This paper was prepared amid increasing concerns about the
care of elderly patients in longstay settings and newspaper
criticism of doctors' attitudes to older people. Abuse is
maltreatment as a single or repeated act or neglect; it may be
intentional or due to ignorance or thoughtlessness, by a person or
persons in a position of power. It covers five domains: physical,
sexual, social, psychological and financial. It is under-recognised
and under-reported. Elder abuse takes many forms ranging from
subtle interactions to acts which are frankly criminal. What links
the range of behaviours is that they occur in situations in which
the victim is dehumanised. The abuser relates through power in the
absence of clear thinking. Institutional abuse includes individual
acts or omissions and managerial failings in which the regime of
the institution itself may be abusive.
The subject of elder abuse has generated an increasing body of
literature but little specifically about the role of doctors. This
paper aims to define the role of doctors in prevention, detection
and management of abuse in institutions, to raise awareness,
improve practice and to extend an understanding of a social,
organisational and individual psychodynamic perspective to the
aetiology and manifestation of abuse. Some abusive behaviour is
consciously enacted. The majority is out of ignorance, unthinking
and ageism, factors which can be addressed in training.
Doctors are in a position to influence significantly the
culture and atmosphere of the units where they have patients.Old
age psychiatrists have a responsibility to take the lead in
prompting an examination of ageism and the capacity for abuse in
the homes and wards where they work.
The paper concludes with a list of recommendations for the
organisation, the clinical setting, and training. The
recommendations are applicable to other vulnerable people in
institutions