This report was prepared amid increasing concerns about the care of elderly patients in long-stay 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 underrecognised and underreported. Elder abuse takes many forms, ranging from subtle interactions to acts that 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 report 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 that 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 report concludes with a list of recommendations for the organisation, the clinical setting and training. The recommendations are applicable to other vulnerable people in institutions.