Elder abuse is one of those topics many of us might prefer to believe didn’t exist. Unfortunately, it is very much a reality in Australia – with one in six older Australians likely to be victims of it. Two thirds of those do not report the abuse, which is especially likely when it is perpetrated by a family member, and particularly the person’s adult child or children.
This is a sobering reality, and one we explore in this conversation with integratedliving Australia psychologist, Daniela, who explains the main forms of elder abuse in more detail. According to the Federal Government’s National Elder Abuse Prevalence Study released in December 2021, elder abuse affects 15% of older Australians, and can take the following forms, with its prevalence also listed:
- Psychological abuse (11.7%)
- Neglect (2.9%)
- Financial abuse (2.1%)
- Physical abuse (1.8%)
- Sexual abuse (1%)
What is also particularly important in this podcast conversation is the exploration of those subtler forms of abuse that some of us may not be aware are indeed abusive. Things such as preventing older people from driving their cars; changing or rearranging their homes without their permission; restricting them to or from certain places or people; and so on.
Daniela explains how to recognise where values clashes may lead to unintentional abuse, and why so many victims of elder abuse have trouble reporting the abuse when it is perpetrated by those close to them, especially their adult children.
This is an important conversation and an issue we all need to be aware of, and do our bit to prevent.
You can also call the National Elder Abuse Helpline on 1800 ELDERHelp (1800 353 374). 1800ELDERHelp automatically redirects callers seeking information or advice on elder abuse to their state or territory phone line service. If you require assistance in an emergency or life-threatening situation, you should dial 000.
Hello and welcome to the Live Well podcast. I'm Liz Moore, a communications partner at integratedliving Australia. And I'm speaking to you from Gubbi Gubbi country on the Sunshine Coast where the Gubbi Gubbi people have been the traditional custodians of the land I'm recording from for thousands of years.
integratedliving Australia acknowledges Aboriginal and Torres Strait Islander peoples as the traditional owners and custodians of this country, we pay our respect to them, their cultures, and customs, and to elders both past, present and emerging.
Today, I'm very pleased to be joined by one of Integrated Living psychologists, Daniela. We're going to be discussing elder abuse in light of World Elder Abuse Awareness Day this month. We'll look at the various types of elder abuse that happen and explore some of the subtler forms that some people may not even recognize as abuse.
In a recent National Elder Abuse Prevention Study, it was found that almost one in six older Australians have experienced some form of abuse in the previous 12 months and only one third of those victims sought help for it. These are sobering figures and highlight how important it is to have these conversations so we know what to look out for and what we can do about it.
First, I'd like to introduce Daniela from the Hunter Valley, who's been a psychologist for more than a decade, four of which have been with Integrated Living, working with older Australians living in regional, rural, and remote areas. Daniela, can you tell us a little bit about what drew you to psychology initially?
Oh, it's a question I often get and I have some trouble answering it, but I put it down to being a very curious person and also around, especially during my school life, feeling a bit on the outer and not quite understanding everybody else and their behaviors and just being very curious about people.
So I'd say for about year nine, I remember going to a careers expo and only looking for information on psychology and which universities offered it, what their criteria was for entry. So I guess fairly early to have it set, "Yep. That's what I want to do." But yeah, it's often been really difficult pinning down the exact reason why, and I put it down to that curiosity.
And what have you learned from your time working specifically with older Australians in rural, regional, or remote areas while at integratedliving?
A specific thing I'd say that I've learned has been, I think, I went, well, I definitely went in with a preconceived idea that the older population was going to be a bit funny about engaging with psychology services. They were going to have that mentality of: ‘That's all rubbish and pull up your bootstrap, stiff upper lip. No one had depression back when I was young’. It could not have been further from the truth.
I've been surprised how willing they have been when that's been suggested to them to take up that offer for that sort of assistance. And sometimes how open they've been about it with family as well. So I thought that they'd have feel a bit more of a stigma with it. They might feel a bit more uncomfortable, but they've been a lot more comfortable than I would've expected.
So I guess that's something specifically I've learned working with an older population is to not have those preconceived ideas about them being really set in their ways and their beliefs because often they're not.
That's fascinating. And why do you think that is?
I'm not sure. I think more recently I've seen, because I guess this idea that they don't like technology and they try to shy away from it, but I've seen that if they can see the benefit of something then yes, they'll jump on that as well.
So during COVID, they learned a lot more about how to use things to go on video to call family. They were a lot more open to learning those things. So the older population isn't silly, if they can see a real benefit to themselves, then they're keen to learn about it. They're keen to be involved. And that's the case with the technology and with psychology services.
So not to underestimate them and think that they're not going to be interested in something because they're in that category, they're old, they don't move past that. No, they definitely want to improve themselves and improve their situation. And if it means they have to learn something, then yes, they're on board with that. Some of them might lack the confidence, but if they can be shown that, "No you're perfectly capable of this." Then yes, definitely.
So along with those lovely positives comes the reality of elder abuse within our communities. Can you please tell us a bit about the different types of elder abuse that people do experience?
Well, I guess they come in different categories. It depends on whether some get blended together or that people recognize them as distinct groups. But guess the first type that people would probably think about, if they were thinking about elder abuse, because it gets the most media attention, would be the physical abuse. So actual physical violence toward the elderly.
And I guess it's really in our consciousness because of the media because I think most people who've ever watched the TV can think of a time when someone was secretly recorded, usually in a nursing home, having harmed someone elderly. So if we hear elder abuse, that's probably the first one we're going to think about.
For probably next would be financial abuse. And that can take forms other than just stealing somebody's money. So that can be a fairly obvious one that they've got details of their accounts or how to withdraw it, or they've coerced them for their card.
I've known of someone who had people waiting while he would go and get money out of the ATM because then they were going to pretty much demand it from him. But there's also, I guess, future money. So coercing somebody into going and doing a will that is really beneficial to that person. Coercing them into going to see a solicitor and getting them to sign over powers of attorney and things like that.
Which is one of the reasons why, if you go to say the public trustee and guardian to do something like a will, or I know definitely if you decide to appoint them as your power of attorney, they will see the person if you make the appointment on their behalf, only certain people are allowed to do that. And if you, they have an appointment with that person, they don't want anyone else in the room with them because they have to ensure that nobody's pressured them into going there to do something they don't want. And the fact that they do that for all of those appointments tells you that they must see that often enough.
So I guess financial abuse would probably be one that people would think of. Somebody having their money stolen outright, or gradually losing possessions, things like that.
I guess while it gets less attention than those two categories would be the category of neglect. So somebody who's relying on the care of another person, whether that's because physically they can't take care of all their needs or their cognition is impaired and they need a lot of a support from another person and those needs aren't being met.
So it might be that they're not being given food as often as they should be. So a significant amount of weight loss can be a sign that something like that might be happening. There's other reasons why they can lose weight, even if they're eating, but that can be a sign. If their hygiene isn't being taken care of. If they're being left by themselves, when they're not safe to be left alone and they're really high falls risk or a wanderer, and they're just being left alone. If they're not being given their medications, not taken to the doctors, when they should be, not taken to medical appointments, their home environment is not being looked after by the ones who are caring for them and meant to be keeping on top of that. Those sorts of things.
If you look at it, it often gets combined emotional or psychological abuse. So that can be the things that we'd think were fairly obvious. Somebody berating and verbally abusing somebody, but it can also be things such as telling them or making them believe that, "If I wasn't around, you'll be in a nursing home. If you kicked me out, you wouldn't be able to look after yourself."
It can be suggesting to them that they're losing their mind if they question something, "Oh, I think you're losing it." And telling others, "I think that they're losing it. They're just making stuff up and they think this has happened." So it's bit more insidious, I guess, because it's not a physical mark or somebody who's visibly losing weight or a bit smelly, because they're not being washed by somebody or account statements showing money's gone out. If it doesn't happen in front of other people and they don't tell anyone then it would be a bit harder to pick up.
There's social abuse. So that sometimes gets included with psychological or emotional abuse. But that can be things such as with withholding access to grandchildren, unless you do exactly what they want. It can be telling them that other people don't want anything to do with them. It can be putting up barriers so that the sibling that your child doesn't like, doesn't get to visit mom. It can be just trying to limit their services so that they're not going to have much time alone from this person to tell someone else.
So that can be, even if it's not physical, that can be quite damaging as well. I'd say sexual abuse, again, that's one where I guess people seem to associate more with somebody who's in a nursing home, even though it would happen, probably, I'm not sure what the stats are of it happening in the community, but that's obviously sexual assaults on an elderly person.
Yes. And sexual is its own form?
Yes. And I think with that abuse, you can get them if, some of them I've seen even questioning like, "But I'm older. Why would this person do that? It mustn't have been their motive." Whereas it's like, "No, it definitely still can be." And this does happen.
Yes, I was reading that according to a 2021 study by the Commonwealth Governments Australian Institute of Family Studies, the most prevalent type of elder abuse was psychological at 12% followed by neglect at 3% financial and physical at 2% and sexual abuse at 1% and 4% of their respondents experienced multiple forms of abuse over the previous 12 months. Is any of that a shock to you or would you have expected?
Not particularly. And I guess though, some people, depending on how they were asked about that, things that they would never accept from a neighbor or a stranger when it's a family member, they may not recognise it as abuse, even if it's distressing. So I would wonder if the numbers were correct based on whether they'd recognise it or how well it was explained. And also because I guess there's a lot of shame when it comes to elder abuse by someone you are related to, particularly children.
So I think people would be reluctant to often disclose it because there's shame that it's your child doing this to you. There's shame that, "Well, I raise them. So hat must be the reason that they're the way they are." Which is not correct whatsoever.
So yeah, it wouldn't surprise me if the numbers were actually a bit greater than those as well, that it would be under reported, but it doesn't surprise me that psychological abuse would be number one.
And to look at some of those forms of abuse that, or actions, that people may not even realize are abusive. Could you elaborate on some of them that might be the case such as preventing someone, an older person, from driving their car?
Yeah. Some of those things that if you gave examples of all those categories on that list, you would say, some of those that people would go, "Yep, that's definitely abusive." But you're right. There are some that people would not even think of as being abusive because they're done out of good intentions or they're done because somebody is overwhelmed and they don't know what to do.
So it's the example that we see every now and then that dad might have been given a diagnosis, very early diagnosis of Alzheimer's, his function isn't really affected at the moment. It's been caught at the very early stages and the kids might go, "You can't drive. You couldn't possibly drive. We're going to take the keys. You can't be allowed to drive. You can't be allowed to do this, this and this."
And that comes not out of any sort of desire to control that person's life or be horrible. It's out of a concern for their safety, for public safety, and it probably mostly comes out of a lack of education around the capabilities of somebody with that early onset. So I'll admit years ago, I would've had a fairly black and white view when it came to dementia if someone's diagnosed with that, then obviously there's things that they can't do now, that they're not capable of, but it's definitely a grey area.
And somebody can be diagnosed for years and still be capable of living most of their life as they did before they need the supports. But if family members aren't educated around, I guess how the conditions progress and how much somebody can do, and also what rights they have to take away those keys, or who gets to make that decision, they might feel that it's a decision they make based on what they think is safe when ultimately it's going to be the decision of doctors when that activity's got to stop. Don't worry, they'll let you know.
But they can kind of overstep that and it's not done to try and get money or to try and get an advantage in any way. It's done for very pure motives, but it still would be considered abusive. And I guess people doing that unintended abuse I'd see, is there somebody who they could learn something from being told.
Somebody who's doing it for, I guess, nasty reasons or financial gain, not so much, but there are people who I would meet who would be absolutely adore their family member, but unintentionally be doing things that they didn't even know would be counted as abuse as well.
So if you looked at other examples of somebody who might be overwhelmed or not know what to do, and they might have a family member that wanders and they're worried about their safety and they can't be with them 24/7 to make sure that they're not going to go anywhere or do anything. So they might think, "If I lock them in this room where I know that there's nothing for them to accidentally set on fire." Or, "I know they're not going to go out onto the road, they've got dementia. So I need to look after them."
And if they are at those later stages where they might be more prone to do things that aren't safe, they would not necessarily understand that that would be considered a restrictive practice, that you can't just go and do that and there's safety risks in putting somebody there and locking them where no one can see them and find them if they fall.
But if someone's very overwhelmed and they don't know that, and they think that this is the lesser of two evils, then yes, I can see how they wouldn't necessarily know that would be considered abusive unless they had that education. And also the support to get around some of those things that come up when it comes to caring for somebody like that.
And so do these fall under neglect, would that be the form of abuse?
I'd say that would probably be considered neglect if their needs aren't being met. If they're locked away somewhere and somebody isn't looking after them, it would be considered one of those restrictive practices, I guess, which we learn about when it comes to. Get told that you shouldn't have somebody sitting in a chair and a table locked in front of them, so they can't get up.
Now you can think that, "Well, if they get up, they might have a fall." And you think, "No, you actually can't do that." If you're going to do a restrictive practice, say in a hospital setting, there has to be a lot of things that go into that decision. It can't just be something that someone decides on the spot. There's a lot of criteria for it because it's been abused in the past.
So it's things that people would do, like I said, for motives that aren't necessarily horrible ones and they'd probably be horrified to hear that's actually could be considered abuse because they don't see themselves as that sort of person, but they can unknowingly do that.
I guess another situation that we sometimes see can be that family members are worried about mom or dad's cluttered house. They're worried about them having a fall or that it just looks wrong. It's there's too much stuff or it's not as clean as they would have it or there's dust on things. It can be a range of reasons. And we've been pushed before that they'll want us to go in and declutter or they'll want to throw things away themselves, or they'll want to change things. And we've had to explain, we can't do any of that stuff without the client's consent, especially if they can make their own decisions.
And sometimes I can understand the frustration. If you think that a family member might be putting themselves in danger with the layout of their house. And I can understand that there can be a clash in values as well, because you might be a super minimalist and you go to mom or dad's place, and there's old newspapers in piles, or there's dusty ornaments everywhere, or there's things that are in spots that don't really make sense to you.
Because we all have a look at the way other people do things. And even if we are fairly relaxed about what someone else does, we still have an idea of how well it sits with us. And so I can understand that somebody's not trying to be horrible to their parent, but they might be wanting to jump in and help them and be worried about a risk, or just want to make their environment nicer to them. And maybe they think that once they've made it nicer for them, they'll think it's great.
So that's another situation where sometimes yes, the motives are really pure or they can be from a clash in values that they're not necessarily recognizing. And that sort of unintentional abuse of controlling someone's life or their environment could occur.
Yes, it's good to reflect on that. So really you're not, even if there's a safety issue, you don't have the right to come in and change your parents' home unless they've given permission?
Yes. Especially if they still have some capacity to understand the risks of living that the way they do. And also I can see situations where I would think, "Oh my goodness, if I was the child in this situation, I would be just as frustrated with this." But I also would not like somebody to see some of the decisions I make or how many chocolates, family size, that my family's not going to see in my trolley and follow me around and say, "Well, it's bad for your health." I understand that. I understand that it's probably not great, but I've made that decision myself, weighed up the pros and the cons and I want to do that.
And that's the same with the way we live as well. So sometimes it can be extreme and sometimes if somebody doesn't have that capacity to weigh that up, then maybe some actions warranted. But it's important to determine if that is the situation. And also question’ is this because I feel a bit ick about this and I think that they should feel ick about this?’
Yes. And that's the values clash that you're speaking about, is that right?
Can you tell me a bit more about how that happens, and any helpful tools to identify and deal with when you have a values conflicts?
Yeah. Let's see it's hard if you see... It's getting to recognise that life itself isn't black and white. So the way you keep your home is good for you. There are ways that other people could keep theirs that it's still safe, but it's not what you would like for yourself. And sometimes it's hard for people to move past that they're doing things the right way, and others are doing them the wrong way.
It's also important to recognise that the right to make decisions, which our parents have, also includes the rights to make decisions that aren't great. Like the aforementioned bars of chocolate that I will probably still purchase at that age. We still have that right to make those decisions.
I guess a bit of a guide, which I would think might be helpful, is would I be allowed to do this to my neighbours? Would I be allowed to go in and start doing stuff? Would I be allowed to take their car keys even if I thought that they shouldn't be driving? And if the answers, no, you probably shouldn't be doing that just because you're related to somebody as well.
And especially if you've not been appointed this substitute decision maker and that's been recognised by their medical professional, that that needs to be active. So I think that's a good guide is, ‘would the cops be called if I did this to the neighbours?’. If the answer's yes, maybe that's a discussion with mum or dad before you run in and start doing things because they might not call the police. They probably won't, but that can cause a bit of distress, as you imagine somebody taking away your right to make decisions would.
Yes, that's a really good barometer. I think that we get very blurred dealing with family. We think that we have the same rights over their lives as our own.
We get blurred as well when it comes to elder abuse and how much we should tolerate. So if you use that barometer for the neighbours, stuff that you would not put up with from the neighbours, such as a physical assault, someone stealing from you, somebody verbally abusing you over the fence. They're not things that you most people would tolerate, but it's a lot harder, it becomes more blurred, I guess, in someone's mind when it is a family member doing that because of that close bond and that feeling of responsibility. So I guess those blurred lines go both ways.
Yes, indeed. And what would you say to any listeners today, especially about the unintentional abuse, and if they've just realised that they have experienced abuse or may have what's the best way for them to handle it from here?
Oh, I think it's already a good sign if they would hear something like that and actually have the insight to go, "Hang on. Ah, that thing that I was doing out of care or concern or because I was overwhelmed, that would actually be considered abuse." Somebody like that I think could be very much reached by this sort of message. So I would say to them that not to be too hard on themselves for being a human being that also didn't know that it would be considered abuse and had the best intentions in their heart.
I would say to reach out for support from organizations for, I guess, managing some of those things that they are worried about when it comes to their parents or getting that education that, I myself did not have, for much longer before I started working with older people about what their rights are, what to do when it comes to some of those concerns and what supports there are for you if you're caring for someone who's older and you are overwhelmed and the level of care might be slipping up just because you feel like you don't have the support to do this.
So I would say to make sure that you are aware of what supports can help you or what can help that person you're caring for that is outside of you. So sometimes you find carers think that accepting external services, especially if they're a carer under Centrelink, because people feel like it's the wrong thing if they are recognised by Centrelink as a carer and they have someone coming in to help their mother with showering or help her with this and that. Or to look after mum while they go out and do something for themselves.
Whereas I tell them that, "Well, if you were a carer under Centrelink," I think it might be 63 days. I'm trying to remember how many days there is a calendar year where they recognise that you have time off as well. So it's making sure that not feeling bad for having supports to care for somebody, if you are overwhelmed as well, because you're going to be a much better carer and a lot less likely to do the wrong thing because you are overwhelmed if you've got those supports in place as well.
I guess I'd say to them that I don't necessarily judge harshly straight away someone who doesn't know, who didn't know, that what they were doing wouldn't be considered to be the right way of doing things. Because I know, especially if you see yourself as a good person and you are a good person, you're going to feel a bit defensive if somebody waves around some of those words, "It's horrible. I'm not abusing my mother."
But I don't necessarily judge someone who didn't know and who I could see was just trying to do the best by their parents, going about it the wrong way because they didn't know or they didn't know what supports were there. So I would say that mentioning some of those things or that you do need that help. You're not necessarily going to get judged as not being a good carer or a daughter or a son because you didn't know something.
And what would you say to someone coming to terms with the fact that they have, or may have been, abused by someone that they most likely trusted otherwise?
Yeah. I feel like there's a lot more shame around abuse from your own children and people that are close to you than say that neighbour who did horrible things because it doesn't fit with our idea about how the relationship's supposed to go. And there's that shame or that feeling of responsibility. So the feeling of responsibility that, "Well, I raised them, so this must be why they're the way they are." But also that feeling of responsibility that, "I've got to make sure they don't get in trouble. This could ruin their life if I report this or if I stop them taking my money, then they won't be able to pay their own bills and something bad will happen."
So I guess what I try to say to people who, especially if it is children or someone else really close, I do acknowledge that it is really hard to do something about it because they might have other people in the background saying, "You should do this and you should go straight to the cops." And I might think, "Yes, they should do that." But I will acknowledge that I understand that it's really hard to do that if there's that close connection.
I'd also try to reassure them that there's no reason that is their fault that this is happening because there's that belief that, "Okay, well, I raised them. This is on me." And I say, "Well, we are not born and raised in this vacuum where it's just what our parents put in and that we're born this blank slate and our entire personality depends on what our parents did." If that was true then the families where one person has been abusive and the rest of the siblings are fine wouldn't exist. Because they were all raised by the same people.
And anyone who's ever had a newborn before knows that they already come out with a bit of a personality at that stage. There's influences from friends, from other relatives, from all sorts of things that are out of a parents' reach as well. So regardless of whether you think you were a great parent or you're more realistic and think, "Well, I fell down every now and then like every other parent." There's no excuse why a grown adult should be abusing you, especially they know it's the wrong thing, if they're doing it out of that malice or out of personal gain.
So I'd say, "No. You didn't fail as a parent just because one of your children or more have done this to you."
That's a really important point I think. And I've got the helpline number, I'll list that at the end. Where do people go that realise they've been abused and want to do something about it, whether that's even just have their voice heard?
Yes, you can. If you feel confident with it, you can speak to the police because they're not necessarily going to race and do something unless you're willing to give a statement anyway. So they might be a source of advice, but most people wouldn't feel confident with that.
I know in New South Wales, and I'm sure every state would have the equivalent, we have the Ageing and Disability Commission and they've got a hotline where you can call to report if you think somebody is being abused, who is elderly or disabled, but you can also call yourself and you can ask for advice.
That might be somebody to speak to. You don't necessarily even have to give your name where you can ask about your questions about your situation and what you could do. And I've found them to be very respectful even when somebody has not wanted their assistance with getting out of a situation of abuse or dealing with that, they'll check in with them, but they can't go and take action without their say so. Especially if they do have capacity.
So I think that would be a good number to contact just to get that information, or even if you know somebody who you think is being abused, to find out if there's anything you should do or action you should take, because I've always found their guidance very good. And they're set up specifically for, I guess, these sorts of questions and these sorts of reports as well.
Well, thank you, Daniela. Thank you very much for joining us today on our Live Well podcast. It's a very important conversation to have and issue to be aware of and help prevent in any way possible.
Listeners, if you suspect that you may have been the victim of elder abuse, please reach out and contact the hotline that Daniela was talking about. Aging and Disability Abuse Helpline on 1800-628-221. That's 1800-628-221. And thank you very much for tuning in to this Live Well podcast today. Bye for now.
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