Vulnerable in a safe place: institutional elder abuse.

Elder abuse in institutions is a slippery concept. Besides inherent difficulties in operationalizing definitions of elder abuse, it is well-recognized that under-reporting and methodological problems in research studies have created a knowledge base that is far from definitive. There is, however, much that can be gleaned from the literature and translated into clinical practice. Environmental factors, including both interpersonal and institutional dimensions, may contribute significantly to risk for elder abuse. A number of client characteristics such as physical impairment, social isolation, cognitive status, and aggression also appear to increase the potential for elder abuse. While professional caregivers have not yet been extensively studied in terms of their role in elder abuse, burnout, lack of training, excessive workload demands, and other stressors may be implicated as factors contributing to abusive behaviour.