knowledge about elder mistreatment. However, the inclusion of self-neglect within the jurisdiction of adult protective services can easily confound research on elder mistreatment. Thus it is essential for researchers studying adult protective services interventions (or studying other interventions derived from adult protective services activity or using subjects identified in adult protective services databases) to exclude cases of self-neglect or segregate them from cases involving harm or neglect by others.

HEALTH SYSTEM INTERVENTIONS

Wolfe (this volume) describes the progress made in child abuse detection when health care professionals began to routinely screen for child abuse indicators and to report worrisome cases. Family physicians and the emergency room physicians are ideally situated to see mistreated elders and to refer suspected abuse and neglect for appropriate action. The task of designing and implementing an elder mistreatment screening program for health care professionals presents special challenges. It will require educating health care professionals about the normal changes of aging and how these changes may influence the appearance of forensic markers of elder mistreatment, such as bruises, fractures, and pressure sores (see Dyer et al., this volume.) They must be able to distinguish between cases in which an injury is accidental or unpreventable and those in which it is inflicted or otherwise preventable.

Research on the effects of training health care professionals in responding to family violence indicates that the best practices are based on adult learning theory—that is those in which the curriculum is attached to screening instruments and the ability to practice the skills. The same is likely to be true for neglect cases. Several initiatives are under way to provide specialized training to health care professionals. For example, the geriatric program at Baylor University is developing a curriculum on elder mistreatment for medical school use and is involving medical residents in their elder mistreatment assessments. The California Medical Training Center has also developed a program to train health care providers to identify, evaluate, and document injuries in collaboration with law enforcement and social services.

The increase in home health nursing services has put a number of nurses on the front lines, well situated to see potential abuse or neglect victims. Nursing training typically includes information on family violence but is also limited on its information about elder mistreatment. A promising nursing specialization, developed along with the field of family violence, is forensic nursing. Similar to the development of a national cadre of sexual assault examiners, these and other nurses are expanding their focus to include evaluation of suspicious and serious unexplained injury. These



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