SYDNEY (AP) -- By the time the ambulance showed up to the house, the old woman's screams were, as the paramedics would later tell it, already at a 10 out of 10.
On a bed in the foyer lay 88-year-old Cynthia Thoresen, her eyes screwed up in agony, her skin covered in feces, with a broken leg gone untended for weeks.
The fact that Cynthia even lived in the house was a surprise to the neighbors. None had seen her. None had any idea she'd spent her final days in hellish pain after a fall. None knew that her daughter and caretaker, Marguerite Thoresen, had waited at least three weeks, and up to three months, before calling for help.
In the end, Cynthia Thoresen joined a large and growing cohort of elderly people across the world who live, and increasingly die, in silence, left to fend for themselves against a problem society has barely begun to notice: Elder abuse.
This type of abuse, which often includes neglect, is still so hidden that it is hard to quantify. But the broad picture gleaned from hundreds of interviews and dozens of studies reviewed by The Associated Press is clear: Tens of millions of elders have become victims, trapped between governments and families, neither of which have figured out how to protect or provide for them.
EDITOR'S NOTE -- As the world ages faster than ever, who will care for the old? This story is part of an occasional series about elder neglect and abuse worldwide.
Most of the elderly live with family or at home, and researchers estimate at least 4 to 10 percent of them, and probably a lot more, are abused. Even by the lowest count, that means 30 million people.
The demographics alone show the problem is growing. By the year 2050, there will be more old people than children for the first time in history.
Australia, where Cynthia Thoresen lived, is a wealthy nation and considered progressive, but even in high-income countries, the abuse rate is 4 to 6 percent, according to the World Health Organization. And even here, the system repeatedly failed Cynthia, in life and in death.
"Nothing in the past has disturbed me like this job disturbed me," paramedic Christopher Curtis told police. "I've not seen anyone, regardless of their age, that could withstand the level of pain inflicted by a fractured femur for five seconds, let alone three weeks."
In a way, aging in today's world can be a slow slide into invisibility: Older people often say they exist in the shadows, their words dismissed, their cares unheeded.
Information on elder abuse lags decades behind research on child abuse. Only a handful of countries legally require the reporting of suspected elder abuse, compared to dozens for child abuse. In the U.S., the government passed the Elder Justice Act in 2010, compared to 1974 for its counterpart on child abuse.
The data varies wildly across cultures because researchers can't agree on who is an elder, let alone what elder abuse is. But other statistics are telling: Only one in five older people worldwide has a pension. Elders figure prominently among the more than 100 million who fall into poverty each year because of health-care expenses. And the suicide rate among men over 75 is the highest in the world.
Cynthia Thoresen's story can be pieced together through legal documents, newspaper clippings, interviews and police testimony. Marguerite Thoresen did not answer repeated requests, by phone, email and letter, for comment.
Cynthia's world began to shrink with a fall that left her dependent.
She moved into Marguerite's home in Perth, and in 2001, Marguerite applied for a government carer's benefit that came to around $500 every two weeks. Once the payments started, the government welfare agency, Centrelink, never asked for further medical updates on Cynthia, Marguerite said.
Cynthia vanished from the health care system. Medicare records show that for years she saw doctors and took prescription medications. But in 2003, Cynthia's medical treatment stopped.
Marguerite's explanation: "Well, she didn't say she was ill."
In 2007, Marguerite moved with her husband, daughter, grandsons and mother to a Brisbane suburb.
There, Cynthia's world shrank to a pinpoint.
In the 18 months Cynthia lived there, no visitors were invited inside. Cynthia did not talk on the phone or write letters. Her only other close relative, her son Thorolf, lived nearly 1,700 kilometers (1,000 miles) away, and dementia left her confused at times.
One morning, probably in late November 2008, the family found Cynthia on the floor next to a pool of liquid.