Sitting in her office in St Mary's Hospital in the Phoenix Park, Dublin, Anne O'Loughlin suddenly starts to punch the air, her fists moving very fast, as if she is in a boxing ring delivering a flurry of blows to a bewildered opponent.
She is imitating a very old woman who used this stark and wordless way to reply to a social worker who had asked why she had bruising around her face.
The attacker was her son.
These blows may not have been the worst of what this woman was experiencing. Hospital records (not St Mary's Hospital) show that, months before, she had turned up in a casualty department complaining of a sore foot. The X-ray showed she had fractured two of her toes.
"They did not inquire as to what happened at the time," says Anne O'Loughlin. The woman was treated with "bed rest" and sent home. This was in 1989. There was little awareness of the abuse of older people.
"It's kind of hard to break two toes of your left foot," Ms O'Loughlin observes. Today, with awareness of abuse growing, questions would be asked, she says. And there is little doubt, when all the reports are put together, that this was just one of a catalogue of abuses inflicted on this woman by her son.
Six months before that, the public health nurse had expressed worries because the woman had black eyes. It later emerged that a "home help" had been trying to get help for the woman because she had been heard crying and screaming.
The home help also told the social worker that the son had made very offensive and derogative sexual comments to her about his mother.
A sister later came home from England to tell the hospital that the son was sexually abusing the mother.
The woman was finally made a ward of court and brought into long-term institutional care.
Anne O'Loughlin - who, with Dr Joseph Duggan, compiled the report Abuse, Neglect and Mistreatment of Older People, for the National Council on Ageing and Older People - has been working since 1986 to raise awareness of this form of abuse.
At the time she was a social worker in the Richmond Hospital in Dublin when the niece-in-law of a patient asked to have something done to help her aunt.
The aunt had been brought to casualty by her (the aunt's) husband with a "huge" bruise and swelling over her left ear. Unusually, "the husband actually admitted that he hit her a belt to make her go to bed."
On investigation, she uncovered a history of assault and neglect by the husband, described by those who dealt with him as "an impatient man". The wife had dementia, which made matters worse. Her diet consisted of chocolate and Lucozade. He had punched her in front of the neighbours several times. When she was finally admitted to hospital extensive bruising was discovered on her back.
Anne O'Loughlin realised that if this woman had been a child, a social worker would long ago have been assigned to her case, reports would have been made to the health board, her situation monitored, perhaps a case-conference held.
She set out to raise awareness of the issue. She wrote to health boards, produced reports, wrote to the Department of Health. Through the Irish Association of Social Workers she tried to arrange a conference: there was little or no interest, and the conference had to be cancelled.
She has personally documented 50 cases, many of them in the past few years. Awareness is growing within the nursing, medical and social work professions. The publication of the report by the National Council is another step forward in recognising and tackling a problem which, the authors estimate, affects 12,000 older people.
For these, says Anne O'Loughlin, "there's a lot of suffering involved", and the need for action is urgent.