higher than at lower levels of frailty. Further study of issues such as these is absolutely critical to a research agenda on elder mistreatment.

A research agenda for risk factor research on elder mistreatment is to some degree straightforward, because it parallels our general recommendations for research on this topic. Studies using larger and more representative samples, as well as scientifically accepted epidemiological techniques, must be conducted before risk factors can be more accurately specified. The importance of case-control designs and cohort studies cannot be over-emphasized. We do not reiterate all of these recommendations here.

The following are specific additional recommendations to advance knowledge of risk factors for elder mistreatment.

  1. Studies are urgently needed that examine risk and protective factors for different types of elder mistreatment. Studies are needed to advance understanding of what places older and vulnerable adults at risk for mistreatment and what places persons at risk for becoming abusive. These studies can be carried out using well-established methods for determining risk factors, including epidemiological case-control studies. These studies must, however, use common measures that allow for comparison across studies. Moreover, they must focus not only on the composite concept of elder mistreatment, but also on its various forms.

    Intensification of epidemiological research to establish risk factors will be facilitated by greater collaboration between researchers and the adult protective services and elder services systems. Researchers in the field have generally been hampered in their efforts to establish risk factors because they have often needed to find both mistreatment cases and “controls” in general population samples. Most retrospective epidemiological research has used readily available case populations for studies, while attempting to sample well-defined control groups. Many of the advances in understanding risk factors associated with child abuse and intimate partner violence occurred as the result of participation and engagement between the research communities and the service provider agencies. In the panel’s view, advances in risk-factor research in elder mistreatment will require cooperation between adult protective services agencies and the research community, such as exhibited in the work of Dyer and her colleagues in Texas. By using persons clearly identified by some external source as victims of mistreatment, the focus can shift from concern about sample size to the identification of an appropriate group of controls.

    Such studies have the potential for providing vital information for both policy makers and program developers to help define target behaviors for intervention. In addition, this information can be used to develop profiles of persons at risk for being mistreated, as well as to develop forensic mark-



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