Abuse, neglect and family violence, including elder abuse

At a glance

• Family violence includes intimate partner violence, elder abuse, child abuse and abuse by other relatives or carers. It covers physical, sexual, psychological or emotional, financial and spiritual abuse, coercive control, and neglect.
• In Australia about 1 in 4 women have experienced intimate partner violence since age 15 (ABS 2021 to 22), and about 1 in 6 older people experienced abuse in the past year (AIFS 2021).
• Ask when there are indicators, alone, with a professional interpreter, never with the partner, carer or a child present.
• Respond with LIVES, assess lethality risk (strangulation, separation, threats to kill), document carefully and connect to services.
• Children exposed to family violence trigger mandatory reporting duties in every state and territory.

Definitions and forms

Form	Examples
Physical	Hitting, strangulation, burns, restraint, rough handling, overmedication or sedation
Sexual	Any non-consensual sexual activity, reproductive coercion (sabotaging contraception, forced pregnancy or termination)
Psychological or emotional	Threats, humiliation, isolation from family and friends, threats to harm children or pets
Coercive control	A pattern of controlling behaviour: monitoring phones and location, restricting money and movement. A criminal offence in NSW (from July 2024) and Queensland (from May 2025). South Australia legislated an offence in 2024 with delayed commencement. Tasmania has had economic and emotional abuse offences since 2005 (Family Violence Act 2004, ss 8 and 9)
Financial	Taking pension or savings, misusing an enduring power of attorney, pressure to change a will, preventing work
Neglect	Failure of a carer to provide food, medicines, hygiene, aids or medical care
Self-neglect	A person failing to meet their own basic needs, often with squalor or hoarding

The National Plan to End Violence against Women and Children 2022 to 2032 sets the national framework, including a target to end gender-based violence in one generation.

Who is at higher risk

• Women, particularly during pregnancy and after separation, the two periods when violence often starts or escalates.
• Aboriginal and Torres Strait Islander women, hospitalised for family violence assault at around 30 times the rate of other women (AIHW). The drivers include colonisation, intergenerational trauma and dispossession. Offer an Aboriginal Health Worker or Liaison Officer and a culturally safe service.
• People with disability or cognitive impairment, including dementia.
• Migrant and refugee women, especially on temporary or partner visas (fear of deportation; the family violence provisions of the Migration Regulations allow some to stay after leaving).
• LGBTQIA+ people, rural and remote residents, people who use alcohol or drugs.
• Older people who depend on a family member for care, live with an adult child with substance use or mental illness, or are socially isolated.

Recognition

Clinical indicators of partner violence

• Injuries inconsistent with the explanation, delay in presenting, multiple injuries at different stages of healing.
• Injuries to the head, face, neck, breasts and abdomen, defensive injuries to forearms.
• Strangulation: voice change, sore throat, dysphagia, petechiae above the ligature line, subconjunctival haemorrhage, neck bruising or no visible marks at all, loss of consciousness or incontinence.
• Repeated presentations with chronic pain, headache, IBS-type symptoms, insomnia, depression, anxiety, PTSD, self-harm or substance use.
• Sexual and reproductive: repeated STIs, unplanned pregnancies, terminations, miscarriage, late antenatal booking.
• A partner who is intrusive, answers for the patient, or won't leave the room.

Indicators of elder abuse and neglect

• Unexplained bruises, especially large (5 cm or more) bruises on the face, lateral right arm or posterior torso (Wiglesworth 2009).
• Pressure injuries, dehydration, malnutrition, poor hygiene, missing glasses, hearing aids or dentures.
• Medicines not given, or sedatives given to excess.
• Unpaid bills or no food despite adequate income, sudden changes to a will or power of attorney, a carer who controls the money.
• A carer who refuses to let you see the patient alone, or delays in seeking care.

Pitfall: attributing everything to frailty, dementia or falls. Abuse and falls coexist.

Asking and screening tools

• Universal screening for partner violence isn't recommended outside antenatal care (WHO 2013). Routine antenatal enquiry is part of the Australian Pregnancy Care Guidelines and most state maternity services.
• Elsewhere, ask when there are indicators. Use direct, non-judgemental questions: "Has your partner ever hurt you or made you feel afraid?"
• Validated tools, for case-finding rather than diagnosis:

Tool	Population	Content
HITS	Partner violence	How often a partner Hurts, Insults, Threatens or Screams at you; scored 4 to 20, with over 10 positive
HARK	Partner violence	Humiliation, Afraid, Rape, Kick in the past year
WAST	Partner violence	Woman Abuse Screening Tool: relationship tension, difficulty resolving arguments, fear
EASI	Older people with intact cognition	Five patient questions plus one doctor observation

• In cognitive impairment, rely on observation, collateral history from other services, and a home or aged care assessment.

Responding to a disclosure

LIVES (WHO first-line support)

First-line support is recommended in the WHO 2013 guideline; the LIVES acronym comes from the WHO 2014 clinical handbook.

• Listen closely, without judging.
• Inquire about needs and concerns: emotional, physical, social, practical.
• Validate: "This is not your fault. No one deserves to be treated this way."
• Enhance safety: assess current risk and make a safety plan.
• Support: connect to services, housing, legal help and ongoing care.

Risk assessment

High-risk factors for serious harm or homicide:

• Non-fatal strangulation (about a 7-fold rise in homicide risk, Glass 2008).
• Recent or planned separation.
• Threats to kill the patient, children or themselves.
• Access to weapons or firearms, escalating frequency or severity.
• Pregnancy or a new baby, stalking, sexual violence, coercive control, and perpetrator substance use or unemployment.

Most states use a common risk framework (Victoria's MARAM, NSW's DVSAT). If risk is high, involve police and specialist services that day, with the patient's consent where possible.

Safety planning

• A safe place to go and a way to get there, a packed bag with documents, medicines, money and phone charger.
• Safe ways to contact services. Phones and accounts may be monitored.
• Plan for children and pets.
• Respect the patient's decisions. Leaving is the most dangerous time, and the patient often knows best when it's safe.

Documentation

• Record the patient's own words in quotation marks, who they say caused the injury, and when.
• Describe injuries precisely (size, colour, site) on a body map. Photograph with consent, including a scale.
• Avoid "alleged" and "claims", which undermine credibility in court.
• Strangulation: document symptoms, and arrange CT angiography of the neck if there was loss of consciousness, incontinence, neurological symptoms, or significant neck findings.
• Keep notes secure and be careful with what the perpetrator could see on shared portals or discharge summaries.

Reporting duties and the law

• Children: doctors are mandatory reporters of suspected child abuse and neglect in every jurisdiction. Exposure to family violence counts as harm in most.
• Adults: reporting domestic violence to police generally needs consent. The NT requires anyone to report serious physical harm or an imminent threat. Privacy law in all states allows disclosure without consent to lessen a serious threat to life, health or safety. Information-sharing schemes (such as Victoria's FVISS) let prescribed services share risk information.
• Residential and home aged care: providers must report serious incidents, including abuse and neglect, to the Aged Care Quality and Safety Commission under the Serious Incident Response Scheme, with priority 1 incidents within 24 hours. The Aged Care Act 2024 (in force from November 2025) keeps this duty.
• Older adults with capacity decide for themselves. When capacity is impaired, refer to the state guardianship tribunal or Public Advocate/Public Guardian (and, in NSW, the Ageing and Disability Commission) to investigate, appoint a guardian or financial manager, or revoke a misused enduring power of attorney.

Neglect and self-neglect

• Carer neglect may be wilful or come from a carer who is overwhelmed, unwell or untrained. Carer support, respite and aged care services often fix the second kind.
• Self-neglect (Diogenes syndrome) is often linked to frontal dementia, depression, psychosis or alcohol use.
• The key step is a capacity assessment for the specific decision. A person with capacity may choose to live in squalor; one without it may need guardianship.

Services in Australia

Service	Contact
Immediate danger	000
1800RESPECT (sexual, domestic and family violence, 24/7)	1800 737 732
1800ELDERHelp (connects to state elder abuse services)	1800 353 374
13YARN (Aboriginal and Torres Strait Islander crisis support)	13 92 76
Men's Referral Service (people using violence)	1300 766 491
Kids Helpline	1800 55 1800
Lifeline	13 11 14

• State specialist family violence services provide case management, crisis accommodation and court support.
• Leaving Violence Program (formerly the Escaping Violence Payment) gives financial help to people leaving a violent relationship.
• In hospital, involve social work early, and sexual assault services for forensic examination within 72 hours (some up to 7 days).
• Professional interpreters, never family members.

Pitfalls

• Asking about violence with the partner, carer or an older child in the room.
• Pushing a patient to leave immediately, or making help conditional on leaving.
• Missing strangulation because there are no marks.
• Writing "alleged assault", or recording details that a perpetrator could later read.
• Forgetting that children in the home bring mandatory reporting duties.
• Assuming an older person lacks capacity because they are frail or have mild cognitive impairment.
• Labelling bruising in an older person as "falls" without asking how it happened.