Elder Mistreatment Abuse, Neglect, and Exploitation in an Aging America (2003) / Chapter Skim
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2. Concepts, Definitions, and Guidelines for Measurement
2. Concepts, Definitions, and Guidelines for Measurement
Pages 34-59
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From page 34... ...
Because legal definitions of abuse and neglect vary widely from state to state, efforts to match research definitions in any given state with the statutory definitions tend to undermine efforts to achieve comparability in research designs. In addition, legal definitions ultimately depend on value judgments (initially by clinicians and then by judges and juries)
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From page 35... ...
On the other hand, in most states, anyone, even a stranger, can be found to have committed "abuse." The common statutory patterns in definitions of abuse, neglect, and financial exploitation are depicted in Figures 2-1, 2-2, and 2-3. TOWARD A SCIENTIFIC VOCABULARY The scientific vocabulary and measures that are used to study elder abuse and neglect must diverge from the legal definitions in three important respects: First, the conduct (by a perpetrator)
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From page 37... ...
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From page 38... ...
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From page 39... ...
It bears repeating that whether "mistreatment," as the pane! is defining it, amounts to "abuse" or "neglect" in a legal sense depends on the statutory definitions in a particular jurisdiction, the actor's state of mind, and other factors.
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From page 40... ...
uses the phrase "trust relationships" to denote the relevant relationships. Financial exploitation is illustrative: the conduct of interest is exploitation by family members and others who may have as
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From page 41... ...
Professionals who are clinicians, such as physicians, nurses, psychologists, or social workers, are de facto in trust relationships with elders for whom they care. In this context, the relevant relationships include only those people who have assumed the responsibility for caregiving or are expected to do so.
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From page 42... ...
Not surprisingly, most adult protective services statutes include elder abuse and neglect within the broader category of vulnerable adults.
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From page 43... ...
" or "How will we know whether we should count this as a case of mistreatment? " Ideally, operationalization leads to the development of a set of criteria for answering this question and a process by which these criteria can be applied in the field the measurement method.
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From page 44... ...
Explanation C ~ V ~ R represent a sequential analysis of the necessary elements of elder mistreaatment (conduct by people in caregiver roles or other trust relationships that injures a vulnerable elder, deprives the elder of basic needs, or exposes the elder to risks of injury or deprivation) ; each of these elements can be operationalized descriptively for research purposes.
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From page 45... ...
Also, as already indicated, characterization of particular conduct as mistreatment requires value judgments, contestable at the margin if not at the core. Using the example of other fields confronted with a similar problem, a "LEAD standard" (longitudinal, experts, all data)
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From page 46... ...
This involves deciding on the specific purpose of the measure and the measurement method, followed by an assessment of its reliability and validity. Measures may have different purposes, such as to ascertain occurrence of mistreatment in the population for research purposes or for surveillance, to assess the risk of mistreatment for early intervention, to screen for mistreatment in different settings (e.g., emergency department, long-term care)
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From page 47... ...
Thus, a definition for what constitutes a trust relationship is needed. For both these items, operationalization is straightforward in the sense that an a priori definition, whatever its strengths and weaknesses, can be applied in the process of research so that a particular situation can be assessed against that definition (e.g., "Does this particular person meet the definition of being an older
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From page 48... ...
In some cases, when direct observation is available, it is possible to state unequivocally that a specific conduct caused the injury. For example, if a caregiver hits an elder on her upper right arm and there is a bruise where there the elder was struck, causality for the bruise is clear.
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From page 49... ...
the loaner recommends that researchers trv to 1 ) 1 J avoid stand-alone, unmodified use of the terms "abuse" and "neglect" because these terms require legal interpretations and community value judgments that inevitably vary across states and localities.
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From page 50... ...
are of special concern in the fields of elder mistreatment and adult protective services, these risk factors require careful attention. (Research on risk and protective factors is discussed in Chapter 5.)
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From page 51... ...
However, a family relationship clearly will not always amount to a relationship sufficient to give rise to a caregiver obligation; this is why the panel has distinguished between these two concepts and has defined trust relationships as a broad category that includes, but is not limited to, caregivers. In some circumstances, of course, existence of a trust relationship is unambiguous and harm caused by the other person would always constitute mistreatment.
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From page 52... ...
Therefore, an early priority of research in the field ought to be the conceptual and empirical development of different operational definitions of trust relationships. Conduct of the Other Person in the Trust Relationship The relevant conduct of the other party that may be of interest includes direct physical contact (hitting, pushing, shoving, etc.)
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From page 53... ...
Indeed, in the absence of direct observation, conduct is harder to assess than harm, since it may not leave evidence in the form of readily observable physical or emotional consequences, since it may be forgotten by the elder if she is cognitively impaired, since the older person may be reluctant to report the occurrence of such conduct, or since the other person may not report it out of conflict of interest. The investigator is faced with the difficult task of detecting a "latent variable" requiring a research methodology that optimally employs several modalities of assessment and takes repeated observation.
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From page 54... ...
Measurement of harm must be able to determine the presence or absence of different consequences in the various domains above. Since many harms may not be anticipated prior to the initiation of the research, the measurement method must be general and flexible so as to detect a wide range of consequences that may be specific to the specific elder-trust relationship, and to the setting involved (home, hospital, long-term care etch.
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From page 55... ...
In some cases, methods have been developed to assess the occurrence of elder abuse using telephone or in-person interviews of family members or proxies or direct assessments of samples of older adults. However, there is a dearth of such measures, and most existing measures have had limited assessment of their measurement characteristics, reliability, or validity.
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From page 56... ...
For example, a single instance of pushing an older person down the stairs may constitute mistreatment regardless of whether an injury occurs, whereas forgetting to feed her a meal now and then may not. Furthermore, the absence of both specific conduct and specific harms .
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From page 57... ...
It is important for researchers to focus their attention on serious forms of mistreatment and not to define "normal" negative human interactions as pathological. The purpose of the cross tabulation is not to lay out all harms and consequences involved in interactions between an older person and another in a trust relationship; rather it is to limit the definition of elder mistreatment to a specific number of intersecting sets that have been defined by the researcher as plausible forms of mistreatment.
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From page 58... ...
the injurious conduct or omissions of other parties in trust relationships, how they manifest themselves, , ., . 1 1 · 1 - · 1 ~ ~ ~ 1 1 1 · 1 rr ~ · anu their clinical course; At)
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From page 59... ...
To the extent that dichotomous classifications of mistreatment are needed, agreement must be reached on what LEAD-type methodology will be used in place of a gold standard for such studies. Agreement on operational definitions for research may provide a useful foundation for developing standard definitions and classification criteria for surveillance and reporting.
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