occurred. Since elder mistreatment is almost always assessed by indirect means, a gold standard of case identification may not yet be possible. Investigators will need to create new approaches to case standardization and develop alternative benchmarks for case identification. One useful approach discussed in Chapter 2, applies the LEAD (longitudinal, expert, all data) standard. This method must be well described, widely accepted, and replicable in a variety of settings in which mistreatment might be encountered.

Applying Causal Logic to Case Finding

In addition to the determination of relevant conduct and harm, the occurrence of mistreatment requires a determination of cause, especially in studies aiming to improve clinical methods of case identification and screening. In some cases the co-occurrence of harm and relevant conduct is such that an unequivocal determination that the perpetrator’s conduct caused the harm can be made. For example, a caregiver might be observed striking an elder. In many situations, however, the critical issue is whether the observed harm suffered by the victim was attributable to the trusted other’s conduct. (As noted in Chapter 2, in some circumstances there is conduct of interest but no evidence of harm. The issue of causality is not relevant in such cases, unless there is concern that harm has not been detected, in which case the problem involves the detection of consequences.)

Determination of cause is most relevant in two types of situations. In one type, consequence and conduct could both be detected but neither alone would constitute mistreatment, unless the conduct was shown to have caused the consequence. This scenario is most relevant to neglect. For example, an older person might have fallen and fractured her hip at the same time that the caregiver was known to leave her alone at home for several hours during the day. If the elder had a problem walking and always needed help to get around, it might be concluded that the lack of supervision was critical to the older person’s fall and thus constituted mistreatment. In contrast, if the elder had no problems walking and fell because she rushed to go downstairs to answer the phone, the caregiver’s conduct would not constitute mistreatment.

Applying causal reasoning that meets research standards to this sort of circumstance is clearly complex. While logical inference is critical to determine whether certain prerequisites are met (e.g., “Did the conduct occur before the consequence?” or “Was the conduct such that the specific consequence would be expected to have resulted from it?”), ultimately, the determination of causality may often be judgmental, requiring a process by which the determination can be made. This decision process itself may be the object of important research and at a minimum should have high face

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