perpetrator to isolate the victim. In child abuse, the child goes to school, but the family itself is isolated. This may be even more so for older persons who may be isolated because of physical impairments or loss of friends and family. Living arrangements are a major focus for examination. Generally, abuse or neglect takes place in the context of people living together, yet there is an obligation on the part of adult children, for example, to not neglect their elders. Theoretical frameworks are in need of great attention.
Moving into risk assessment instruments, since elder abuse first emerged as a problem, the focus has been on developing some instrument that determine whether a person is at risk. There are a number of groups working on this. Hwalek and Sengstock (1986) did some of the earliest work with funding from the Administration on Aging. They asked many people from various agencies what items in fact should be considered and came up with a list in the hundreds, if not thousands; they then conducted a multivariate analysis and came down to 15 and later to 10 statements from self-reports on elder abuse. Another study tested those original 15 statements by using the Australian longitudinal study on health, in which they had a sample of 12,000 women age 65 and older (Kurrle, 1993). They added two additional intimate family violence questions, coming up with a brief screening tool of six questions, which were reliable as a test for elder abuse. The idea is that a physician or any other screener could use these questions in the interview and could at least identify an at-risk elder.
A team from Montreal (Reis and Nahmiash, 1998) developed a completely different screening effort. They had nurses and social workers conduct a comprehensive interview of clients who had been seen by a social service agency and screened to determine who was abused. Their original research across demographics came out with three categories of risk factors relating to: (1) the abusive caregiver, (2) interpersonal characteristics (personal alcohol or substance abuse, characteristics of depression, personality disorder, mental outlook, behavioral problems), and (3) reluctance to discuss abusive behavior. The last is quite important, but it has not been followed up. The second category, interpersonal characteristics, includes poor relationships with the caregiver, marital or family conflict, lack of empathy for the elder, and financial dependence.
There has been very little work done on the consequences of elder abuse, in terms of both the effect on physical health and on mental health. We know from the family violence area that abuse has a substantial effect