Sexual abuse – what it is and how to stop it

Elder abuse happens within relationships of trust, whether personal or professional.

Top 3 messages about sexual abuse of older people:

• Sexual elder abuse often involves physical contact, but it can also be non-contact in nature.

• Friends are the relationship group most commonly reported as being responsible.

• Aged care settings must report and act on suspected or actual incidents of abuse.

What is sexual abuse of older people?

Sexual abuse of older people is any unwanted behaviour of a sexual nature by someone known to them, such as a family member, friend, carer, professional or neighbour.

It may involve physical interaction, but it can also take the form of non-contact acts, such as unwanted sexual talk. Sexual abuse is a criminal act and one of several recognised types of elder abuse.

Examples of sexual elder abuse

• Touching an older person in a sexual way against their will

• Speaking to an older person in a sexual way that they did not welcome

• Forcing an older person to participate in sexual acts

• Trying to engage an older person in any other kind of unwanted sexual experience, such as viewing pornographic material

Of 7,000 people aged 65 or over who responded to the 2020 Survey of Older People[i], 1% (around 70) reported experiencing sexual abuse.[ii] Women were nearly twice as likely as men to report an experience of sexual elder abuse – but men did report.[iii]

The Final Report of the Royal Commission into Aged Care Quality and Safety (2021) noted that the number of alleged incidents of ‘unlawful sexual contact’ in residential aged care was estimated to be as high as 2,520 in 2018–19 – almost 50 per week.[iv]

Sexual elder abuse may actually be much more common than those numbers suggest. It’s likely that many instances of sexual abuse, particularly of older women, are not disclosed and that many disclosures are dismissed as imagination or fabrication.

Effects of sexual elder abuse

Older people can experience significant short- and long-term physical, psychological and social effects from sexual abuse, and it can take them a long time to recover. The effects can include:

• direct injuries sustained during the abuse

• secondary physical effects such as weight loss and inability to sleep

• anxiety, depression, shame and trust issues

• nightmares or flashbacks

• fear of contact, leading to isolation and increased loneliness

• fear of the abuser returning

• withdrawal from necessary care or medical services

• a decline in the person’s overall health due to the physical and psychological harm done.

If a person discloses an experience of sexual abuse but is not believed or listened to, their distress and psychological harm can be made worse.

Unwelcome touch: Cem’s story

After his wife of 60 years passed away, 80-year-old Cem moved into residential aged care. A few months later, Cem’s care team staff noticed that the previously polite and gentle resident began to refuse help with showering and toileting. He became cranky and withdrawn, particularly around one of the regular female care workers.

The truth was that Cem was very uncomfortable with the care worker’s contact when she assisted him with personal care. He was a very private man, and only his wife had helped him shower and toilet before. Now, he felt the care worker was being too intimate, but he didn’t feel he could talk about his distress.

How sexual elder abuse happens

Elder abuse happens within relationships of trust, whether personal or professional. These relationships naturally involve close contact and interaction, so there is the potential for trust to be broken through abuse.

Sexual abuse is often about power, and older people may be vulnerable because they are often seen as frail, powerless and unlikely to speak up. Older people who are more isolated or live with dementia or cognitive decline may be particularly vulnerable, as they may have less opportunity or ability to report the abuse.

It can sometimes be hard for a person to decide that behaviour is sexually abusive, because it may start in a low-key way – for example, inappropriate comments that are dismissed as ‘I’m just joking’. But gradually, the behaviour may become more offensive, intimate and physical, making it harder for the older person to recognise and acknowledge what’s happening to them.

Reporting sexual assault at 95: Margarita’s story

When 95-year-old Margarita was sexually assaulted in her residential care unit by the acting manager, she reported what happened to the regular manager. They didn’t believe her, but Margarita then spoke to other people who did. The abuse was reported, police attended, the case went to court, and the abuser pleaded guilty.

Along the way, Margarita was connected to Dr Catherine Barrett at the OPAL Institute, who specialises in the areas of older people’s sexuality and sexual elder abuse. Catherine supported Margarita and helped her to tell her story publicly to encourage other older women to speak out against abuse.

Sexual abuse and professional settings

Different kinds of professional services may feature in the lives of many older Australians, such as doctors and other medical services, home and residential aged care, allied health practices and support services. Some of these services are delivered in the person’s home, and others are provided elsewhere.

The relationships associated with these services offer 2 possible contexts around sexual elder abuse. One is the potential for abuse to occur, since the interactions involve close contact and the relationships may involve degrees of power and dependence. Sexual elder abuse has been reported in professional settings, as the Royal Commission into Aged Care Quality and Safety heard in 2020.

However, professional services are also well placed to spot signs of sexual abuse and take action. This opportunity for intervention can be the catalyst for the abuse stopping.

Aged care workers are obliged to report any incidents of abuse and neglect, and all providers must have an incident management system in place. Professional staff who suspect that a client has experienced sexual elder abuse should follow their organisation’s process for reporting. Family and supporters of older people should raise their concerns directly with the service management.

You can read more about the Serious Incident Response Scheme here.

Raising awareness in professional services

OPAN’s Ready to Listen training program aims to build the skills and capacity of residential aged care service providers to better respond to – and prevent – sexual assault in residential aged care.

The Older Women’s Network NSW has launched the Hear Our Voices awareness program to better equip sexual and domestic violence services to support older women following sexual assault.

Why sexual elder abuse may stay hidden

When the abuse is happening, there’s no one else around to see it. That means stopping sexual elder abuse depends on 2 things: the older person speaking up, or someone close to them noticing the warning signs.

We know that not all incidents of sexual elder abuse are reported, but it’s hard to know how many. An older person might not speak up because they:

• struggle to recognise what’s happening as ‘abuse’ when it’s done by a person they trust

• somehow feel they are to blame for what happened

• fear, or have experienced, not being believed when they speak up

• are scared of the person who’s perpetrating the abuse

• have difficulty talking about ‘private’ things

• feel embarrassed or ashamed.

If an older person lives with dementia, a disability or cognitive decline, it may also be difficult for them to communicate what’s happened.

Common signs of sexual abuse in older people

Like all forms of elder abuse, it’s important that we all look out for warning signs of sexual abuse so that we can help stop or prevent it happening to older people we know. The signs may be behavioural or physical, such as:

• sudden or unexplained withdrawal from social contact and activities

• increased (or new) depression and anxiety

• fear or agitation around certain people

• conflicting explanations for injuries or for avoiding certain people

• shame or embarrassment

• distress during personal care

• reluctance to undress for medical examinations

• unexplained loss of interest in personal hygiene

• genital or anal bruising, bleeding or pain

• new incontinence issues or symptoms of sexually transmitted infections.

Noticing changed behaviour: Beatrice’s story[v]

Ella visited her 70-year-old mother, Beatrice, regularly since she returned home from hospital after a fall. Ella soon noticed that her mother’s behaviour changed – she is now withdrawn and depressed.

Beatrice was receiving temporary home care from a local nursing service since she came home. Ella spoke to the visiting nurse about her concerns, and together they talked to Beatrice about her changed mood.

Beatrice started sobbing. With gentle support from Ella and the nurse, Beatrice admitted that her husband of 49 years often forced her to have sex with him when she did not want to. He even did this immediately after she returned home from hospital, not yet fully recovered.

Because Ella noticed and responded to her mother’s changed behaviour, they were able to take steps to stop the abuse happening.

How to respond to sexual elder abuse

If you are experiencing abuse

• 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.

• If the incident happening in a professional setting, report it to the service management.

• 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.

• Call a support service – see Where to get help, below.

If someone else is experiencing abuse

• Take note of the signs that suggest sexual 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). However, you should first try speaking to the service management.

Where to get help

• Your local police: 131 444

• 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

Find out more

Recognising elder abuse – Compass article

The five types of elder abuse – Compass webinar

National Elder Abuse Prevalence Study: Final Report

The OPAL Institute – research and advocacy about older people’s sexuality

Norma’s project: a research study into the sexual assault of older women in Australia