, lesbian or homosexual, with a further 4% as bisexual or pansexual.

The qualitative data, particularly from some older lesbian women, gay men and older transgender and/or gender diverse people, also highlighted abuse and mistreatment by LGBTIQA+ people, and most commonly in the form of psychological/emotional abuse and discrimination.

The data indicates that abuse or mistreatment of LGBTIQA+ older people was undertaken by people across the age groups, with those aged 35–44 and 45–54 years more likely to be reported as engaging in abuse or mistreatment (18% and 22% respectively).

There were no clear patterns in the relationships with people using abuse or mistreatment – however, the most commonly reported relationships were siblings (8%) and LGBTIQA+ and non-LGBTIQA+ friends (8% respectively), followed by partners/spouses (6%). Children (4%), children-in-law (6%) and stepchildren (2%) were also identified by participants, as well as neighbours (6%) professionals and service providers (2-4%).

Just over half (51%) of LGBTIQA+ survey participants who reported experiencing abuse or mistreatment indicated that those engaging in such behaviour had one or more issues involving alcohol and drugs, gambling, financial hardship, mental health or with their physical health.

• Mental health issues, followed by issues with substance use, were most commonly reported and these response patterns were similar to the reports in the National Prevalence Study relating to issues characterising those engaging in abuse or mistreatment of older people.
• A substantial proportion of LGBTIQA+ survey participants who reported experiencing abuse or mistreatment indicated that the person engaging in the abuse or mistreatment had multiple, co-occurring issues.

Individual and relationship factors for people who experience abuse and mistreatment and its effects

The data suggest that LGBTIQA+ older people with certain characteristics are at higher risk of abuse or mistreatment.

The overall pattern in relation to experiences of abuse and mistreatment varied according to age but these differences were not statistically significant. The highest rate of reported abuse and mistreatment is among participants aged 71 years or older (44%) and the lowest for participants aged 65–70 years.

These higher reports of experiencing abuse and mistreatment among participants aged 71 years and older were particularly evident for financial abuse, sexual abuse and neglect. Higher reports for this age group were less pronounced for emotional abuse and discrimination. After controlling for other characteristics in regression modelling, the effect of age was not found to be statistically significant.

Overall, there was no statistically significant difference in the experience of abuse or mistreatment by gender (women: 37% cf. 33% of men), however, there were some differences by abuse types, with women more likely to report experiencing neglect than men to a statistically significant extent (3% cf. 2%).

Importantly, transgender and/or gender diverse people were more likely to report experiences of abuse or mistreatment (67% cf., 31%).

• A large and statistically significant difference in the experience of abuse and mistreatment (discrimination) was identified for those who identify as transgender and/or gender diverse.

LGBTIQA+ participants who reported living with a disability were also more likely to experience abuse or mistreatment than those without disability.

• Statistically significant differences were identified in relation to LGBTIQA+ older people living with disability experiencing abuse, especially financial abuse and neglect.

There were also statistically significant differences in the experiences of abuse and mistreatment by relationship status, with most participants who reported experiencing at least one form of abuse being separated, divorced, widowed or currently single but previously married or in a de facto relationship, compared to married participants or those in de facto relationships.

Variations were identified in relation to the sexuality of the person experiencing abuse or mistreatment, with gay men more likely to report financial or emotional abuse and bisexual people more likely to report experiences of physical abuse, neglect and discrimination, compared with other LGBTIQA+ older people.

There were no apparent differences in rates of experiencing abuse or mistreatment by geographical remoteness.

The reported effects of abuse and mistreatment were far-reaching and devastating. They included isolation and disconnection from social and family relationships and adverse health and wellbeing outcomes including physical health issues, mental ill-health and post-traumatic stress disorder (PTSD).

Financial distress and hardship were other identified effects, as was lower quality of life satisfaction and the distressing need to conceal sexuality and gender, including to service providers, professionals and more generally.

Seeking help and barriers to seeking help

Most (90%) of those survey participants aged 65 years or older reported they were confident in their ability to identify the signs of abuse and mistreatment, which was significantly higher than the 64% of people aged 49 years or younger.

However, data from both the LGBTIQA+ surveys and from the focus groups and interviews indicated challenges associated with identifying abuse and mistreatment when it occurs and in relation to seeking help.

• Just under half of LGBTIQA+ older people who reported experiencing abuse or mistreatment indicated that they sought help, which is higher than for older people experiencing abuse or mistreatment in the National Prevalence Study.
• Help was most commonly sought when financial abuse was experienced.

Even where the LGBTIQA+ participants who reported experiencing abuse or mistreatment did not seek help, more than three-quarters (77%) still took at least one form of action to stop this abuse or mistreatment.

Most commonly this involved breaking contact with the person engaging in the abuse or mistreatment. This pattern of taking action is consistent with findings from the National Prevalence Study.

Additionally, the data indicate more than one-quarter (28%) of LGBTIQA+ younger participants expressed concerns about experiencing abuse or mistreatment in older age (65 years+). Although participants aged 50 years and older reported higher rates of concern compared to younger participants, age group differences were not statistically significant. Non-binary participants had higher rates of concern than men and women.

Improving service responses and education and awareness

Survey participants were most likely to agree that improvements to service responses, education and awareness would be supported by:

• collaborative partnerships between specialist elder abuse services and other organisations
• mentoring and support programs
• community visitor schemes (where LGBTIQA+ people visit isolated or at risk LGBTIQA+ older people)

Some participants in the qualitative data components, as well as insights from the desktop review, suggested the need for:

• dedicated services for LGBTIQA+ older people with specific knowledge of the issues experienced by LGBTIQA+ adults and older people
• LGBTIQA+ employee representation to ensure LGBTIQA+ older people accessing services feel safe and understood
• improved service linkages and holistic service provision
• greater financial and geographical accessibility of services.

Improvements identified to combat discrimination included improving visibility of older people within the LGBTIQA+ groups and improving education and awareness for professionals, the general public and for LGBTIQA+ people too.

Co-designing education, awareness and response initiatives with LGBTIQA+ people will support measures to address the safety and wellbeing of LGBTIQA+ older people.

Implications and next steps

Understanding abuse and mistreatment for LGBTIQA+ people

The working definition of abuse for research that was developed for the National Prevalence Study facilitated the exploration of additional types of abuse and mistreatment experienced by LGBTIQA+ older people. This included the additional abuse type of discrimination, and it supported the consideration of systemic issues critical to understanding their experiences.

This research shows that because of their experience of discrimination and potentially violence and abuse earlier in their life course, LGBTIQA+ older people commonly have multiple compounding and at times specialised needs that require a careful and specific response.

Information, awareness and education

The data in relation to the incidence of abuse suggest a critical need for both public and targeted information, awareness and education campaigns to improve both the community knowledge and understanding of:

• the experience of each of the National Prevalence Study forms of abuse but, particularly, psychological/emotional abuse and financial abuse, given their higher rates of experience by LGBTIQA+ older people
• the additional abuse type of discrimination specifically experienced by LGBTIQA+ older people.

This would involve directing these campaigns and education activities at reducing ageist and abuse-condoning attitudes in the general community and LGBTIQA+ communities.

For older people in each of the LGBTIQA+ groups, the information, awareness and education campaigns could take into account their generally greater awareness and understanding of abuse and mistreatment as identified in the data and could focus on:

• supporting the continued identification of what constitutes abuse and mistreatment and how abuse and mistreatment might present for LGBTIQA+ older people
• providing information to LGBTIQA+ older people about safeguarding themselves from psychological/emotional and financial abuse (having regard to their assets) and discrimination specifically, as well as other forms of abuse and mistreatment more generally
• providing clear pathways to services and supports LGBTIQA+ older people who experienced abuse.

The data in relation to lower levels of confidence in identifying abuse and mistreatment among LGBTIQA+ younger people and non-binary people participating in the survey (64% and 63% respectively) compared to LGBTIQA+ older participants (90%), suggest a need for information tailored to these cohorts to help them identify the signs of abuse and mistreatment.

Given that less than half of participants sought help for abuse and mistreatment, information, awareness and education campaigns that encourage awareness more generally of elder abuse specific services (including the 1800ELDERHelp phone line), are also warranted.

This would be supported by education and training for health and other service professionals.

In light of the substantial concerns about ageing and about experiencing abuse across LGBTIQA+ communities, information about protective measures and activities to implement these measures are also required. Targeted information for people aged 50 years and older and for non-binary people would assist in addressing the higher levels of concerns among these groups.

Insights into drivers and dynamics of abuse and mistreatment can also help to inform future information and awareness-raising campaigns and education activities directed at reducing ageist and abuse-condoning attitudes in both the general community and LGBTIQA+ communities.

• Measures could also be designed to target heterosexual people who are more likely to be identified in the survey as engaging in discrimination and psychological/emotional abuse of LGBTIQA+ older people.
• The data relating to the co-occurring issues, including mental health and alcohol and other drug use for people engaging in abuse and mistreatment, suggest that targeted information, awareness-raising and education materials designed for these cohorts should also be considered. The data also suggest a need for improved and evidence-based prevention and response measures for the range of co-occurring issues identified for those engaging in abuse and mistreatment. A multi-faceted approach that addresses both individuals who experience abuse and mistreatment and those who engage in abuse and mistreatment should be considered. Interventions should be aimed at reducing risk factors, providing support, and promoting awareness of positive attitudes towards LGBTIQA+ older people

The data on experiences of discrimination by LGBTIQA+ older people not only informs the content and target groups for information, awareness and education measures. This data, together with data from the National Prevalence Study on discrimination as a form of cultural abuse experienced by Culturally and Linguistically Diverse older people, and the data on institutional and systemic abuse/discrimination examined in the Aboriginal and Torres Strait Islander Research Stream, also informs our developing understanding of what constitutes the abuse and mistreatment of older people. This is particularly important for older people who experience intersecting and overlapping factors and characteristics associated with the experience of these forms of discrimination.

Service design and implementation

The findings from this research in relation to both the incidence and drivers and dynamics of abuse and mistreatment of older people can also inform service design and implementation of improved prevention and response policies and practice.

Specifically, the design and implementation of policy and service provision for prevention and response activities should be informed by data about the priority target populations.

• The finding of a heightened risk of abuse and mistreatment among LGBTIQA+ people living with a disability (in relation to financial abuse and neglect) and transgender and/or gender diverse older people (in relation to discrimination) suggests the need for targeted prevention measures and supports that take an intersectional approach.
• Separated or single LGBTIQA+ older people were also identified as being in greater need of support.
• Although the effect of age was not found to be statistically significant, the data may still suggest that there are protective effects associated with the earlier stage of older age, with participants in the oldest age group more likely to experience health issues and to require aged care. Targeted measures for LGBTIQA+ people in the older age groups may therefore be warranted.
• The absence of geographic differences in the data may also suggest that more universal action is required.
• Given the substantial concerns about ageing and about experiencing abuse across LGBTIQA+ communities, information about protective measures as well as activities to support their implementation are required. This may include facilitating connections between LGBTIQA+ people and networks and building LGBTIQA+ friendly services. Targeted information and activities for people aged 50 years and older and for non-binary people would assist in addressing the higher levels of concerns among these groups.
• With middle-aged men and women equally likely to be identified overall as engaging in abuse or mistreatment, service responses must also address the non-gender related aspects of elder abuse. However, the data suggest targeted prevention and response measures will still be required in relation to specific types of abuse, with men more likely to be identified as engaging in financial abuse and emotional abuse and women more likely to be identified as engaging in discrimination.

The findings from this study also suggest the need for further education and professional development to support inclusive and specialised service delivery by health, aged care and other professionals.

Prevention and response activities provided by services will also need to be cognisant of the varying dynamics of abuse and mistreatment of LGBTIQA+ older people – including in the context of relationships with siblings and friends, partners/spouses, children/stepchildren as well as professionals and engagement with members of the public.

Relevant support services should be provided together with the information and education activities for people who engage in abuse towards LGBTIQA+ older people, which will assist in equipping services to both identify and respond to behaviours. In addition to primary prevention efforts, evidence-based interventions supporting and/or responding to people who engage in abuse and mistreatment towards LGBTIQA+ older people (e.g. behaviour change initiatives) are required in order to prevent incident re-occurrence.

Services that provide support for co-occurring issues should adopt risk-screening and assessment and response practices to improve:

• the identification of older people who may be at risk of abuse and mistreatment
• the services and supports provided to those at risk of engaging in this abuse and mistreatment.

The development of specialist responses should nevertheless be considered given that some people engaging in the abuse and mistreatment will not engage in these mainstream support service settings.

Given that passive responses to abuse and mistreatment (including withdrawing contact) are more common than seeking help to address the abuse and mistreatment, service responses will need to provide broader or alternative support options to those currently available for older people where they experience abuse and mistreatment. Alternative options raised in the findings of this study included dedicated LGBTIQA+ services that strengthen social networks, dedicated LGBTIQA+ aged care services and services for LGBTIQA+ older people undertaking caring roles (where they may be experiencing abuse).

Co-design and collaboration

The co-design of education, awareness and service responses with older people in each of the LGBTIQA+ groups is essential to support their safety and wellbeing.

The emphasis on collaborative partnerships, consistent with the establishment of a ‘web of accountability’, facilitates:

• cooperative working relationships and joined-up service provision and referral pathways to enable effective identification, assessment and specialist responses to abuse and mistreatment
• engagement with preventative measures at the broader community level through education and awareness activities that challenge LGBTIQA+ discrimination as well as ageism, and abuse-condoning attitudes towards older people more generally.