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4. The Occurrence of Elder Mistreatment
Pages 71-87

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From page 71...
... Research to determine mistreatment occurrence rates or trends should, above all, be guided by the rationale for conducting the epidemiological inquiry. Is universal case finding critical within a population, or will probabilistic assessments to estimate incidence and prevalence suffice?
From page 72...
... 72 ELDER MISTREATMENT OCCURRENCE OF ELDER MISTREATMENT While clinical descriptions of elder mistreatment are present in historical texts, even now there have been few population-referent, geographically based studies of elder mistreatment occurrence in the modern, peer-reviewed literature. The latter third of the twentieth century saw the descrip
From page 73...
... elder mistreatment victims who have come to public attention and probably underestimate the true elder mistreatment occurrence rates. One of the first and historically most important population-based studies of elder mistreatment was conducted by Pillemer and Finkelhor (1988~.
From page 74...
... a two-stage process, beginning with screening potential victims for risk factors or risk indicators, using questionnaires, medical record review, and various biomarkers, with subsequent more intensive evaluation of high-risk persons, (b) screening fiscal records for types of behaviors associated with financial abuse, (c)
From page 75...
... These issues require detailed attention and are important requisites for planning population- and institution-based epidemiological research on elder mistreatment occurrence. The following sections synthesize and highlight some of these issues specifically with respect to determining elder mistreatment occurrence, adding further suggestions for conducting this research.
From page 76...
... -Historical data more likely to be obtainable. -Some elder mistreatment victims will not admit mistreatment events for various reasons.
From page 77...
... -Legal dimensions of elder mistreatment occurrence more fully documented. -Observers are often professionals who have other obligations.
From page 78...
... It is at least a hypothesis that knowledge of elder mistreatment occurrence rates over time could be helpful in understanding secular trends in the prevalence and outcomes of elder population disability. In fact, elder mistreatment may be important and common enough to also consider when planning and evaluating long-term disease and disability prevention and treatment trials targeting vulnerable, dependent, and frail elders.
From page 79...
... Interface with the Public Health, Medical Care, and Social Services Systems From a community perspective, it is clear that cases of elder mistreatment are underascertained by existing public health, social, medical, and legal activities and systems; this is understandable despite the need for improvement. Several papers in this volume acknowledge the important roles of these systems and programs in identifying cases as one technique for determining elder mistreatment occurrence.
From page 80...
... . Any substantial increase in either activity could lead to increased elder mistreatment detection rates and could lead to spuriously increased population occurrence rates; community-based elder mistreatment prevention and treatment programs should be alert for this.
From page 81...
... factor, such as living in a community in which the police make frequent domestic violence calls. It is also possible that some putative risk factors, such as cognitive or other functional impairment, may in some instances result from elder mistreatment as well as being potential causes, as these impairments may be due to head trauma, misuse of medications, or some forms of bodily neglect.
From page 82...
... Several papers in this volume note the use of qualitative techniques to further define the various elder mistreatment "syndromes" and characteristics; further application of these methods would seem to be of value. Finally, very little is known about elder mistreatment occurrence and related risk factor status among minority populations in the United States, including cultural variation in how mistreatment is defined and perceived.
From page 83...
... The issue of household sampling is paramount in defining elder mistreatment occurrence rates. The general experience of household surveys targeting elders is that the older and more vulnerable potential respondents are the ones most difficult to access, leading to the potential for underassessment of elder mistreatment occurrence.
From page 84...
... Preparatory funding should be provided to develop and test measures for identifying elder mistreatment. There is inadequate information on elder mistreatment occurrence among both community-dwelling and institutionalized elders.
From page 85...
... After appropriate methodological development, a national survey of elder mistreatment occurrence and risk factors, designed to inform important policy issues relevant to elder mistreatment prevention and treatment, should be conducted. The pane!
From page 86...
... 3. In addition to improved household and geographically referent sampling techniques, new methods of sampling and identifying elder mistreatment victims in the community should be developed in order to improve the validity and comprehensiveness of elder mistreatment occurrence estimates.
From page 87...
... Longitudinal studies are needed to explore the relationship among different forms of mistreatment, to place descriptive information about risk factors in context, to trace outcomes, to draw causal inferences, and to identify potential targets for intervention. For example, what are the individual and familial outcomes of elder mistreatment?


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