TO PRACTICE RESEARCH Recognising, preventing

RESEARCH Recognising, preventing
TO PRACTICE and responding to abuse
of older people living in the
BRIEFING 3 community: A resource for
community care workers

There is a growing recognition of the incidence of abuse of
older people by people in a relationship of trust with them
such as family, friends or others on whom they depend.
Community care workers are in a unique position to
support older people who are vulnerable to abuse, and to
assist them if abuse occurs.
Recognising the signs of abuse of older people and
responding appropriately is a challenge confronting all
care workers and service systems. Preventing abuse of
older people is an even greater challenge.
The aim of this briefing is to distil evidence from research
to guide care workers and managers in their day-to-day
work with older people living in the community.

Research to Practice Briefings

Research to Practice Briefings bring together lessons learned from the
literature on a topical issue in community aged care as a resource for
those working in this sector. As in most areas of social policy and practice,
the research evidence in the literature on community aged care is
continually evolving. The Briefings aim to distil key themes and messages
from the research and to point to promising and innovative practices.
An advisory group of academics and expert practitioners working in the
area of aged care provide advice and peer review.An advisory group of
academics and expert practitioners working in the area of aged care
provide advice and peer review.

This briefing has been prepared by the Department of Social Work at The University
of Melbourne in partnership with The Benevolent Society.

www.benevolent.org.au

Research to Practice Briefing 3

What is abuse of older people? families and professionals in the home, hospital and
residential care settings (O’Keeffe et al 2007).
Abuse of an older person is defined by the World
Health Organisation as any behaviour that causes Who is vulnerable to abuse?
physical, psychological, financial or social harm to an
older person occurring within any relationship where Some older people have characteristics which may
there is an expectation of trust between the older make them more vulnerable to abuse (NSW Office
person and the abuser (WHO 2002). Abuse may for Ageing 2007):
involve a single act, repeated behaviour, or neglect.
It may occur when a vulnerable older person • those in need of high levels of support and care
is persuaded to enter into a financial or sexual from a family member (ABS 2006)
transaction to which he or she has not consented, or
lacks the capacity or capability to consent to. Many • women who have experienced domestic violence
forms of abuse of older people are crimes. (Mears and Sargeant 2002, Whittaker 2007, OWN
NSW 2008, Bagshaw et al 2009, McFerran 2009)
Abuse can take many forms including:
• those who are isolated from neighbours, family
Financial or material – using an older person’s and/ or the community (Grenade & Boldy 2008)
money or property without their permission
• those people from culturally and linguistically
Emotional or psychological – verbal or physical diverse backgrounds who are socially isolated,
threats, intimidation, threats of abandonment, without English language skills and wholly
threats to harm others or pets, withdrawal of love dependent on family members (Advocare 2009)
and support
• people suffering from dementia who might be
Physical – any deliberate act resulting in physical confused about their property, belongings and/or
pain or injury, including physical coercion and surroundings (Department of Human Services et al
restraint 2000)

Social – restricting the person’s social freedom and • frail older people who have diminished ability to
isolating him or her from family and friends (which advocate for themselves and so are more vulnerable
can also have the effect of hiding abuse from outside to exploitation (Mullins et al 2008)
scrutiny)
• older people whose own aggressive and violent
Neglect – not providing life’s necessities such as behaviour, or personality change associated with
adequate food, shelter, care and emotional support. dementia or chronic illness might provoke abuse
Neglect can be intentional or unintentional (Department of Human Services et al 2000)

Sexual – sexually abusive or exploitative behaviour. • those Indigenous older people in communities
where cultural obligations make it difficult for them
Financial and psychological abuse are the most to say no to pressure for money (Advocare 2009).
common types of abuse (Lowndes et al 2009).
Understanding abuse of older people
How many people are affected? holistically

International estimates of the prevalence of abuse No single factor causes abuse of older people and
vary between two and a half percent to six percent one of the issues in intervening is how to address
of older people over 65 living in the community the multiple factors that may impact on an individual
(O’Keeffe et al 2007). Australia lacks reliable national case (Bonnie and Wallace 2003). This involves
data (Boldy et al 2002). There is considerable looking at the older person’s family dynamics and
evidence to suggest that abuse of older people relationships, social connections, physical and
is often unrecognised and under-reported by mental health, financial status and cultural context.

2 ABUSE OF OLDER PEOPLE

Research to Practice Briefing 3

Principles of practice in responding to also make it difficult for older people to report abuse
abuse of older people (Elder Abuse Prevention Unit 2008).

When responding to suspected abuse of older Abuse may be indicated by the behaviour of the
people, the rights of the older person must be people involved as well as by more obvious physical
respected. The following principles have been set signs and symptoms.
out by the Victorian Department of Human Services
(2009): Statements about abuse made by an older person
must be taken seriously, including by a person with
Competence – all adults are considered competent dementia.
to make informed decisions unless demonstrated
otherwise Responding to abuse of older people
living in the community
Self-determination – individuals should be
encouraged to make their own decisions, with There are different levels of intervention when
appropriate information and support responding to the suspected abuse of older people,
on a continuum from less to more interventionist.
Appropriate protection – where a person is not The appropriate intervention will depend on
competent to make their own decisions, it may be the specific abuse situation, the wishes and
necessary to appoint a guardian or administrator situation of the older person and their capacity to
make decisions. Interventions could range from
Best interests – an older person’s safety and counselling and case management (Bonnie &
wellbeing are paramount. Even when they are Wallace 2003), provision of community services,
unable to make all decisions themselves, their views safety and risk management through monitoring,
should be taken into account legal interventions such as guardianship and financial
management, to criminal prosecution (James and
Importance of relationships – all responses to Graycar 2000).
allegations of abuse should be respectful of the
existing relationships that are considered important When responding to suspected abuse, it is essential
by an older person that the rights of all parties – including the older
person, family members and care agency employees
Collaborative responses – effective prevention and – are maintained.
response require a collaborative approach which
recognises the complexity of the issue and the skills Most state and territory governments have
and experience of appropriate services introduced best practice frameworks and
protocols to improve professional recognition and
Community responsibility – the most effective intervention. The following checklist is drawn from
response is achieved when agencies work the Victorian Government’s With Respect to Age
collaboratively and in partnership with the 2009. It provides questions to be addressed at each
community. stage. The full report gives a clear guide as to their
implementation.
Recognising abuse of older people
Initial contact and needs identification involves
Older people may not report abuse or ask for help identifying the presenting and underlying issues,
for a variety of reasons including fear, not wanting determining risk, priority and balancing service
to jeopardise their relationship with the abuser, and capacity with client need.
shame associated with the abuser being a family
member. • How do I know when someone has been abused?

Lack of culturally appropriate services and sources of • When abuse is suspected, what should I do?
assistance, language barriers and social isolation may

ABUSE OF OLDER PEOPLE 3

Research to Practice Briefing 3

• How should I deal with different values and cultural • What kind of structured supports might assist an
differences? older person?

• How do I ask an older person about possible abuse? • What other forms of support might be suitable?

• If abuse of an older person or their carers is • What types of legal intervention might support an
suspected but not acknowledged, what should I do? older person?

Assessment involves weighing and interpreting • When is an agreed coordinated service plan
relevant information about the person’s situation and between multiple agencies necessary?
needs, in terms of whether this is a case of suspected
or actual abuse.

• What do I consider to assist the determination of an
older person’s mental capacity?

• What are the formal steps to determine testing for
mental capacity?

• What are undue influence and consent?

• Is support required for others who are aware of the
abuse?

• What does the carer think about the situation?

• Does the older person want the intervention or
assistance?

• Are there cultural considerations to take into
account?

• What elements should a safety plan cover for an
older person?

• What happens to an older person when there is an
emergency response?

• How do I continue providing support services to an
older person when suspected or confirmed abuse is
occurring?

• How do I continue to provide services to an older
person if the alleged perpetrator is integral to the
older person’s life?

• What does managing risk involve?

• What does assessing risk involve?

Care planning documents the agreed service needs,
planned intervention strategies, appropriate referral,
timelines and worker/ organisation responsibility.

• What should be considered and included in a care
plan when addressing suspicion of or confirmed
abuse?

• What should the intervention plan achieve?

• How do I assess an older person’s response to
suspected abuse?

4 ABUSE OF OLDER PEOPLE

Research to Practice Briefing 3

Agency policies and procedures

All care agencies are encouraged to develop their own approaches to prevention, management and
intervention in response to suspicions and allegations of abuse, utilising clear principles and taking account of
their duty of care to their clients and staff. The following is an example of a typical response flowchart.

Abuse of older person alleged, disclosed, witnessed or suspected

Is the older person in Protect evidence and provide
immediate danger or at risk of support to the older person as
significant harm? required

Yes No or don’t know

Contact emergency services Advise/ discuss with your
(Police and/ or ambulance) supervisor or line manager

Discussion suggests possible Discussion suggests it is not
abuse abuse. Record what happened
and outcome of discussion.
Agency policy and procedures Is there a need for further
implemented protection/ and/ or additional
Relevant authorities and risk management to be put in
services contacted for advice, place?
intervention or referral
Intervention and case
management including:
• comprehensive assessment

for vulnerable older people
• discussing options with

older person

Note: Workers should seek advice from a specialist service if they are
concerned about an individual’s capacity to consent

Adapted from NSW Department of Ageing, Disability and Home Care (2007) Interagency protocol for responding to abuse of older people

Appropriate supervision and support for frontline workers (paid and volunteer) is essential so that they are
aware of the signs of possible abuse. Managers should also be trained in how to support care workers who
report abuse.

ABUSE OF OLDER PEOPLE 5

Research to Practice Briefing 3

Interagency protocols Strategies for prevention/ early
intervention
The varied nature of abuse means that agencies may
need to seek advice from and work with a range of Key strategies for preventing abuse include:
other agencies and services. An interagency protocol
is a guide to best practice across government and • encouraging and supporting older people to stay
community sector agencies in a given geographical active and socially connected
area, for responding to potential, suspected and
actual abuse of older people. The NSW and Victorian • ensuring that older people have access to
Governments (2007, 2009) have recently issued independent information and advice prior to making
interagency protocol guides. These spell out the decisions about financial and housing matters
service networks that may need to be mobilised
including: • educating older people to assert their rights and
gain support where necessary
• the police, for emergency intervention and the
investigation of criminal offences • facilitating older people’s use of powers of attorney
and guardianship which can enable them to plan
• health agencies which provide assessment and for and have choice over who will have control over
referral their affairs if they lose capacity in the future

• hospitals which provide emergency and ongoing • educating professionals to identify and respond to
medical treatment abuse

• Aged Care Assessment Teams which undertake • raising community awareness of abuse.
comprehensive assessment and care coordination
Community care agencies and workers have an
• sexual assault services important role to play in implementing these
strategies.
• mental health services which may need to provide
specialist consultation and case management Strategies to provide easier access to information
and advice through ‘helplines’ and specialised abuse
• guardianship bodies, for people who lack capacity services can be effective. Queensland, Victoria and
to make their own decisions (NSW Government the ACT have implemented ‘helplines’ with positive
2007). feedback from a Queensland evaluation (Procopis
2007).

The Victorian, WA and ACT Governments
have developed statewide policy frameworks
addressing the abuse of older people. The Victorian
Government’s Elder Abuse Prevention Strategy, for
example, includes a financial literacy program, an
education and training package for professionals,
specialist legal and advocacy services and community
education (Office of Senior Victorians 2009).

6 ABUSE OF OLDER PEOPLE

Research to Practice Briefing 3

Discussion guide

1. What signs of the different forms of abuse would you be looking out for?

2 Are some forms of abuse easier to recognise than others? How does this affect the work we do with older
people who are victims of abuse?

3. Have you ever been in a situation where you suspected abuse but in fact no abuse was occurring? What
issues did/ would this highlight?

4. Have you ever been in a situation when you have felt an emotional response as result of an abusive
situation? Have you felt angry, sad, helpless etc? How do you, as a professional working with someone in
an abusive situation, respond to these feelings?

5. How would you support a client who is experiencing abuse? What kind of support would you need from
your agency and other agencies?

6. What would you do if you suspected financial exploitation?

7. Can you identify any differences (e.g. complexities in identification and/ or management) between
situations of acute abuse (e.g. acute physical abuse) and chronic long term abuse (e.g. ongoing financial or
psychological abuse)? Explore differences and similarities.

8. Have you ever experienced a situation where the abuser and abused work together to disguise the
abusive situation? What strategies might you use to respond in these situations?

9. Do you believe adults have the right to choose to continue to live in an abusive environment?

10. If an older person was concerned about abuse, what avenues could they explore to get independent
advice and advocacy support?

This discussion guide has been prepared by The Benevolent Society in partnership with
Community Care (Northern Beaches) as a resource for community care teams. The
aim of the guide is to facilitate reflection and learning based on Community Aged Care
Research to Practice Briefing 3: Recognising, preventing and responding to abuse of
older people: A resource for community workers in Australia. We welcome feedback
on the discussion guide as well as the Briefing.

Practice implications 4. Community care agencies should have internal
protocols for responding to suspected abuse of
1. Care should be taken to respect the wishes and key older people, covering identification of abuse, needs
relationships of the older person when abuse is identification, referral, assessment and care planning.
suspected.
5. Agency protocols should be linked to wider interagency
2. Older people require ready access to information, agreements between local services and agencies.
resources and advocacy to enable them to manage
their own safety and security. 6. Research into abuse of older people and evaluation
of interventions are central to preventing abuse and
3. Agency staff and volunteers require ongoing training improving responses when it occurs.
about the risk factors associated with abuse of
older people, recognition of abuse and effective
interventions. They should also receive adequate
support and supervision.

ABUSE OF OLDER PEOPLE 7

Helpful resources WA
There is no excuse for abuse, Department of
Victoria Communities: www.communities.wa.gov.au/seniors
With Respect to Age, 2009, Victorian Government
practice guidelines for health services and community Advocare Elder Abuse Prevention Program: 08 9479 7566
agencies for the prevention of elder abuse
ACT
Seniors Rights Victoria: 1300 368 821 or info@ Elder Abuse Pathways for Response:
seniorsrights.org.au www.dhcs.act.gov.au/wac/ageing

NSW Elder Abuse Information and Referral Phone Line:
Interagency Protocol for Responding to Abuse of (02) 6205 3535
Older People, DADHC 2007.
TAS
Are you experiencing violence or abuse?, Legal Aid Advocacy Tasmania: (03) 6224 2240 or
Commission www.advocacytasmania.org.au

Qld NT
Elder Abuse Prevention Unit: 1300 651 192 or Darwin Community Legal Service Aged and
[email protected] Disability Rights team: (08) 8982 1111 or
www.dcls.org.au
SA
Aged Rights Advocacy Service (ARAS): 08 8232 5377 or
[email protected]

Regaining your control, ARAS 2008

We welcome feedback on this Briefing.
A full list of references can be accessed on The Benevolent Society’s website.

The Department of Social Work is in the Faculty of Medicine, Dentistry and Health Sciences
at The University of Melbourne. The Ageing and Long Term Care Research Unit within the
Department undertakes research and consultancy in relation to all aspects of aged policy,
practice and programming. t 03 8344 9403 e [email protected]

We are The Benevolent Society

We help people change their lives New South Wales Queensland
through support and education, and Level 1, 188 Oxford Street 9 Wilson Street
we speak out for a just society where Paddington NSW 2021 West End QLD 4101
everyone thrives. PO Box 171 PO Box 5347
Paddington NSW 2021 West End QLD 4101
We’re Australia’s first charity. We’re a T 02 8262 3400 T 07 3170 4600
not-for-profit and non-religious F 02 9360 2319 F 07 3255 2953
organisation and we’ve helped people, ABN 95 084 695 045
families and communities achieve positive
change for 200 years. www.benevolent.org.au or find us on

Originally printed February 2010. Republished April 2013. © 2013

www.benevolent.org.au

Research to Practice Briefing 3

Recognising, preventing and responding
to abuse of older people living in the
community: A resource for community
care workers

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