What is abuse and neglect?
Elder abuse is any action, or failure to act, that harms an older person. Abuse can occur once or repeatedly. It can happen within any relationship where there is an expectation of trust, and it causes harm or distress to an older person. [1, 2]
Abuse can happen in different ways. [2]
| Types of abuse | Common forms |
| Financial |
|
| Neglect |
|
| Physical |
|
| Psychological |
|
| Sexual |
|
Neglect is one of the most common forms of abuse. It is hard to recognise because it often occurs when staff are rushed, understaffed or not well trained. In busy care environments, neglect can become normalised and overlooked. [4]
The World Health Organization (WHO) identifies elder abuse and neglect as a global public health issue. It increases illness, hospitalisation, institutionalisation and even death. It also violates older people’s rights, dignity and wellbeing. [1, 4]
In residential aged care settings, staff-to-resident abuse occurs when care staff harm, mistreat, or neglect residents. This may be physical, verbal, emotional, sexual, or controlling in nature (for example, limiting movement or access to the community for people with dementia). Staff-to-resident abuse is often linked to staff stress, poor leadership, weak workplace culture and inadequate training. Staff who are younger, less experienced or feel overwhelmed at work are more likely to engage in abusive behaviour. Stress and burnout have also been identified as key staff-related factors contributing to abuse. [4-6]
Resident-to-resident abuse happens when one resident harms another. This can be related to cognitive impairment, frustration or lack of supervision. It can involve physical or verbal abuse or invading personal space. It is sometimes overlooked or misinterpreted as normal behaviour. Relatives of residents can also experience other forms of abuse such as maltreatment, which can cause stress, anxiety and distrust. [4]
Elder abuse in home-based and community settings is often committed by people close to the older person. Family members are the largest perpetrator group, especially adult sons and daughters. [7, 8] Elder abuse can involve financial, physical, or psychological abuse and neglect. Older people who commonly become victims of abuse in home-based and community settings are those from low socio-economic status, poor health status, and socially isolated. [8]
Why does this matter for rights-based care?
Elder abuse is a major public health and human rights issue. Globally and in Australia, about one in six people aged 60 and over experience some form of abuse each year. [1, 7, 8] Abuse violates older people’s rights and undermines their dignity, safety and freedom from discrimination. [4, 9]
Every older person has the right to live with dignity and respect, free from mistreatment, neglect and abuse. When dignity and respect are missing, abuse is more likely to occur. A human rights-based approach helps safeguard older people against abuse and enables them to live safe, respected, and dignified lives. [9]
In residential aged care settings, safeguarding measures are often weak. Safeguarding older people means taking the steps needed to protect their fundamental human rights when they may be at risk of abuse or harm. Safeguarding focuses on preventing abuse, reducing risks and responding appropriately when concerns or incidents arise. [9] Often, the focus is on risk management rather than safety or prevention. Poor staffing, weak regulation and variable ways of protecting residents mean abuse, neglect and violence remain systemic issues. [5, 9-12]
Safeguarding measures against abuse aim to create safe and supportive environments. Examples include policies to conduct thorough background and reference checks and verify credentials to avoid employing individuals with a history of abusive behaviours, and disciplinary measures for offenders. [9] These measures uphold residents’ wellbeing, dignity, and human rights while reducing the risk of abuse. [9, 13] However, many systems and organisations still lack accountability and strong protection for residents. [9, 10, 13]
Recognising the harm done to older people, especially in the case of people living with dementia (PLWD), is the first step to reparation. Reparation is the act directed towards repairing harms. [14] Acknowledging the harm done, the impact on the person, the care team and family members can support healing, moral repair, and the restoration of trust. Recognition should therefore be embedded in reparations through measures such as truth-telling processes, public apologies and the symbolic value of monetary payments. [14]
Sexuality and sexual rights are often overlooked in aged care, partly due to staff discomfort or family concerns. Rights-based care guidelines must explicitly include sexual rights, consent processes, privacy practices, and culturally aligned approaches. Without clear organisational guidance and policies to uphold sexual rights, sexual abuse can happen. [15] Read about sexuality and older people.
Fear of retaliation is a major reason many aged care residents choose not to report concerns about abuse or identify themselves, because they depend on staff for their daily care. This fear is significant and must be acknowledged and addressed to ensure residents feel safe to speak up.[16] It is important that older people, carers and family members are aware of complaints and feedback processes. Educational programs are needed so older people, carers and families know their rights and feel safe reporting concerns.
Want to learn more?
Explore these resources if you want to understand what elder abuse is, why it happens, and what can be done to help keep older people safe, protected and treated with respect.
- Abuse of older people
- Tackling abuse of older people: five priorities for the United Nations Decade of Healthy Ageing (2021-2030)
- Protecting the rights of older Australians
- Complaints and feedback
- Reparations for harm to people living with dementia in residential aged care
Read about complaints and advocacy.
What can be done?
Autonomy and independence of older people
Care teams:
- Promote autonomy and independence of older people. Support them to make their own decisions about daily life, healthcare, routines and living arrangements.
- Provide choice and control over routines and activities rather than applying blanket restrictions. Supporting autonomy reduces vulnerability to abuse.
The evidence:
- Maintaining older people’s rights to autonomy, respect, dignity, privacy, equality of opportunity and treatment, and non-discrimination are promoted and protected by those providing care to older people. All staff need to be aware of these rights, as set out in legislation, national policy, and national standards. [13]
- There is a need to shift from a risk-first focus to a rights-informed decision-making. Focus should be on protecting older people’s rights and choices while managing risks safely to prevent abuse. A rights‑based approach to aged care recognises that frailty or any impairment does not remove a person’s ability to make choices and decide for themselves. [11]
Staff education
Organisations:
- Providers can improve staff knowledge about residents’ rights, recognising abuse, reporting procedures, safeguarding policies, and ethical decision-making.
- Training should ensure staff know how to recognise signs of elder abuse and respond appropriately. Recognise the signs of elder abuse and how to respond.
The evidence:
- Inadequate staff training about residents’ rights and lack of staff supervision can lead to poor responses to complaints and increase abuse and neglect. Improving training and monitoring focused on rights-based practice and understanding of relevant principles and their application are important to consider. [9, 11, 13]
Recognition, reparation and accountability
Care teams and organisations:
- Organisations should formally acknowledge harm and its impact on residents, families and carers. Recognition is the first step towards reparations.
- Organisational policies should hold perpetrators, including staff, volunteers, and relatives, accountable for harm done. Take reparative action, such as public acknowledgement and apology for the harm done, remove people from harmful settings and address systemic causes of harm as part of quality improvement processes.
The evidence:
- Recognition was identified as the foundation of reparations and such acknowledgement is essential for healing and moral repair. [14]
- Reparations directed towards those who are harmed or impacted by that harm need to be accompanied by explicit recognition and condemnation of actions of perpetrators and holding them accountable. [14]
- Being accountable and responsible for any harm done is important in ensuring that reparations processes are safe, transparent and independent. [14]
Policies and guidelines
Organisations:
- Organisations should develop clear policies and guidelines on respectful workplace(s), violence prevention, sexual rights and consent assessment.
The evidence:
- Organisations need explicit policies addressing sexuality. Staff require guidance on how to navigate autonomy, consent, and risk. Residents’ sexual rights deserve formal recognition as part of dignity and wellbeing. [15]
- Having policies for abuse and violence prevention and respectful workplaces in local and national policy manuals is important. Mandatory reporting of suspected abuse and violence is a primary legislative approach to addressing violence against older people. [12]