Guidelines for preventive activities in general practice

Injury prevention

Elder abuse

      1. Elder abuse

Injury prevention | Elder abuse

Abuse of older people may be physical, emotional, sexual or financial, and may include neglect. It can occur in any setting, including in aged care facilities and in the community, and affects 16% of the Australian population.1 Abuse of older people is linked to increased mortality and disability.1,2 Caring for older people who are being abused is critical to the health of these patients.1,2 Risk factors for the abuse of older people can be related to the individual, the perpetrator, relationships, the home and the wider community. There are many barriers to the older person being able to disclose the abuse.1,2

Screening

Recommendation Grade How often References
Routine screening for abuse of older people is not recommended. Practice point N/A  1,3

Case finding

Recommendation Grade How often References
Clinicians should be alert to symptoms and signs of abuse. See further information. Practice point Opportunistically 1

Preventive activities and advice

Recommendation Grade How often References
Be aware of carer stress as a contributing factor to elder abuse. Practice point N/A 1

Risks factors at the individual level include:1,4,5

  • poor physical health or frailty
  • cognitive impairment and dementia
  • poor mental health, including psychiatric illness
  • behavioural problems
  • functional dependency (needing assistance with activities of daily living)
  • low income or wealth
  • trauma or past abuse
  • ethnicity
  • social isolation or loneliness and lack of social support
  • gender.4

Risk factors related to the carer or care relationship include:1,4,5

  • caregiver burden or stress
  • mental health problems
  • alcohol or substance use
  • financial dependency on the older person
  • a history of trauma or abuse.

Relationship risk factors include a history of poor family relationships and unrealistic expectations of caring. Being in a shared living situation is a risk factor for the abuse of older people. However, it is not clear whether spouses or adult children of older people are more likely to be the perpetrators of abuse.2

Within residential aged care homes, abuse is more likely to occur where:2

  • standards for healthcare, welfare services and care facilities for older people are low
  • staff may be poorly trained, poorly remunerated and overworked
  • the physical environment is deficient
  • policies operate in the interests of the institution rather than the residents.

For possible signs and symptoms of abuse in older people, see table 15.1 in the RACGP’s Abuse and violence: Working with our patients in general practice.

There are no specific recommendations or advice for Aboriginal and Torres Strait Islander peoples.

  1. The Royal Australian College of General Practitioners. (RACGP). Abuse and violence: Working with our patients in general practice,. 5th edition. East Melbourne, Vic:edn. RACGP, 2021 [Accessed 31 January 2024].
  2. World Health Organization. (WHO). Elder abuse Abuse of older people 20220. Geneva: WHO, 20220 [Accessed 21 February 2024].
  3. Mikton C, Beaulieu M, Yon Y, Genesse JC, St-Martin K, Byrne M, Phelan A, Storey J, Rogers M, Campbell F, Ali P, Burnes D, Band-Winterstein T, Penhale B, Lachs M, Pillemer K, Estenson L, Marnfeldt K, Eustace-Cook J, Lacasse F.Mikton C, Beaulieu M, Yon Y, et al. PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions. Campbell Systematic Reviews,Syst Rev 2022: ;18(2):e1227. doi: 10.1002/cl2.1227.
  4. Johannesen M, LoGiudice D. Elder abuse: A systematic review of risk factors in community dwelling elders. Age Ageing 2013 May; 42:292–98. ;42:292–98. doi: 10.1093/ageing/afs195. [Accessed 24 August 2021].
  5. Joosten M, Vrantsides F, Dow B. Understanding elder abuse. A scoping study. Melbourne: MelbourneThe University of Melbourne and National Ageing Research Institute, 2017:1092–110. [Accessed 24 August 2021].
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