Elder abuse

Understanding issues, frameworks and responses
Research Report No. 35 – February 2016

9. Summary and discussion

This report has examined the issues that elder abuse raises in the context of Australia's ageing population and complex jurisdictional frameworks. A feature of the policy backdrop to the issues covered in this report is a ten-year period that has seen momentum for national approaches to child protection and family violence build to the extent that frameworks in both of these areas have been developed through Council of Australian Government processes. The National Framework for Protecting Australia's Children 2009-2020 is now supported by its Third Action Plan 2015-2018. The National Plan to Reduce Violence Against Women and Their Children 2010-2022 is half-way through its Second Action Plan 2013-2016. In each of these areas, the driving concerns have been to find improved responses to complex social problems in the context of Australia's federal system, which sees responsibility for policy and legislative frameworks spread across various levels of government. Both child protection and family violence have a much longer history of knowledge development than elder abuse, with research about these issues gathering pace from the 1960s onwards. In each of these areas, royal commissions are currently underway, reflecting community and government concern about historical institutional responses to child sexual abuse, and contemporary policy and practice responses to family violence in Victoria. The recommendations of each of these royal commissions have the potential to substantially re-shape the policy and legislative landscape in each of these areas (Australian Government, 2014; Victorian Government, 2015).

The material considered in this report establishes that calls for a national consideration of elder abuse are gaining pace (e.g., see Chesterman, 2015a; Lacey, 2014), with widespread recognition among experts in the field that both the existing knowledge base concerning elder abuse and approaches to preventing, identifying and addressing such abuse, however defined, have significant limitations (Clare et al., 2011; Wainer et al., 2010). Community concern is also increasingly evident, reflected in the NSW Parliamentary Inquiry Into Elder Abuse currently underway, and the House of Representative Inquiry Into Older People and the Law in 2007.

The discussion in this report has established that elder abuse is a complicated construct, with varying conceptualisations, in part depending on the theoretical and disciplinary lens through which it is approached (section 2). From a definitional perspective, the lack of an agreed approach in various legislative, policy and practice frameworks is seen to inhibit the development of a coherent approach from the perspectives of both measurement and response. The absence of a consistent approach to elder abuse from a chronological standpoint is emblematic of a deeper need to consider how elder abuse and neglect should be conceptualised, and why it raises questions of public policy that are not dealt with adequately within existing private and public law frameworks (Clare et al., 2011). Considerations in relation to human rights principles and obligations are relevant in this respect; so too are considerations in relation to professional, institutional and personal accountability.

Evidence about prevalence in Australia is lacking, though if international indications provide any guidance, it is likely that between 2% and 14% of older Australians experience elder abuse in any given year, with the prevalence of neglect possibly higher (section 3). In the absence of systematic empirical data, the dynamics, circumstances and effects of elder abuse are difficult to assess. However, the available evidence suggests that most elder abuse is intra-familial and intergenerational, with mothers most often being the subject of abuse by sons, although abuse by daughters is also common, and fathers are victims too. Financial abuse appears to be the most common form of abuse experienced by elderly people, and this is the area where most empirical research is available. Psychological abuse appears slightly less common than financial abuse, and seems to frequently co-occur with financial abuse, suggesting a pattern of behaviour analogous to grooming in the sexual abuse context. For some women, abuse in older age reflects the continuation of a long-term pattern of spousal abuse. Unlike other countries, such as America, the UK, Portugal and Israel, Australia does not have a strategy for measuring prevalence. In the absence of systematic data to shed light not only on prevalence but also on dynamics and effects among different groups and in different circumstances, the evidence base to support further development of policy and practice initiatives is underdeveloped.

The statistical evidence on Australia's age profile is clear (section 4): in the coming decades unprecedented proportions of Australia's populations will be aged. In 2050, just over a fifth of the population is projected to be over 65 (compared with 15% in 2015), and those aged 85 and over are projected to represent about 5% of the population (compared with less than 2% in 2011).39 With three in ten people over 85 having dementia, the numbers of aged people with a primary risk factor for elder abuse are likely to increase substantially. There will be significant cultural diversity among this population. Given that women tend to outlive men, it seems reasonable to suggest that a substantial number of widowed women will be living alone in 2050, a circumstance that again reflects a key risk factor for elder abuse. The numbers of aged people with dementia living in assisted care will also be substantial, underlining the need to consider this context in the development both of prevalence assessment strategies and future policy responses.

With the first annual cohort of the baby boomer generation turning 70 in 2016 (section 5), the evidence on intergenerational wealth and inheritance dynamics raises some challenging issues. In aggregate, the baby boomer generation holds higher levels of wealth than preceding generations due to higher home ownership rates and rising house prices. They, and the annual cohorts that follow them until 1980, are also the generation that was forming and unforming families when no-fault divorce was introduced in 1975. The five years after the introduction of the Family Law Act 1975 (Cth) saw the divorce rate rise substantially, with 63,230 divorces in 1976, a rate of 4.6 per thousand of the resident population, an increase from 1 per thousand of the population in 1970.40 While the highest number of divorces recorded was in 1976, since then the crude divorce rate has remained higher than that apparent prior to 1976, fluctuating between 2.5 and 2.9 for several years, then falling slightly in more recent years (from 2.3 in 2009 and 2010 to 2.1 in 2013), which partly reflects a decline in the marriage rate.41 The research discussed in section 5 suggests that complex family dynamics, including those arising from re-partnering, are associated with conflict in relation to wealth transfer and estates. One implication of such dynamics may be reflected in an escalation of disputes over pre- and post-mortem wealth transfers in the next two or three decades. A relevant social factor in this respect is housing affordability dynamics among the grandchildren of baby-boomers.

Another relevant factor potentially associated with elder abuse warrants mention in light of recent empirical evidence about levels of family violence among separated parents. In section 3, the association between traumatic life events and elder abuse was discussed, with complex family dynamics (including a history of trauma and/or family violence) being a predictor of elder abuse. In the past five years, three nationally representative cohorts of separated parents participating in AIFS research examining the experiences of separated families have demonstrated consistent levels of reports of experiences of family violence in each annual cohort studied.42 These findings suggest that stable and relatively high proportions of separated parents experience complex family dynamics, including family violence. The implications of these findings for future vulnerability to elder abuse among parents (and step-parents or partners) who have experienced separation merit further examination in any future research program.

The discussion in section 6 outlines an array of structures, frameworks and organisations that engage with issues related to ageing and potential elder abuse, with a particular focus on Commonwealth areas of concern. As with child protection and family violence, but to an even greater extent, our federal system of government means that responses to elder abuse are contained within multiple layers of legislative and policy frameworks across health, ageing and law at Commonwealth and state level, with intersections in some areas (health and ageing) and parallel operation in others (state/territory criminal and civil law frameworks). Several international conventions and treaties that establish human rights obligations relevant to elder abuse are also outlined in that section. The discussion of Commonwealth aged care provisions outline measures associated with the oversight of the quality of aged care that enable the identification of, and response to, elder abuse, although shortcomings associated with the absence of a comprehensive national framework for protection against elder abuse, and the current "patchy and under-resourced" (Barnett & Hayes, 2010, p. 57) legal and policy approaches were noted. Important efforts directed at encouraging financial literacy and an effective regulatory framework for elderly clients dealing with financial institutions have also been acknowledged, although calls for improvements in integrated and collaborative responses in this sector are also acknowledged.

A varied range of legislative and policy approaches are evident internationally, and in some countries, including America, the development of response strategies to elder abuse reflect a process of systematic policy and practice engagement with a history exceeding two decades. Among the approaches described in section 8 are legislative responses specific to a legally recognised and defined concept of elder abuse (e.g., the California Penal Code) and the establishment of Adult Protective Services in the US. In common with developments in the area of child protection and family violence in Australia, the discussion of international approaches also highlights international recognition of the need for multidisciplinary, multi-agency approaches, awareness raising campaigns and national action plans.

39 According to one set of projections developed by the ABS (2013b), the proportion of the total Australian population that is aged 65 years and over would increase from 14% in mid-2012 to 22% in mid-2061, while the proportion aged 85 years and over would increase from 2% to around 5%. As the ABS explains, population projections are not predictions. They are based on sets of assumptions concerning future changes occurring in the total fertility rates, mortality (and hence life expectancy) and net immigration. The projections quoted here are based on the ABS' "Series B" set of assumptions.

40 See the AIFS Divorce in Australia web page: <aifs.gov.au/facts-and-figures/divorce-australia>.

>41 See the Australian Bureau of Statistics series Marriages and divorces, Australia (various years) (Cat. No. 3310.0).

42 These studies were conducted by AIFS on behalf of the AGD and DSS in 1998, 2012 and 2014. See: Kaspiew et al. (2009); Qu & Weston (2010); and Qu, Weston, Moloney, Kaspiew, & Dunstan (2014).