a different radiographic appearance than those due to an inflicted injury. Research is needed to help illuminate the characteristics of common injuries, such as their etiology, natural course, distribution, and severity so that the process of identifying cases of elder mistreatment can become more accurate and reliable. While certain physical signs (such as burns and ligature marks) are likely to be more reliable indicators of elder mistreatment than others (such as fractures and pressure sores), neither the challenge nor the importance of advancing knowledge in this area should be underestimated. Mistakenly characterizing a spontaneous bruise or other injury as intentionally inflicted may lead to substantial clinical, social, and legal jeopardy for all concerned.

CONCLUSIONS

The need for accurate and efficient screening and case identification methods for elder mistreatment is immense. We must minimize false negatives to protect the elder subject and minimize the false positives to avoid false accusations of the trusted other. Just as mistreatment can have devastating consequences for an elder, a false accusation can have devastating consequences for the trusted other. It is likely that screening and case identification will hinge on understanding the constellation and interaction of signs, symptoms, findings, and the context in which they occur.

Substantial research is needed to improve and develop new methods of screening for possible elder mistreatment in a range of clinical settings. These methods should be able to detect a broad range of categories of mistreatment and be highly accurate and efficiently deployed. Candidate techniques include improved questionnaire designs; record linkage to other clinical, public health, social and legal databases; automated alerts based on concurrent clinical records; and previously defined risk status based on prescreening methods. Special attention should be placed on the predictive value of various clinical injuries and other relevant clinical findings as indicators of mistreatment for therapeutic, social, and forensic reasons. Also, the panel sees value in economic analyses of cost-effectiveness for elder mistreatment screening in various clinical settings.

Research is needed on the process of designating cases as incidents of mistreatment in order to improve criteria, investigative methods, decision-making processes, and decision outcomes. The absence of a gold standard for case identification, and the momentous consequences of inaccurate decisions, highlight the need for studying and improving the process of case investigation and designation. The impact of resource constraints on the designation process and its consequences for affected persons should also be studied.



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