Building a stronger response to elder abuse starts with better data

Abuse of older people is an important public health issue, and the impacts can be both immediate and long‑lasting. The term elder abuse covers a range of harmful behaviours, including physical, psychological or emotional, sexual, financial, cultural or spiritual abuse and neglect.

Public inquiries, including the Australian Law Reform Commission’s Inquiry into Protecting the Rights of Older Australians from Abuse, have raised awareness and called for coordinated action. In its 2017 report, the ALRC recommended that all levels of government work together to develop a national plan to protect older people from abuse. This led to the first National Plan 2019-2023, supported by the Commonwealth, state, and territory governments. An independent evaluation of the National Plan highlighted several important achievements including the National Elder Abuse Prevalence Study (NEAPS), Australia’s first attempt to measure the national prevalence of elder abuse. The NEAPS estimated that 14.8% of older people (approximately 1 in 6) experienced some form of abuse. However, this was based on a survey of 7 000 people aged 65 and over and is likely an underestimate as the study excluded people with cognitive impairment and those living in residential aged care homes. 

Concurrently in September 2018, the Australian Government announced the Royal Commission into Aged Care Quality and Safety. Following recommendations from the Royal Commission, the Serious Incident Response Scheme (SIRS) was introduced in 2021 to identify and prevent abuse and neglect among people receiving residential aged care and home services. In the 2024-25 financial year there were 59 574 SIRS reports in residential care, compared with 6 323 in home services. The establishment of the SIRS is an important step to recognising and responding to elder abuse; however, the numbers, especially for people receiving home services, are likely underestimated.

The most recent National Plan to End the Abuse and Mistreatment of Older People 2026-2036 was launched in March 2026 with four key focus areas, including “to address gaps in the evidence base and increase collaboration”. The Plan highlights that improved data collection is required to drive evidence-based policy, evaluation and accountability. While large-scale surveys are costly and it is difficult to obtain a representative sample, there are missed opportunities with the use of routinely collected data which could provide more accurate elder abuse prevalence monitoring and improved evaluation of prevention and intervention strategies. Better integration of elder abuse data into routinely collected datasets, such as health, aged care, criminal justice, and social service records, would also support longitudinal analyses that are currently not possible through periodic surveys.

The latest research from ROSA

A recent study by the Registry of Senior Australians (ROSA) Research Centre used its National Historical Cohort to examine elder abuse coded during emergency department (ED) presentations and hospitalisations among people accessing aged care services in Australia. Of 965 986 non-Indigenous older people who had an aged care eligibility assessment between 2010 and 2019, 580 (0.06%) had an emergency department presentation or hospitalisation coded for elder abuse. The cumulative incidence of elder abuse was found to be slightly higher in people living in socioeconomically disadvantaged areas (0.07%), for people living with dementia (0.08%) and for people with a preferred language other than English (0.09%).

The results using ROSA were found to be consistent with findings from the United States, where estimates for elder abuse have been 0.05% based on hospitalisation data and 0.01% for ED visits. The estimate is, however, lower than elder abuse observed in other national studies in Australia, including from the National Elder Abuse Prevalence Study, SIRS data, and the Older Persons Advocacy Network. The findings suggest that elder abuse is likely underreported and under-recognised in hospital settings, despite health professionals being in a key position to identify it. Detection is often constrained by the brief and task-focused nature of hospital interactions, leaving health professionals with only a narrow window to act. Many older adults hesitate to disclose abuse due to fear, shame, or a lack of opportunities to seek help. Concerns about breaching privacy or confidentiality laws can further discourage intervention, with some professionals fearing legal or regulatory consequences if abuse is reported without consent. In the high-pressure hospital environment, competing clinical priorities often take precedence, further limiting the exploration of suspected abuse. Furthermore, when abuse is identified, it may remain difficult to capture in electronic health records because the notes are not always translated into standardised elder abuse codes. However, as older people frequently visit hospitals and other clinical settings, coding of elder abuse during these visits provides an opportunity to improve prevalence estimates and strengthen detection efforts, as routine documentation may reveal patterns of mistreatment that might otherwise go unnoticed. 

Greater attention needed on elder abuse

Better data on elder abuse is a global concern, yet the issue continues to receive limited attention from both international and national bodies. To effectively respond to this problem, Australia needs a comprehensive and accurate picture of the prevalence, characteristics and impact of elder abuse. The United Nations has identified improved data collection as one of its five priority areas for addressing elder abuse, and the Australian and New Zealand Society for Geriatric Medicine has recommended strengthening alder abuse screening during aged care eligibility assessments through the Integrated Assessment Tool. Improving our national evidence base not only supports better policy and service responses nationally but also contributes to a more complete understanding of elder abuse worldwide.

Associate Professor Stephanie Harrison is an Associate Professor in Health Services and Epidemiology at the Registry of Senior Australians Research Centre at the South Australian Health and Medical Research Institute (SAHMRI) and Flinders University. She uses ROSA data to improve care quality and health outcomes for older people, including those receiving long-term care services.

Professor Gillian Caughey is the Associate Director of the Registry of Senior Australians Research Centre at SAHMRI and Flinders University. She is a pharmacoepidemiologist with expertise in improving care and health outcomes for older people, particularly in aged care, using large population-based data and registries.

Professor Maria Inacio is the Director of the Registry of Senior Australians Research Centre at SAHMRI and Flinders University. She is an epidemiologist with expertise in population health and aged care surveillance systems, using existing data and informatics to enhance these systems.

Dr Sahar Barmomanesh is an Analytical Research Associate at the Registry of Senior Australians Research Centre at SAHMRI and Flinders University. She has strong experience working with large-scale linked health, aged care, and social welfare datasets. 

Bryan Morden is a member of the Registry of Senior Australians Consumer and Community Advisory Committee.