Another assessment issue of considerable importance that has not received sufficient attention, at least insofar as elder abuse is concerned, is the categorization of elder mistreatment along lines of cognitive impairment. Although the same behavior of physical abuse might be manifest against two individuals, one demented and the other nondemented, by the same class of perpetrator, the optimal method of assessing these two events may vary widely. Research to date has not thoroughly considered cognitive status as the major parameter determining relevance of assessment methodology. Rather, as mentioned above, assessment of elder mistreatment has been divided into abuse versus assault studies according to perpetrator identity. This is problematic in that researchers attempting to document the extent and rate of elder abuse (irrespective of cognitive status) have adopted methodologies that are better suited for one class or the other of older adults. That is, methods 1, agency record review, and 2, sentinel reports, may be effective in assessing abuse against cognitively impaired elders, whereas they will not be very effective in assessing abuse against nonimpaired elders, who may actually avoid these individuals and agencies. Similarly, method 5, anonymous older adult assessment, is probably preferred when cognitive status is intact but is precluded in instances of dementia. Method 4, caretaker assessment, walks the line between these two, in that its effectiveness is not determined by an elder’s cognitive status and may therefore be an appropriate stopgap or supplemental technique (see Pillemer and Finkelhor, 1988). However, this method is less statistically sensitive than respondent interviews (i.e., when cognitive status is intact) and probably should not be relied on exclusively.
A distinction based on the mistreated elder’s cognitive status is conceptually, as well as methodologically, important in that the social context of abuse or assault of nondemented older adults by family members appears to more closely resemble domestic violence, whereas the social context of abuse of cognitively impaired older adults appears to be more akin to child abuse. This is particularly the case when one considers the nature of the relationship between violence perpetrators and recipients (Finkelhor and Pillemer, 1988; Utech and Garrett, 1992;Whittaker, 1996). Thus, violence between two individuals of equal or near-equal societal status, and of equal or near-equal cognitive development, describes both domestic violence and abuse of noncognitively impaired elders (Finkelhor and Pillemer, 1988). By contrast, violence between individuals of varied social status and dependency resulting from differences in cognitive functioning or independence (due to either dementia or lack of development) describes both child abuse and abuse of cognitively impaired elders.1