Elder abuse in residential care

Jean-Claude Monfort and colleagues (Jan 22, p 300) bring helpful attention to neglected aspects of elder abuse. Elder mistreatment in institutions is poorly catalogued, and is especially complex in consisting of both in stitutional abuse—towards all residents—and acts of elder abuse specifi cally towards a single resident. Monfort and colleagues’ Correspondence raises the further challenge of abuse by other residents, who, along with care staff , are recognised as the most common perpetrators of sexual abuse of nursing home residents. Most defi nitions of elder abuse are premised on their occurring within a relationship where there is an expectation of trust, and the precise nature of the relationship between residents, particularly when one or both might have cognitive impair ment, is not at all clear. More attention needs to be paid to developing techniques to prevent, detect, and manage resident-toresident abuse, and experienced care staff can provide helpful insights into how to develop these strategies. However, it would be important not to assume that only those with a past history of paedophilia are likely to be off enders, since vulnerability and inadequate vigilance about access might be more important factors than an agebased “gerontophilia”. Ad ditionally, we are as yet far from understanding how best to meet the sexual and emotional needs of residents in nursing homes. The expression of sexuality by nursing home residents often creates discomfort among care staff , and fresh thinking and multidisciplinary strategies are required to address the emotional and sexual wellbeing of older people in residential care.