''[In the investigation that followed, the nurse] said that he was applying vaginal cream, to which I replied, 'Well, was it listed [on the medication chart] that my mother needed vaginal cream?' It wasn't.''

This appalling story is one of many in Norma's Project, a groundbreaking report from La Trobe University that lifts the lid on the sexual assault of older women in Australia.

The women's stories are confronting, and often complex. The acts committed are abhorrent. Just as abusers prey on children, so too do they prey on society's most vulnerable at the other end of the spectrum: frail or dependent older women. But advocates say that acknowledgment and understanding of sexual crimes against older women lag by at least a generation.

Norma's Project, released today, is named after the mother of a La Trobe University researcher whose assault led to the report's conception. In 2011, aged 84, Norma was sexually assaulted by a care worker during a respite stay in an aged-care facility. When she cried out, ''You can't do that!'' her perpetrator laughed and said, ''I can do whatever I want.''

Despite a police investigation, no charges were laid due to a lack of forensic evidence. Norma's ''spark faded'': her dementia, which had been mild, accelerated and she went from living independently to being anxious and fearful and needing permanent care.

Though Norma survived the experience, her decline is sadly typical; one US study found that more than half of women aged over 70 who are sexually assaulted die within a year.

One of the authors of Norma's Project is Catherine Barrett, who co-ordinates La Trobe's sexual health and ageing program. Barrett had heard anecdotes about the sexual abuse of older women for years but a dearth of data made it difficult to quantify.

That lack of evidence, combined with negative community attitudes and denial around older people and sexuality, contributed to these crimes remaining taboo and conviction rates of the perpetrators were less than 1 per cent.

But Norma's experience was like a bomb going off for Barrett and her team, compelling them to smash the silence by producing their own evidence. ''The four of us got together and said, 'We have to make this stop','' says Barrett. The way to make this stop is to get some money for some research, so that there's a body of evidence. No one can say it doesn't happen if there's a body of evidence.''

That evidence includes 66 hard-won interviews with women who have been abused, as well as family members, care providers and sexual assault support workers.

The report examines the range of contexts in which abuse occurs and explores cultural attitudes towards older women. It provides recommendations to raise awareness and encourage prevention and early intervention.

It also recommends the introduction of a ''working with vulnerable people'' check similar to the equivalent for children, and to promote better partnerships between care providers, police and support services.

The report comes as a relief to those hoping that the scale of the problem would one day be articulated.

While there are ample statistics about sexual violence against younger women, older women - those aged over 50 - are largely absent from the data and their voices have rarely been represented in research literature or in public discussion - though, of course, not every older woman is vulnerable to attack.

In 2012 there were 344 reports of alleged unlawful sexual contact in Australian aged-care facilities. Using the estimated proportion of sexual assaults that are reported across the board as a guide - 19 per cent - the number of assaults against older women annually in aged-care facilities could be close to 2000.

It's likely to be even higher, however, as older, dependent women are less likely to report abuse. Add in assaults in other contexts where data isn't collected- such as homes, hospitals, retirement villages and other settings such as crisis accommodation and the numbers would be dramatically higher.

There are many parallels between child abuse and elder abuse. But just as only a generation ago sexual crimes against children were rarely acknowledged or publicly discussed, community awareness of elder abuse is now only its infancy.

Ageism is a major barrier to understanding. As the report notes: ''The lack of community awareness can be partly attributed to commonly held assumptions that older women are asexual. How, then, can they be the target of sexual assault? What is unimaginable and unacceptable becomes unsayable or invisible.''

Sue Hendy, chief executive of the Victorian Council on the Ageing (COTA), says the deep effects of ageism have not been quantified or understood.

''There's a disbelief about rape of older women. We've got past that for younger women - but for older women it's disbelieved that it would happen. There is a 'we don't believe you' attitude because 'you're old, you've lost your mind, you're making it up.'

''If you've got dementia people think you can't make any decisions. But a woman still knows if she doesn't want to be raped or touched, even if she can't tell you what day it is.''

Compounding the ignorance is the sexualisation of rape and a common portrayal of victims as young and attractive. This wrongly correlates sexual crimes with physical attractiveness, experts say, because rape and sexual assault are about power. And few people - other than children - are easier to exert control over than frail or vulnerable older women.

Carolyn Worth, manager of the South Eastern Centre Against Sexual Assault (SECASA), says: ''There's this myth about why you get sexually assaulted - that it's because someone thinks you look splendid. But quite a lot of older women get raped at home, in their flannelette nighties.

''They're not looking at all like they've just left the disco. That makes it really clear that this isn't about sex, it's a violent act with a sexual overtone. It makes the person doing it feel more powerful. They head for someone they vulnerable person: someone who is frail.''

SECASA's oldest client is a 99-year-old woman who was raped in her own home by a stranger who helped her with her shopping.

Susan Ryan, the Age Discrimination Commissioner, who wrote the foreword to Norma's Project, says: ''With child abuse we've found how widespread it is - it occurs in almost every situation in which adults have power over a child. Unfortunately we're starting to see a similar picture with older people, particularly those who are frail or dependent [on carers at home] or in aged-care residences. There are perverted, vile people who get some sort of satisfaction out of abusing them.''

Norma's Project also illustrates the extent to which older women are abused in their own homes. Scenarios range from long-term domestic violence in which a husband rapes his wife, to an Alzheimer's sufferer who has previously been loving but loses his inhibitions, to other male relatives carrying out sexual assaults.

One care provider recalls a situation in which a woman's adult son was physically abusive and sexually perverse. ''He would be sitting in the lounge room knowing that she's cooking dinner, masturbating, looking at her.'' In this case, as in others involving family members, the woman was frightened and ashamed, financially tied to the perpetrator and disinclined to take action because, ultimately, he was family.

Common phrases used by respondents included, ''You've made your bed so you lie in it'' and, ''You don't air your dirty laundry in public''.

Barrett recalls another incident in which a woman in her 80s was living on a rural property with her husband who had dementia but had been prescribed Viagra. He repeatedly raped her and when she reluctantly - and diplomatically - disclosed to her three sons that he wanted sex all the time, they joked about his prowess.

It wasn't until a year later, when a care worker came to the home and built a rapport with the woman, that the man was taken off Viagra and given regular respite care to take the pressure off her.

Barrett says in this case, like many others, the physical and emotional consequences for the woman were lasting. In addition to the known effects on mortality, research has found that older women who experience abuse suffer poorer mental health and more likely to experience chronic conditions and require hospitalisation than women who haven't.

While older women can be the targets of hypersexual, cognitively impaired men - be they partners or co-residents in aged-care facilities - one of the most complex areas of sexual assault is that involving women with dementia.

The response of the manager of the aged-care facility where Norma had respite was initially disbelief.

This is common because, as one sexual assault support worker attests, dementia can result in a ''stripping back of the onion layers'', bringing back trauma from the past. But it doesn't occur to some aged-care operators that the trauma might be occurring in the present.

It's important to respond to a woman's distress regardless of where it stems from, says SECASA's Ms Worth. She recalls speaking to gerontologists about a woman who became hysterical during a medical procedure.

''I asked them if it had crossed their minds that a male doctor standing over her trying to put in a catheter might mirror what's happened to her when she was little,'' she says. ''They may be right - she may be hysterical, but I suspect … she's back where she was when her dad or her uncle was abusing her.''

Catherine Barrett says she was advised by a police officer in a sexual assault unit that ''it's not about believing, it's about listening'' - that while it's true that a person with dementia may be confusing past events with the present, it's important to investigate allegations. In residential aged care any alleged unlawful sexual contact must be reported within 24 hours.

Paul Sadler is an expert in elder abuse and the chief executive of Presbyterian Aged Care, which runs residential facilities in NSW and the ACT. He says: ''You can't afford to dismiss it or assume that there's nothing behind what they're saying'' - but adds that no link has been found between compulsory reporting of allegations and higher conviction rates. He also says the reporting system is badly designed and bureaucratic rather than productive for victims.

Sadler says the recommendations in Norma's Project are much better. He is particularly supportive of measures that involve older women themselves. The report recommends providing education for women and their families about their rights and including older women in policy related to gender-based violence, and in data collection.

Training for aged-care staff in preventing and responding to suspected sexual assaults is also a central plank of the group's findings, a measure that lies close to Susan Ryan's heart.

''In the training of care workers we must have a greater emphasis on human rights,'' she says. ''Training a carer is more than training to assist with a person's physical needs. It needs to be understood that no matter how frail they are, they still have the human rights of any human being; they're entitled to our protection because they can't protect themselves.''

Carolyn Worth agrees with the researchers that better partnerships between in-home and residential care providers and sexual assault services such as SECASA would make a big difference. Most providers, she says, have ''no idea what they're doing'' around sexual assault. ''They need training, they need protocols in place so they know what to do. In a busy place you can't think through every incident. We could develop that with them; it's not that difficult to do. You just have to allocate resources to it.''

COTA's Hendy, along with Worth and Sadler, supports a ''working with vulnerable people check'', similar to the current checks needed to work with children; though Hendy would urge cross-checks between both registers to prevent perpetrators migrating between the two sectors.

She says: ''There's currently no register, so if someone is dismissed from an area and goes to another organisation, there's no way of picking that up. You might be hiring someone who has a track record.''

Sadler warns, however, that any register would need to record ''reports of concern'' as well as convictions - as the UK has done - given the very low conviction rates.

Barrett says the royal commission into child sexual abuse shows that taboos can be broken and justice can be achieved for victims of sexual crime.

''One of my friends was sexually assaulted by a priest. Twenty years ago she tried to tell people about it, but no one would listen.

''There's a parallel here; we're at a point where people are saying sexual abuse of older people can't happen. Well we want a conversation to say it can and does happen, and when people report it, we'll listen.''

Tragically, however, many elderly victims of sexual crime won't live long enough to see the taboo broken and justice served.

Julia May is a Melbourne journalist.

Online: latrobe.edu.au/arcshs/publications/advanced