Child Discovering what Family works for families Community Australia aifs.gov.au Elder abuse Key issues and emerging evidence CFCA PAPER NO. 51 Adam Dean Child Family Community Australia | information exchange © Commonwealth of Australia 2019 With the exception of AIFS branding, the Commonwealth Coat of Arms, content provided by third parties, and any material protected by a trademark, all textual material presented in this publication is provided under a Creative Commons Attribution 4.0 International licence (CC BY 4.0) creativecommons.org/licenses/by/4.0/. You may copy, distribute and build upon this work for commercial and non-commercial purposes; however, you must attribute the Commonwealth of Australia as the copyright holder of the work. Content that is copyrighted by a third party is subject to the licensing arrangements of the original owner. 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Australian Institute of Family Studies Level 4, 40 City Road, Southbank VIC 3006 Australia Phone: (03) 9214 7888 Internet: aifs.gov.au Cover image: © gettyimages/SuzanaMarinkovic ISBN 978-1-76016-205-4 (Online) ISBN 978-1-76016-206-1 (PDF) Edited by Katharine Day Typeset by Lisa Carroll CFCA Papers/51_Elder abuse Elder abuse 1 Summary Elder abuse is a multifaceted and often hidden form of abuse. There is currently no national data on the prevalence of elder abuse in Australia. Based on international studies, it is estimated that between 2% and 14% of older people in high- or middle-income countries experience elder abuse every year. The term ‘elder abuse’ covers a range of harmful behaviours, including physical, emotional, sexual and financial abuse and neglect. This paper provides an overview of elder abuse in Australia. It discusses key issues involved in how elder abuse is defined and examines its prevalence, impact and associated risk factors, with a focus on implications of recent research for policy and practice. Key messages z Elder abuse is a complex phenomenon that takes many forms, including physical, psychological, sexual and financial abuse and neglect. z An estimated 2–14% of older people in high- or middle-income countries are victims of abuse or neglect every year. Prevalence rates are likely to be much higher in institutional care settings than in community settings. z A range of factors associated with older people, perpetrators, relationships and broader contextual factors contribute to older people’s risk of abuse and neglect. Emerging evidence suggests that social isolation and poor quality relationships are among the main risk factors associated with elder abuse in community settings. z Social support and healthy relationships with family members are key protective factors for older people at risk of abuse or neglect. z Research and evaluation on specific prevention and intervention strategies are needed to give a clearer understanding of what works to protect and promote the dignity of older Australians. 2 Child Family Community Australia | information exchange Introduction Elder abuse1 is a multifaceted and often hidden form of abuse. Based on international prevalence data, between 2–14% of older people in high- or middle-income countries are likely to be victims of abuse or neglect every year (Kaspiew, Carson, & Rhoades, 2016). This rate is likely to be higher for older people with disability and those living in institutional care settings (Yon, Ramiro-Gonzalez, Mikton, Huber, & Sethi, 2018). The term ‘elder abuse’ covers a range of harmful behaviours, including physical, emotional, sexual and financial abuse and neglect. While not a new phenomenon, the abuse of older adults has gained increasing recognition in Australia in recent years. Several recent public inquiries2 – including the inquiry into Protecting the Rights of Older Australians from Abuse conducted by the Australian Law Reform Commission (ALRC; 2017) – have helped raise awareness of elder abuse in the community and highlighted the need to develop comprehensive and coordinated approaches to address it. This paper provides an overview of elder abuse in Australia with a focus on the implications of recent research for policy and practice. It reviews recent theoretical literature to explore what it is and how it is defined, and draws on recent empirical research to examine its prevalence in community and institutional care settings, its impact and associated risk factors. The paper also summarises current initiatives and policy frameworks that aim to prevent and address elder abuse, and explores the emerging evidence for effective or promising practices that respond to the needs of older adults at risk of abuse. The paper concludes with future directions for research, policy and practice. Older people in Australia In Australia, older people are generally defined as aged 65 years or older (Australian Bureau of Statistics [ABS], 2016b), though some definitions of elder abuse define older people as aged 60 years and older (Kaspiew et al., 2016).3 For Aboriginal and Torres Strait Islander peoples, who have a lower life expectancy than non-Indigenous Australians, older people are typically defined as 45–50 years and older (Kaspiew et al., 2016). In 2017, an estimated 3.8 million people were aged 65 years or older in Australia. In 2016, an estimated 124,000 Indigenous Australians were aged 50 and over (Australian Institute of Health and Welfare [AIHW], 2019). Life expectancy and an ageing population The proportion of people aged 65 and over has grown steadily over the last century from 5% in 1926 to 15% in 2016, and is projected to rise to 22% by 2056 (Figure 1; AIHW, 2017b). Following this trend, people aged 85 years and older represented 2% of the population in 2017 and are predicted to increase to 4.4% in 2057 (AIHW, 2017a). Life expectancies for people born in Australia during 2014–16 were 80.4 years for males and 84.6 years for females. In the same period, people aged 65 years could expect to live longer than the average life expectancy; males had an expected age at death of 84.6 years and females had an expected age at death of 87.3 years. For Aboriginal and Torres Strait Islander peoples born between 2015–17, life expectancies were approximately eight or nine years lower than non-Indigenous Australians: 71.6 years for Indigenous males and 75.6 years for Indigenous females (Department of the Prime Minister and Cabinet, 2019). 1 The term elder abuse is used throughout the paper to refer to the abuse or neglect of older people. However, it should be noted that in some Aboriginal and Torres Strait Islander communities the term ‘elder’ is a title reserved for community leaders (Office of the Public Advocate, 2005). The ‘abuse or neglect of older people’ is a preferred term when used in reference to older Aboriginal and/or Torres Strait Islander peoples. 2 Recent public inquiries that have focused, or have included a focus, on elder abuse have been conducted in New South Wales (Inquiry into Elder Abuse NSW), South Australia (Joint Committee on Matters Relating to Elder Abuse), Victoria (Royal Commission into Family Violence) and Western Australia (Inquiry into Elder Abuse). At the time of writing, a Royal Commission into Aged Care Quality and Safety has been established with a final report due by 30 April 2020. 3 In this paper, ‘older people’ refers to people aged 65 years and over, unless otherwise stated. Elder abuse 3 Figure 1: Australia’s ageing population: Proportion of Australian population aged 65 years and older (%) 30 25 20 15 Percentage 10 5 0 1927 1937 1947 1957 1967 1977 1987 1997 2007 2017 2027 2037 2047 2057 2067 2077 2087 2097 Year Source: AIHW (2017b) Box 1: Australia’s ageing population and elder abuse It is hard to talk about elder abuse in Australia in its broader context without reference to Australia’s ageing population. As the proportion of people aged 65 years and over increases over time, the overall population of older people vulnerable to abuse is expected to increase with it. This observation can be double-edged. On the one hand, an ageing population raises important issues relating to workforce participation, its impact on economic outcomes and the provision of social support and other services that respond to the diverse needs of older Australians, including the costs associated with their care and protection (Productivity Commission, 2013). On the other hand, this focus can exacerbate existing intergenerational conflicts and further contribute to ageist attitudes that view older people as a burden to society (Dow & Joosten, 2012; Harbison et al., 2012). As discussed in this paper, emerging evidence suggests that attitudes that devalue the role and status of older people can negatively impact their health and wellbeing and may contribute to their risk of abuse by others (ALRC, 2017; Hirst et al., 2016). It is important, therefore, to balance these considerations; to take seriously the social and economic challenges of an ageing population while avoiding disempowering older people through negative stereotypes and social exclusion. Diverse backgrounds Older people in Australia are a diverse population, representing different cultural backgrounds, lifestyles and abilities. In 2016, more than a third (37%) of older people were born overseas, mainly from European (67% of those born overseas) and Asian backgrounds (16%) (ABS, 2016a).