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SYDNEY — 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.

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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.