Who most commonly abuses older people in Australia?

The most common perpetrators are adult children, accounting for roughly 50% of cases; spouses and partners account for around 30%; other relatives, friends, neighbours, or formal carers make up the remainder. The abuse typically occurs in the family home, making it largely invisible to community services. The perpetrator commonly attends the GP appointment on behalf of the older patient — which is precisely why seeing the older patient alone is the non-negotiable first step of any assessment. The perpetrator's presence in the consultation is itself a red flag.

What is the Serious Incident Response Scheme?

The Serious Incident Response Scheme (SIRS) is a mandatory reporting framework under the Aged Care Act requiring approved providers to notify the Aged Care Quality and Safety Commission of defined serious incidents. It has applied to residential aged care since 1 April 2021 and to home care since 1 December 2022. Reportable categories include: unreasonable use of force, unlawful sexual contact, psychological or emotional abuse, neglect, unexpected deaths, financial coercion, inappropriate restraint, and missing consumers. Priority 1 incidents (immediate or serious harm) must be notified within 24 hours; Priority 2 incidents within 30 days.

What is decisional capacity and why does it matter for elder abuse?

Decisional capacity is the ability to understand relevant information, appreciate the consequences of a decision, reason through the options, and communicate a choice. It is decision-specific — a person may have capacity to decide where to live but not to manage complex finances — and time-sensitive, fluctuating with delirium, medication changes, and dementia progression. When a patient with intact capacity declines intervention despite experiencing abuse, their autonomy must be respected; the GP's role is to offer ongoing support, information, and a named contact. When capacity is absent, the relevant state guardianship or civil and administrative tribunal pathway activates.

What financial abuse red flags should a GP ask about?

Financial abuse is the second most common subtype of elder abuse. Red flags include: a new signatory on bank accounts; recent changes to wills or enduring power of attorney where the older person may not have had capacity; unexplained withdrawal of large sums; unpaid bills or rent despite apparent financial means; missing valuables; a family member controlling access to accounts; and the patient expressing confusion or distress about money they cannot account for. GPs can alert patients to the Australian Banking Association's elder financial abuse protocols — banks now have specific safeguard procedures including staff training and delayed transaction processing.

What support is available for carers who are struggling?

Carer burnout is both a documented risk factor for elder abuse and an independent clinical concern requiring its own response. The Carer Gateway (1800 422 737) provides a free national service including counselling, peer support, coaching, and practical assistance. Respite — short-term residential or community respite — can be arranged through My Aged Care, giving the carer a genuine break. Mental Health Care Plans (MBS items 2715/2717) are available for carers in their own right, separately from the patient's care plan. Carers Australia provides peer support, information, and advocacy. Addressing carer strain is not an alternative to investigating potential abuse — both must occur in parallel.

Elder abuse

Elder abuse: detection, assessment, and management in general practice

By Dr HB Lo, FACRRM Reviewed 26 July 2026 13 min read

Elder abuse — harm by someone in a trusted relationship — affects 14.8% of community-dwelling Australians aged 65 and over each year. Psychological abuse is most prevalent; financial abuse, neglect, physical, and sexual abuse also occur, often together.

GPs are well placed to detect elder abuse — they see older patients alongside the very family members who may be the perpetrators. Key actions: see the patient alone, screen with EASI, assess decisional capacity, document meticulously, and refer to 1800ELDERHelp (1800 353 374). Mandatory reporting applies in residential and home aged care through the Serious Incident Response Scheme.

What elder abuse is and why it matters

Elder abuse is defined by the World Health Organization and Compass as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” In Australian guidance, “older” means aged 65 and over in mainstream contexts and aged 45 and over for Aboriginal and Torres Strait Islander people, reflecting earlier onset of age-related health burden.

The AIFS National Elder Abuse Prevalence Study 2021 (Kaspiew et al.) — the most comprehensive national study to date, with a sample of 7,000 older Australians — found a 12-month prevalence of 14.8% among community-dwelling adults aged 65 and over. That is approximately 1 in 7 older Australians experiencing abuse in any given year. This figure almost certainly underestimates the true burden — only around 15% of those experiencing abuse report it or seek help, with barriers including shame, fear of the perpetrator, fear of being placed in residential care, family loyalty, cultural and religious factors, and impaired capacity to recognise or articulate the situation.

Elder abuse is not a rare or specialist concern. It is a prevalent condition in every GP’s patient panel, presenting through routine appointments for osteoporosis monitoring, dementia management, blood pressure review, and the annual 75+ Health Assessment — and it is routinely missed when clinicians do not look for it.

The six recognised subtypes, per RACGP Abuse of Older People 2023:

Psychological/emotional abuse — verbal threats, humiliation, intimidation, isolation, gaslighting; the most common subtype (11.7%)
Neglect — active (deliberate withholding of food, medication, care, or social contact) or passive (carer incapacity due to burnout or ignorance); also includes self-neglect in the context of cognitive impairment or hoarding
Financial/material abuse — misuse of money, property, or possessions; coerced wills or power of attorney changes; missing funds
Physical abuse — assault, restraint, inappropriate medication (chemical restraint) (1.8%)
Sexual abuse — non-consensual sexual contact; decisional capacity to consent is central and particularly vulnerable in dementia (1.0%)

Multiple subtypes co-occur in approximately 25% of cases. Psychological abuse is present in most cases of other subtypes.

A. Core clinical — the AU general-practice framework

Who is at risk

Elder abuse is multifactorial — the product of victim vulnerability, perpetrator characteristics, and contextual factors intersecting. Key risk factors:

Victim factors: cognitive impairment (dementia more than doubles the risk of abuse — the combination of dependency, communication difficulty, and impaired capacity to report makes it the most significant vulnerability factor); depression; social isolation; financial dependency on the perpetrator; prior exposure to family violence; physical frailty and dependency for activities of daily living.

Perpetrator factors: mental illness; substance use disorder; financial stress; unemployment; caregiver burnout; intergenerational patterns of family violence; shared housing with the older person; financial dependency on the older person.

Cognitive impairment deserves special emphasis. A patient with moderate to severe dementia who cannot consistently report abuse, cannot reliably distinguish harmful from caring interactions, and whose agitation or withdrawal may be attributed to the dementia itself, is profoundly vulnerable. Clinicians must specifically assess for abuse at every dementia review.

How to screen — see the patient alone first

All older patients should be screened opportunistically, confidentially, and alone. The perpetrator commonly attends the appointment, often positioning themselves as the patient’s advocate and interpreter. The GP must find a clinical reason to see the patient without the accompanying person — a practice nurse completing intake measurements, an in-room ECG, a request to check blood pressure in a separate room, or a request to complete a blood-request form privately. This is not optional; screening in the presence of a potential perpetrator is not screening.

Validated screening tools:

EASI (Elder Abuse Suspicion Index) — Yaffe et al., 2008 — 5 patient questions plus 1 clinician observation; any positive response warrants further inquiry. Brief enough for routine clinical use.
HALF — Health, Attitudes/anxiety, Living arrangements, Finances — a more comprehensive structured interview tool suited to geriatric or aged-care assessments.

Open-ended questions that complement the tool: “Has anyone tried to hurt you?” “Has anyone tried to force you to sign something?” “Is anyone taking money from you without permission?” “Are you afraid of anyone?” “Are you getting the care and help you need?”

Examination

General impression — weight trend (compare to previous); hydration; hygiene and dress appropriateness; demeanour; how the patient interacts with (or avoids looking at) the accompanying person
Skin — bruising location and pattern: suspicious = chest, abdomen, back, buttocks, genitals, bilateral symmetrical bruising, bruises shaped like an object or hand, multiple bruises at different healing stages. Distinguish from senile purpura on the dorsal forearms and hands (common with age and anticoagulants). Photograph injuries with consent.
Oral health — broken teeth, inadequate dentures, dry mucosae (dehydration)
Musculoskeletal — unexplained fractures, contractures from prolonged immobility
Neurological — cognitive screen (MMSE, MoCA, clock-drawing), gait assessment
Pressure injuries — their presence in a person who was previously well-cared-for is a significant concern for neglect

Investigations

FBC, UEC, LFT, albumin, 25-OH-vitamin D, B12, folate, iron studies — assess nutritional and hydration status; albumin below 30 g/L suggests significant malnutrition or neglect
Toxicology if chemical restraint or inappropriate sedation is suspected — review via SafeScript/QScript/PRoDUR for prescription monitoring
Formal cognitive assessment (MMSE, MoCA, clock-drawing) at every concerning encounter; refer for neuropsychological assessment if borderline
Document capacity — specific decisions (finances, accommodation, medical treatment), time-stamped, with the assessment documented clearly

Differential considerations

Confusion, weight loss, bruising, and behavioural change in older adults can reflect underlying medical illness, medication side effects, frailty, or dementia progression independent of abuse. These are not mutually exclusive — investigate for medical causes in parallel with the abuse assessment, not instead of it. The key error is to attribute findings to “just old age” without actively considering abuse.

B. Capacity, documentation, and safety planning

Capacity assessment — the pivot point

Decisional capacity is presumed in adults unless there is evidence to the contrary. It is:

Decision-specific — a person may lack capacity to manage complex financial decisions but retain capacity to choose where to live
Time-sensitive — capacity fluctuates with delirium, acute illness, medication changes, and dementia progression; assess and document at each relevant encounter
Not equivalent to cognitive impairment — a person with mild dementia may retain capacity for many decisions; a person with severe cognitive impairment may lack it for most

When capacity is assessed as absent for a specific decision, activation of legal protections follows: state guardianship or civil and administrative tribunal (NCAT in NSW, VCAT in Victoria, QCAT in Queensland, etc.) for financial and personal matters; the Public Trustee for financial management; or an existing Enduring Power of Attorney (EPOA) — if one exists and was made with capacity, and has not itself been misused.

Capacity assessment must be documented clearly, with the specific decision in question, the time of assessment, and the basis for the conclusion — not a single global statement that the patient “lacks capacity.” (Moye et al., J Gerontol B Psychol Sci Soc Sci 2007)

Documentation

Every elder abuse encounter demands meticulous, time-stamped, contemporaneous clinical notes. Use the patient’s own words in direct quotation marks. Complete a body diagram for injuries. Photograph injuries with date-stamp and scale object, with consent (or in best interests if capacity is absent). Record who else was present during the consultation. Distinguish clearly between what the patient said happened, what was observed, and what was inferred. Clinical notes may be subpoenaed in civil and criminal proceedings.

Safety planning

Safety planning for elder abuse follows similar principles to DFV safety planning but must account for the older person’s specific vulnerabilities:

Alternative accommodation: family member’s home, friend’s home, RACF respite placement
Securing documents: passport, Medicare card, concession cards, financial account details — copied and stored with a trusted person or legal representative
Informing the relevant bank of concerns under the Australian Banking Association’s elder financial abuse protocols
Cessation of perpetrator’s access to financial accounts or the home, where legally supported
Activating EPOA or guardianship application as appropriate

C. Reporting, referral, and the legal scaffolding

Mandatory reporting in aged care

Residential aged care and home care settings have mandatory reporting obligations under the Serious Incident Response Scheme (SIRS) (Aged Care Quality and Safety Commission):

Residential care: mandatory from 1 April 2021
Home care: mandatory from 1 December 2022
Priority 1 (immediate risk, serious harm) → notify within 24 hours
Priority 2 (significant harm but not immediate risk) → notify within 30 days

GPs visiting RACF patients are not themselves the approved provider but should be aware of the scheme, support the notification process, and document their clinical findings carefully.

Community elder abuse reporting is discretionary in most states. A patient with intact capacity who discloses abuse but declines intervention has the right to make that decision. The GP’s obligations are to:

Offer full information about available services and referral pathways
Provide a named contact and safety plan
Document the discussion and the patient’s decision
Maintain the relationship and continue to assess

Narrow exceptions apply through state information-sharing schemes — where a serious threat exists and the patient cannot be safely consulted or is unable to consent. These are used sparingly, with documented rationale, and with notification to the patient where it is safe to do so.

For unexplained or suspicious deaths, a Coroner’s report is required. For criminal acts (assault, sexual assault, theft, fraud), referral to police with the patient’s consent — or without consent if the patient lacks capacity and is in imminent danger.

Referral pathways

Service	Contact
National elder abuse helpline	1800ELDERHelp 1800 353 374
Older Persons Advocacy Network	OPAN 1800 700 600
Victoria	1300 368 821
New South Wales	1800 628 221
Queensland	1300 651 192
Western Australia	1300 724 679
South Australia	1800 372 310
Tasmania	1800 441 169
ACT	(02) 6205 3535
Northern Territory	1800 037 072
1800RESPECT (DFV overlap)	1800 737 732

D. Australian operations

MBS items

75+ Health Assessment — MBS items 703, 705, 707 — includes a comprehensive screen for cognitive, functional, psychosocial, and safeguarding concerns. This is the primary annual opportunity to screen for elder abuse, assess capacity, and document the social situation. The assessment must be completed confidentially, with the patient seen alone for at least part of the consultation.

Standard consultations: items 23 (Level B), 36 (Level C ≥20 min), 44 (Level D ≥40 min). Case conferencing items 132/133 for multidisciplinary planning with social workers, OPAN, the Public Trustee, geriatrician, or aged-care assessment team.

ATSI Health Assessment item 715 for Aboriginal and Torres Strait Islander patients — with the elder threshold at ≥45 years.

Chronic Disease Management Plan items 965/967 — cognitive impairment, frailty, and complex psychosocial needs all qualify; allied health referral (social work, psychology, OT, podiatry — up to 5 per year aggregate) can be arranged.

Mental Health Care Plan items 2715/2717 — for depression, anxiety, PTSD, adjustment disorder, or complicated grief in the patient or carer. The carer in their own right is entitled to a MHCP, separately from the older patient’s care plan.

Telehealth items — 91790 (video) / 91891 (phone) — with standard existing-relationship rules; useful for confidential check-ins where a home visit would not be safe or where the perpetrator monitors in-person appointments.

ACAT (Aged Care Assessment Team) referral via My Aged Care — pathway to a home care package upgrade, short-term residential respite (for safety planning), or entry to residential care.

PBS prescribing

No elder-abuse-specific pharmacotherapy. Treat sequelae with PBS-listed agents: SSRIs (sertraline, escitalopram) or SNRIs (venlafaxine, duloxetine) for depression, anxiety, and PTSD; low-dose mirtazapine where comorbid depression and sleep disturbance; antidepressants for dementia-related behavioural and psychological symptoms (BPSD) per the AMH. Antipsychotics — risperidone on Authority for 12 weeks for BPSD — are appropriate under specific clinical indications but constitute chemical restraint and elder abuse when used inappropriately to sedate or control behaviour for the convenience of carers rather than for clinical need; the Aged Care Quality and Safety Commission monitors this specifically.

Vitamin D (PBS general, criteria apply), B12 (PBS general), and iron supplementation where deficiency reflects neglect. Anti-osteoporosis therapies (bisphosphonates general; denosumab on Authority) where fractures or restraint history are relevant.

E. Special populations

Aboriginal and Torres Strait Islander older patients

The intersection of elder abuse with intergenerational trauma, community kinship obligations, historical distrust of statutory services, and limited access to legal and advocacy resources requires a community-led response wherever possible. Involve an Aboriginal Liaison Officer and partner with the local ACCHO. AFVPLS / NFVPLS provides legal services specific to Aboriginal and Torres Strait Islander family violence including elder abuse. Respect Sorry Business obligations when timing appointments following bereavement. The elder-abuse threshold for ATSI patients begins at age 45 in most frameworks.

Culturally and linguistically diverse (CALD) older patients

Use professional interpreters via TIS National (131 450) — never a family member or community interpreter, who may themselves be the perpetrator or have an interest in concealing the abuse. Recognise that financial dependence on adult children, cultural obligations to defer to family decision-making, and fear of shame or social exclusion create significant barriers to disclosure. Culturally specific advocacy services exist in major cities.

LGBTIQ+ older patients

Historical criminalisation of homosexuality, institutionalised exclusion from medical systems, and the absence of legal family recognition for much of older LGBTIQ+ adults’ lives creates distinct vulnerabilities. Chosen family members — who may hold legal authority through EPOA — may not be recognised by formal systems. LGBTIQ+ Health Alliance and Switchboard (1800 184 527) provide support.

Patients with dementia

Dementia is the most important risk factor for elder abuse. At every dementia review: screen for abuse confidentially (if the patient still has language), assess specific decisional capacity, review the EPOA (who holds it, is it being used appropriately), assess carer wellbeing, and document current functional and cognitive status. Financial abuse — particularly with a cognitively impaired person who can be persuaded to sign documents — is common and often retrospectively discovered. Encourage and support EPOA discussions early, while the patient still has capacity.

When to escalate

Call 000 or arrange immediate emergency services when:

Physical danger is current or imminent
Sexual assault has recently occurred → refer to sexual assault service and police with consent
Suicidal ideation is expressed
The patient is in a situation of imminent harm and lacks capacity to make decisions

Notify the Aged Care Quality and Safety Commission (SIRS) when:

Any Priority 1 serious incident in a residential or home-care setting — within 24 hours
Any Priority 2 incident within 30 days

Refer to state guardianship/civil tribunal when:

Decisional capacity is absent for a specific important decision
EPOA is being misused or is absent and financial or personal decisions are needed
A vulnerable patient needs legal protection beyond what clinical referral alone can provide

Report to Coroner when:

A death in aged care is unexpected, unexplained, or involves suspicious circumstances

What this article is and is not

This is general health information based on current Australian guidelines — RACGP Abuse of Older People 2023, Compass, the AIFS 2021 Prevalence Study, and the Aged Care Quality and Safety Commission SIRS framework. It is not personal medical advice and does not create a doctor–patient relationship. Decisions about mandatory reporting, capacity assessment, guardianship applications, and individual patient management are made with the treating clinical and legal team in the specific circumstances.

For older people seeking information and support: 1800ELDERHelp 1800 353 374 · OPAN 1800 700 600 · Compass · HealthDirect · Better Health Channel.

For acute mental health crisis: Lifeline 13 11 14 · Beyond Blue 1300 22 4636.

Sources cited

Frequently asked questions

Who most commonly abuses older people in Australia?

The most common perpetrators are adult children, accounting for roughly 50% of cases; spouses and partners account for around 30%; other relatives, friends, neighbours, or formal carers make up the remainder. The abuse typically occurs in the family home, making it largely invisible to community services. The perpetrator commonly attends the GP appointment on behalf of the older patient — which is precisely why seeing the older patient alone is the non-negotiable first step of any assessment. The perpetrator's presence in the consultation is itself a red flag.
What is the Serious Incident Response Scheme?

The Serious Incident Response Scheme (SIRS) is a mandatory reporting framework under the Aged Care Act requiring approved providers to notify the Aged Care Quality and Safety Commission of defined serious incidents. It has applied to residential aged care since 1 April 2021 and to home care since 1 December 2022. Reportable categories include: unreasonable use of force, unlawful sexual contact, psychological or emotional abuse, neglect, unexpected deaths, financial coercion, inappropriate restraint, and missing consumers. Priority 1 incidents (immediate or serious harm) must be notified within 24 hours; Priority 2 incidents within 30 days.
What is decisional capacity and why does it matter for elder abuse?

Decisional capacity is the ability to understand relevant information, appreciate the consequences of a decision, reason through the options, and communicate a choice. It is decision-specific — a person may have capacity to decide where to live but not to manage complex finances — and time-sensitive, fluctuating with delirium, medication changes, and dementia progression. When a patient with intact capacity declines intervention despite experiencing abuse, their autonomy must be respected; the GP's role is to offer ongoing support, information, and a named contact. When capacity is absent, the relevant state guardianship or civil and administrative tribunal pathway activates.
What financial abuse red flags should a GP ask about?

Financial abuse is the second most common subtype of elder abuse. Red flags include: a new signatory on bank accounts; recent changes to wills or enduring power of attorney where the older person may not have had capacity; unexplained withdrawal of large sums; unpaid bills or rent despite apparent financial means; missing valuables; a family member controlling access to accounts; and the patient expressing confusion or distress about money they cannot account for. GPs can alert patients to the Australian Banking Association's elder financial abuse protocols — banks now have specific safeguard procedures including staff training and delayed transaction processing.
What support is available for carers who are struggling?

Carer burnout is both a documented risk factor for elder abuse and an independent clinical concern requiring its own response. The Carer Gateway (1800 422 737) provides a free national service including counselling, peer support, coaching, and practical assistance. Respite — short-term residential or community respite — can be arranged through My Aged Care, giving the carer a genuine break. Mental Health Care Plans (MBS items 2715/2717) are available for carers in their own right, separately from the patient's care plan. Carers Australia provides peer support, information, and advocacy. Addressing carer strain is not an alternative to investigating potential abuse — both must occur in parallel.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.