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The House of Commons health select committee estimates that 500,000 older people are being abused at any one time, but concedes this is based on a 1992 survey.

Older people's charities, social services and the care industry suspect the figure is higher, while health minister Stephen Ladyman believes that the situation is improving and that abuse levels are lower.

Nonetheless, last month he announced government funding of £150,000 to examine local authority information on the abuse of older people to obtain an accurate figure. There is also extra money for charity Action on Elder Abuse.

Health select committee chairperson David Hinchliffe says: "Much abuse is not reported because many older people are unable to report it." Some are too frightened or embarrassed, he adds.

Abuse can be physical, sexual or financial, or take the form of neglect, humiliation or over-medication. It most commonly occurs in the victim's home but is also widespread in institutions. Only 5 per cent of older people live in care homes but 23 per cent of calls to the charity Action on Elder Abuse's helpline are concerns about residential care.

Evidence suggests that abuse in the home is rarely the result of a family carer being under stress but usually occurs where there are other risk factors for domestic violence.

MPs want elder abuse to be given the same level of recognition as child abuse. Liberal Democrat MP Paul Burstow contrasts the anger over Victoria Climbi''s ill-treatment with the muted response to the case of 78-year-old Margaret Panting, who died after being abused. Her injuries included cigarette burns and razor blade cuts. "The difference between the two cases was 70 years -Êthat's the difference in attitude," he says.

Gary Fitzgerald, head of Action on Elder Abuse, says: "It's a similar situation to child abuse 20 years ago and domestic violence 10 years ago. We need an investment in societal change. If we can do it for domestic violence we can do it for this."

- Health select committee report on elder abuse from www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/111/11101.htm

Abuse in care homes: better monitoring by GPs of the use of medicines

The report says that concerns about fees, standards and the closure of care homes have led agencies to take a "light touch" towards the protection of vulnerable adults. 

But urgent action is needed to tackle the widespread use of powerful medication for the purposes of sedating care home residents. The report says: "In many cases medication is being used as a tool for the easier management of residents." 

Gary Fitzgerald from Action on Elder Abuse says: "We find that people store medication and then use it on people it was not prescribed for. And drugs have a greater impact on older people. When we are talking about doping people how can you talk about inspecting with a light touch?" 

Twelve per cent of the 1,500 care homes for older people completely failed to meet the national minimum standard on medication, and a further 43 per cent partially failed to meet it, according to a report in March from the National Care Standards Commission. 

But doctors are also to blame, the report says. Under the National Service Framework for Older People, GPs are supposed to review medication annually for patients over 75. But a recent survey found that only 29 per cent of GP practices had achieved this. The report wants GPs to meet the NSF standard and also review medication for older people in care homes every three months. 

Some GPs disagree with this, however. Dr Chris Dunstan, a GP adviser to the government on older people's care, says: "In nursing homes, three-monthly reviews are necessary. But in residential care homes where patients are more stable it is not so useful medically." 

Dunstan says that GPs can be encouraged to conduct reviews under schemes run by primary care trusts. 

But the situation may not improve because the care of older people is not a quality target that gives GPs financial rewards under their new contract.  

However, the Commission for Social Care Inspection and the Commission for Healthcare Audit and Inspection are developing inspection methods to detect abuse by medication. 

The report also calls for an end to the custom of nursing homes paying retainer fees to GPs for their services as everyone who is registered with a GP should have free access. Consultants should also play a greater role in monitoring what goes on in a nursing home. Hinchliffe says that when he was in social services he would invite geriatricians into accommodation. "That does not seem to happen now." 

The inquiry into Dr Harold Shipman's crimes is also expected to make recommendations on medication and has prompted the Home Office to review the certification of deaths in care homes, ending the practice of a doctor signing a death certificate without seeing the body.  

These changes were backed by the select committee, which also recommends that GPs who own or manage a care home should not certify deaths in their own care home. Also care home residents should have regular reviews, which is a practice accorded to children in care.

Abuse in the home:registered staff more likely to spot problems 

The report criticises as "unacceptable" delays in the registration of care workers as this is where the risk of abuse is highest.  

It rejects the government's argument that domiciliary care workers ought to attain NVQ level 2 before they can register with the General Social Care Council and says that signed-off induction training should suffice (news, page 6, 22 April).  

"We are concerned that introducing such pre-requisites will ensure that a large proportion of this workforce remains unregistered for the foreseeable future," the report says. However, there are concerns about the lack of places to train the estimated 25,000 domiciliary care workers every year up to NVQ level 2 (news, page 8, 22 April). 

Nonetheless, the select committee's arguments may be accepted. GSCC chief executive Lynne Berry says: "Our own risk assessment found that service users in their own home or using outreach services were particularly vulnerable. This will be key to informing our approach to rolling out registration to other care workers." 

But ultimately it will be Ladyman who decides and Hinchliffe says there is a "difference between the minister and officials on the approach". 

The report also calls for domiciliary care workers to be trained in detecting signs of abuse. It criticises the national minimum standards for failing to require domiciliary care agencies to report adverse incidents, such as accidents, despite it being a requirement for residential care homes.  

Care workers hired under direct payments should also be encouraged to register with the GSCC, says the report. Although disability groups oppose compulsory registration, there are concerns that abusers could switch to providing services via the direct payment system to avoid detection. 

The government also comes under fire over the delay to the Protection of Vulnerable Adults register, which will finally start in June.  

Preventing the financial exploitation of older people should be a key responsibility of council-led vulnerable adult protection committees. These ought to be mandatory like child protection panels, the report says.  

Sue Fiennes, the Association of Directors of Social Services lead on the protection of vulnerable adults, says: "There ought to be a statutory duty for all agencies to contribute to the committee and an equivalent grant to that given for child protection to support its work." The committee could arbitrate disputes over the mental capacity of vulnerable adults, she adds.