The lack of statutory or well-studied screening instruments can result in highly subjective standards by mandated reporters, leaving prosecutors with very little hard evidence on which to base their cases (Loue, 2001). Health care providers and social services agencies may not reach the people who need them most if cases of abuse and neglect cannot be adequately identified.
Research is vital to creating validated, uniform screening tools. The lack of a gold standard requires using alternative methods for validating tools, such as a lead standard. One lead standard might be an expert consensus panel. Consideration should be given to developing (a) a form with a short format for busy environments, such as emergency centers, with questions applicable to all elders; (b) a form applicable to community-dwelling elders; and (c) a form suited to residents of institutions. These various forms are required because we do not know what risk different settings confer.
A second form with a long format, also validated and uniform, should be developed with a structure similar to that of a, b, and c above. The long form would be intended to be used by those who historically take a lengthy interview, such as protective service specialists or ombudsmen. The long form could serve as a research tool in conjunction with the short form if the individual appears to be at high risk for abuse or neglect. Screening for all elders, coupled with targeted comprehensive assessment in high-risk populations, may be the most practical and fruitful approach.
Finally, comprehensive geriatric assessment is already a well-validated procedure for assessing and intervening in the care of frail elders and merits study in populations of abused or neglected individuals.
Just as in the evaluation of potential abuse and neglect in living persons, there is a need for development of screening or evaluation tools that are specifically useful in the postmortem setting. For example, research could compare the number, location, and type of fractures incurred in documented accidental situations versus those encountered in the setting of inflicted injury. It is intriguing to think that there might be biological markers of elder abuse or neglect. While the need for epidemiological research on screening and assessment tools is clear, it does not preclude searching for other objective laboratory measures.
Although a 100 percent autopsy rate, including proper investigation, review of medical records, consultation with specialists, including geriatri-