In Australia, elder abuse policy and service responses currently have little focus on the particular challenges facing rural and remote communities. Yet evidence suggests that geographic isolation and other factors affecting these communities may heighten older people’s vulnerability to abuse. In this short article, we draw on our recent literature review to summarise how elder abuse can be addressed in rural and remote locations.

Elder abuse is generally defined 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’ (World Health Organization, 2002). It may include financial, psychological, social, physical and sexual abuse, as well as neglect.

Elder abuse in rural and remote communities

While most Australians live in major cities (72%), the remainder of the population live outside of these areas, with around 18% in inner regional areas and 10% in rural and remote areas¹ (Australian Bureau of Statistics, 2019). Though elder abuse may occur across all areas at similar rates (Perrin, 1993), older people in rural and remote areas are potentially more vulnerable due to geographic and social isolation, lack of transportation, lack of appropriate resources and services, and concerns around maintaining confidentiality and privacy in small town settings (Adler, 1996; Bagshaw, Chung, Couch, Lilburn, & Wadham, 2000; Cherniawksy & Dickinson, 2015; Hornosty & Doherty, 2002).

Culturally sensitive approaches are also required to address additional vulnerabilities for Aboriginal and Torres Strait Islander peoples relating to ongoing negative effects of colonisation and the Stolen Generations,² which may pose additional barriers to help seeking and service provision (Australian Law Reform Commission, 2016, 2017; Office of the Public Advocate (WA), 2005).

In light of these issues, services encountering elder abuse in rural and remote settings face a range of challenges.

Services in rural and remote communities

Current rural and remote service responses are provided by a range of health and community services. These may include advocacy, crisis and transitional services, mediation and legal services.

Our review found that elder abuse specific services often include a combination of satellite regional offices, sporadic outreach visits, and online and telephone services, which are further reduced in remote areas. Generally, few services and resources are based locally, and face-to-face outreach to isolated communities from metropolitan-based service providers often comes at a cost premium for services (Barnett, 2017).

Evidence suggests that identifying and responding to elder abuse in rural and remote areas may be more difficult than in metropolitan areas due to a lack of service knowledge about the issue, as well as staff shortages and heavier workloads resulting from fewer available resources (Warren & Blundell, 2018).

Policy frameworks

Our review found that relevant state and territory policy documents could incorporate a more detailed focus on elder abuse in rural and remote communities (Warren & Blundell, 2018). We identified a need for future policy and service development to recognise the distinct features of elder abuse in rural and remote communities, as well as how these may impact on prevention and service responses.

What works in practice?

Recent research suggests that community consultation, collaboration and the creative use of available resources are strategies that can be implemented to better respond to elder abuse in rural and remote areas (Warren & Blundell, 2018).

Given the heterogeneity of rural and remote communities, one-size-fits-all approaches imposed by non-locals are unlikely to be effective. Community consultation and collaboration are important to ensure responses are tailored to the local context and available resources. This is critical in work with Aboriginal and Torres Strait Islander communities, where it’s important to involve community Elders, Indigenous workers, service providers and the whole community, to ensure responses are culturally appropriate and complement existing resources.

Due to the relative lack of services in rural and remote communities, support services may need to be resourceful in addressing elder abuse when it is not overtly part of their role (Harbison, Coughlan, Karabanow, & VanderPlaat, 2005). This may include creating opportunities for workers to speak privately with an older person about suspected abuse away from the presence of an alleged perpetrator, either by bringing a colleague along to home visits or by taking the opportunity to speak with an older person at a local agency if it’s unsafe to do so at their home (Cherniawksy & Dickinson, 2015; Harbison et al., 2005).

Conclusion

There is no indication that elder abuse is any less prevalent in rural and remote areas than in urban areas, but older people may be more vulnerable due to geographic isolation and other factors. Yet our review indicates that services don't always have the resources or capacity to appropriately respond to the abuse of older Australians in these communities.

Service providers and policy makers are encouraged to consider how gaps in rural and remote service provision might be creatively and collaboratively addressed. The development of the first National Plan to Respond to the Abuse of Older Australians (Elder Abuse) 2019–2023 (Council of Attorneys-General, 2019) creates an opportunity to build a focus on rural and remote issues in responding to elder abuse in these communities.

Related resources and further reading

• Elder abuse in rural and remote communities: Social policy, prevention and responses 
  This report by the authors discusses findings of a literature review focused on social policy, prevention and service responses to elder abuse in rural and remote communities.
• Elder abuse: Key issues and emerging evidence 
  This CFCA paper discusses elder abuse in Australia with a focus on its prevalence, impact and associated risk factors.
• Elder abuse: Recent research and effective responses 
  This CFCA webinar presented observations from a recent scoping study and discussed effective practice responses in relation to elder abuse.
• Domestic and family violence in regional, rural and remote communities: An overview of key issues 
  This CFCA practitioner resource provides a brief overview for understanding the issues unique to domestic and family violence in regional, rural and remote communities.
• Assisting families with ageing-related relationship issues 
  This CFCA discussion article explores Relationship Australia's service response to the ageing of Australia's population.
• Victims of circumstance: Disability services in rural and remote areas 
  This CFCA short article explores potential solutions to providing accessible services for people with disabilities living in rural and remote areas of Australia.
• What works in effective Indigenous community-managed programs and organisations 
  This CFCA paper is intended for practitioners and policy makers working with Indigenous communities to manage their own programs and organisations.

References

Adler, C. (1996). Unheard and unseen: Rural women and domestic violence. Journal of Midwifery and Women's Health,41(6), 463–466. doi:10.1016/S0091-2182(96)00066-3

Australian Bureau of Statistics. (2019). Regional Population Growth, Australia, 2017–18 (Cat. No. 3218.0). Canberra: ABS. Retrieved from www.abs.gov.au/AUSSTATS/[email protected]/Lookup/3218.0Main+Features12017-18?OpenDocument

Australian Law Reform Commission. (2016). Elder abuse (Discussion paper 83). Canberra: Australian Government. Retrieved from www.alrc.gov.au/publications/elder-abuse-dp83

Australian Law Reform Commission. (2017). Elder abuse: A national legal response. (ALRC Report 131). Canberra: Australian Government.

Bagshaw, D., Chung, D., Couch, M., Lilburn, S., & Wadham, B. (2000). Reshaping responses to domestic violence. Canberra: Partnerships Against Domestic Violence & Department for Human Services.

Barnett, K. (2017). Review of OPAN elder abuse advocacy and prevention programs: Final report. Adelaide: Stand Out Report. Retrieved from www.opan.com.au/wp-content/uploads/2017/12/Review-of-OPAN-Elder-Abuse-Programs-2017.pdf

Cherniawksy, T., & Dickinson, R. (2015). Promising practices across Canada for housing women who are older and fleeing abuse. Canada: Atira Women's Resource Society. Retrieved from www.bcli.org/wordpress/wp-content/uploads/2014/11/Promising-Practices-for-Housing-Women-who-are-Older.pdf

Council of Attorneys-General. (2019). National Plan to Respond to the Abuse of Older Australians (Elder Abuse) 2019–2023. Canberra: Commonwealth of Australia. Retrieved from www.ag.gov.au/ElderAbuseNationalPlan

Harbison, J., Coughlan, S., Karabanow, J., & VanderPlaat, M. (2005). A clash of cultures: Rural values and service delivery to mistreated and neglected older people in Eastern Canada. Practice: Social Work in Action,17(4), 229–246. doi:10.1080/09503150500425091

Hornosty, J., & Doherty, D. (2002). Responding to wife abuse in farm and rural communities: Searching for solutions that work. (SIPP Public Policy Paper No. 10). Retrieved from https://ourspace.uregina.ca/bitstream/handle/10294/6662/SIPP%20Public%20Policy%20Papers%2010.pdf?sequence=1

Office of the Public Advocate (WA). (2005). Mistreatment of older people in Aboriginal communities project: An investigation into elder abuse in Aboriginal communities. Perth, WA: Office of the Public Advocate (WA).

Perrin, N. (1993). Elder abuse: A rural perspective. In N. C. Bull (Ed.), Aging in rural America (pp. 161–170). Thousand Oaks, CA: Sage Publications Inc.

Warren, A., & Blundell, B. (2018). Elder abuse in rural and remote communities: Social policy, prevention and responses. Perth: Curtin University. Retrieved from https://espace.curtin.edu.au/handle/20.500.11937/71488

World Health Organization. (2002). The Toronto Declaration of the Global Prevention of Elder Abuse. Geneva: WHO. Retrieved from www.who.int/ageing/publications/toronto_declaration/en