Physical elder abuse – what it is and how to stop it

The effects of physical abuse can be complex, long-lasting, emotional and financial.

Top 3 messages about physical abuse of older people:

1. Physical elder abuse is a criminal act and can have long-lasting health, wellbeing and financial effects.

2. Children, partners and neighbours are the people most reported as being abusive towards an older person.

3. Family dynamics, low self-esteem or isolation can prevent someone from seeking help, but help is available.

What is physical abuse of older people?

Physical abuse is an act that causes another person physical pain and/or injury, including threatening to harm them or physically restraining them. It happens within a relationship of trust where there is an expectation of respect or care (such as family, friends or caregivers).

While physical abuse can happen to anyone, certain risk factors can leave older people particularly vulnerable. Increased dependence on other people, cognitive decline, social isolation or ageist attitudes can all increase an older person’s risk of experiencing physical abuse.

Physical elder abuse is one of several types of elder abuse, a growing concern in Australia. It is a criminal act.

Examples of physical elder abuse

• Grabbing, pushing, shaking or shoving someone

• Any kind of hitting

• Injuring someone with any kind of weapon

• Threatening physical harm

• Restraining someone in any physical way

• Giving drugs or extra medicine to make someone docile and controllable

• Denying medical treatment after an injury

An assault charge: Mary’s story

Mary, a 62-year-old widow, had a 39-year-old daughter, Sarah, who regularly demanded money from her and verbally abused her. One night, during an argument over money, Sarah threatened to punch Mary if she didn’t give her $75,000 for a house deposit. Eventually, Sarah kicked Mary and she fell.

Sarah’s threat to harm and her actual physical contact are both forms of physical elder abuse. When police arrived, Sarah was arrested and charged with assault.[i]

Effects of physical abuse

The effects of physical abuse can be complex, long-lasting, emotional and financial. They include:

• long-term health issues

• distress and expense of hospitalisation or surgery

• ongoing feelings of fear, shame or embarrassment

• trauma reactions, such as nightmares, and feelings of hopelessness

• loss of trust in relationships

• decreased independence, motivation or confidence, leading to social withdrawal and loneliness

• withdrawal from much-needed professional services.

How physical abuse happens

Factors contributing to incidents of physical elder abuse are broad. The nature of ongoing personal relationships, such as family, friendships or care arrangements, puts people who could abuse near people who could be abused.

Stressors such as financial difficulties or housing insecurity can contribute to someone acting abusively, even if they haven’t acted like that in the past. A history of domestic violence, controlling behaviours, substance abuse or mental health issues may be related.

An Australian Institute for Family Studies (AIFS) survey in 2020 found that:

• poor physical or mental health and limited social connection were often associated with an older person experiencing physical abuse

• males were the most common perpetrators of physical elder abuse (75% of the reports)

• many of the abusers were unemployed (75%) or experienced mental health problems (63%)

• children were the largest group of offenders (17%) with sons (11%) more likely to be reported than daughters (3%)

• partners/spouses and neighbours were the next largest groups (12% each)

• professional carers accounted for only 1% of the reported incidents.[ii]

Ageism can also be a factor. This often unconscious devaluing of older people can lead to impatience and make it seem ‘okay’ to handle them roughly or to dismiss bruises and scratches as typical of an unsteady older person.

Dementia and abuse: Reshma’s story

The onset of dementia may sometimes trigger physically abusive behaviour in a normally non-abusive older person, placing their partner and family members at risk.

If this happens, it’s important to seek professional help outside the home, as Reshma did in this video from the National Ageing Research Institute.

Physical abuse in professional settings

Physical abuse is sometimes reported in professional relationships such as aged care services, medical services and other care providers. Of the physical elder abuse reported in the AIFS survey, only 1% of incidents were attributed to professional carers.[iii]

The nature of a professional care relationship can make it difficult to determine whether the contact was ‘abuse’ and or simply the physical contact necessary for providing care. Generally, professional carers touching an older person to provide care, attract their attention or offer comfort doesn’t constitute abuse or ‘unreasonable use of force’.

In residential aged care, a low level of restraint or intervention may be necessary in some circumstances for the older person’s own safety or that of other people. These ‘restrictive practices’ are governed by the Aged Care Act 1997, Quality of Care Principles (2014) and relevant state & territory laws. This fact sheet from the Aged Care Quality and Safety Commission lists hypothetical scenarios to guide care providers.

However, if an incident that could be physical elder abuse occurs in a professional care setting, it’s a serious matter that should be reported and investigated.

The first step is to raise the concern with the provider. Speak to the relevant service manager or care coordinator, tell them what you believe happened and ask for a copy of the incident record or the complaint number. If you don’t feel comfortable doing this or your approach is dismissed, you can lodge a complaint with the Aged Care Quality and Safety Commission or the regulator for the type of professional service.

Why physical elder abuse may stay hidden

Physical abuse isn’t always easy for other people to see, despite the often visible signs. There could be several reasons for this.

• Lack of awareness: the older person may not recognise their experience as abuse, because of a history of violence or abuse (which normalises what’s happening), low self-esteem or cultural expectations of behaviour.

• Denial: the older person doesn’t recognise their experience as abuse, can’t believe it’s happening or feels loyal to the family member or friend who’s harming them.

• Isolation: if the older person has limited or no social contact, there’s little opportunity for anyone else to see the signs.

• Guilt, shame or embarrassment: for cultural, spiritual or personal reasons, older people may find it hard to ‘cast a bad light’ on their family.

• Fear: The abused older person may feel too scared to speak up or may not know who to turn to for help.

Common signs of physical abuse in older people

To prevent or stop physical elder abuse happening, it’s important that all of us look out for warning signs. They may be behavioural or emotional as well as physical, including:

• unexplained or recurring injuries such as bruises, scratches, cuts, bite marks, sprains, fractures or dislocations, broken teeth or eye injuries

• injuries vaguely explained as ‘accidents’ or inconsistently explained

• restricted movement or pain without a visible reason

• flinching when touched

• mood or behavioural changes, such as withdrawal, fear, anxiety or fear of a particular person.

How to respond to physical abuse

If you are experiencing abuse

• If you are in immediate danger, phone the police via 000.

• If you have been physically harmed, go to your doctor or a local hospital for treatment. Medical services can document what’s happened and help you contact legal and support services.

• Talk about what’s happening with someone you trust, who can help you think through your options and contact professional support. It’s often easier than doing it alone.

• Call a support service helpline. Click here

If someone else is experiencing abuse

• Write down why you think physical abuse is happening.

• Find a private moment to ask the person gently whether they are okay.

• If they describe or hint at behaviour that could be abusive, help them contact a support service, or make contact on their behalf.

• If they say they are okay, keep gently checking in with them. They may be okay, but they may also be too scared, ashamed or confused to talk.

• If an aged care setting is involved, you can report concerns anonymously to the Aged Care Quality and Safety Commission (call 1800 951 822).

Where to get help

• Your local police: 131 444 (or, in an emergency, via 000)

• 1800ELDERHelp, the National Elder Abuse phone line: call 1800 353 374

• 1800 RESPECT, the National Sexual Assault and Domestic Violence counselling hotline: 1800 737 732

• Legal Aid in your state or territory: search online for contact details

• A service provider helpline

Read more on Compass

Recognising elder abuse – article

The five types of elder abuse – webinar

Clarice’s story about getting the abuse to stop – real story