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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
themselves from further harm. The assessment should also include evaluation of the risk of future abuse.
While adult protective services units have developed several instruments and guidelines to carry out their state mandate—for example, screening, investigation and evaluation of mental competence—and have shared best practices among the states, they are well aware of the need for validation and research and of the subjective nature of the decision making often required in conducting assessments-investigations. The processes of case identification and case management are in need of research for all of its components. Some of the major challenges for both the clinical and community settings are discussed below.
Standardized Criteria for Case Identification
A major barrier to the identification of cases of elder mistreatment is that the researcher or clinician is rarely in a position to directly observe the relevant event(s). Most of the time, the identification of a case is made indirectly, relying on the report of the victim—or the perpetrator—or on the presence or absence of observable signs and symptoms believed to be indicative of mistreatment, such as emotional distress or bruises. However, indirect approaches may be uncertain. The accuracy of self-report by victims or perpetrators is not quantitatively established in most clinical settings. The value of self-report may be further undermined when the victim is ill or cognitively impaired.
The capacity of older persons to provide accurate accounts of their observations or experiences is an important area for research. In many situations, case identification is predicated largely on the injured person’s account of the circumstances. Whether adult protective services or a prosecutor acts on the possible mistreatment is dependent in such an instance on the credibility of the victim.
If an allegation is brought, whether a court even hears the injured person’s account may be dependent on a finding of his or her competence to testify. If the older person has cognitive impairments, then the admissibility of his or her testimony may be contingent on judicial findings that the witness had the ability to form a “just impression of the facts” (i.e., to perceive the situation) at the time that the injury occurred, that the witness has the ability to recall the situation and communicate that memory, that the witness understands the difference between truth and falsity, and that the witness knows the nature of an oath and understands the obligation to tell the truth in court (see Myers, 1993).
Ultimately, the application of these standards arguably depends on an assessment of the jury’s ability to make sense of the witness’s testimony. Given that time will be consumed in any event by a determination of a witness’s competence, the victim’s testimony should be heard if it is not