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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
(Hooyman, 1982; Tomita, 1982), an unpublished index from the University of Massachusetts Medical Center, and three published manuscripts (Block and Sinnott, 1979; Johnson, 1981). The review authors described these measures as largely driven by caseworker familiarity with the older adult’s case and indicated that “such depth of information may require many months to develop.” Moreover, these measures were described as depending “a great deal upon the judgment of the service provider” and may be overly subjective, producing results of questionable validity.
A final group of purely clinical assessment protocols includes the Screening Protocol for Identification of Abuse and Neglect of the Elderly (Johnson, 1981), the Elder Abuse Detection Indicators (Bloom et al., 1989), Tomita’s (1982) Detection and Treatment of Elderly Abuse and Neglect: Protocol for Health Care Professionals, and the Community Based Education Model for Identification and Prevention of Elder Abuse (Weiner, 1991). Although clinically useful, these tools have little or no psychometric validation, generally use little behavioral description (see “Issues Pertaining to Assessment of Victimization,” below) when posing queries about mistreatment, and are inappropriate for epidemiological efforts. They may also lack sensitivity in clinical realms due to the method and context within which questions are vaguely asked. Examples come from Johnson (1981): “8. Can patient relate instances of: being shaken, shoved?” and from Tomita (1982): “Ask patient if he/she experiences: (a) being shoved, shaken, or hit.” These questions, while seemingly relevant, lack specificity and do not employ contextually orienting preface statements or behaviorally specific descriptions about queried events. Research with younger adults indicates that these two characteristics are essential for violence assessment, and further definition and discussion of these aspects is provided in the following section. As such, these protocols represent guidelines, rather than specific assessment manuals or strategies.
ISSUES PERTAINING TO ASSESSMENT OF VICTIMIZATION: WHAT WE’VE LEARNED FROM RESEARCH ON VIOLENCE AGAINST CHILDREN AND YOUNG ADULTS
The following discussion involves techniques used with cognitively intact adolescents and young adults to determine violence prevalence and characteristics. These methods are not appropriate for use with cognitively impaired or demented older adults. For these individuals, the NEAIS methodology in which APS reports and sentinel reports are used to estimate the rate of abuse, combined with caretaker interviews, are indicated to assess the multiple forms of elder mistreatment (see below).