Background and objectives

Abuse of vulnerable adults in institutional settings has been reported from various countries; however, there has been no systematic description of the characteristics of the victims and their abusers. Our aim was to identify and synthesize the literature on victims and perpetrators of abuse in institutions in order to inform interventions to prevent such abuse.

Search of MEDLINE(OVID), CINHAL(EBSCO), EMBASE(OVID) and PsychINFO(OVID) databases identified 4279 references. After screening of titles and abstracts, 123 citations merited closer inspection. Applying inclusion and exclusion criteria, 22 articles were included in the review.

The review suggested that the evidence available on risk factors is not extensive but some conclusions can be drawn. Patient, staff, institution and environment factors may play a role in increasing the risk of abuse. Cases of abuse may be often underreported.

Patients who are considered to be at higher risk need closer monitoring. Patients and staff may often lack the awareness and knowledge to identify and report abuse. Institutions should take proactive steps to monitor patients, train staff and devise systems that would be able to identify and report incidents of abuse and take steps to prevent such incidents from recurring. There should be well advertised policies for staff of all ranks to be aware of and report when they suspect or identify abuse. There is need for further research into the association between the individual factors and abuse. Such information may be useful in quantifying risk to individual patients and planning their care.