psychosis are curable, interventions derived from trials may decrease or even reverse some cases of elder abuse and neglect.

Elder Sexual Abuse

To improve recognition of elder sexual abuse, researchers need to develop precise anatomic diagnostic criteria, something that is yet to be determined for child sexual abuse (Kerns, 1998). Studies are needed comparing anogenital examination findings and psychological characteristics in sexually abused elders with findings in examinations of those who participate in consensual sexual relations.

Studies in each of the additional categories below should be conducted to determine what physical and behavioral signs should catalyze further examination, inquiry, and possible reporting by caregivers. The categories include: abrasions and lacerations, bruises, restraints, decubiti, malnutrition, dehydration, medication use, self-neglect, and financial fraud and exploitation. Additional studies should be conducted to determine what other markers should be added to the list (for example, contractures).

Research on Distinctions in Medical Forensic Markers in Home Versus Residential Settings

The study of these forensic markers in caregiver neglect is difficult because so many variables are involved. Some caregivers may neglect patients because of a lack of knowledge, resources, training, assistance, and available time due to competing responsibilities. Others may neglect intentionally or sadistically. In the institutional context, a corporate decision maker may order cutbacks that result in neglect. Research is needed to develop appropriate standards of care for caregivers that are meaningful and achievable regardless of socioeconomic status.

Most of the adverse events that happen to frail elders are not the result of abuse or neglect. Tracking of data on adverse and unexpected events is important in determining standards for such incidents and is already performed by state and federal agencies. Intermingled with data on, for example, falls, may be data on bruises and fractures that occurred because of abuse or neglect unbeknownst to investigators. Gurwitz and colleagues (1994) have collected data on adverse and unexpected events in long-term care settings. A study in which investigators collect a single stream of data, screen data for abuse and neglect, and compare positive cases to negative cases may give results that are more accurate.

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