national elder mistreatment occurrence rates is critically needed for improved policy formulation. After appropriate methodological development, a national survey of elder mistreatment occurrence and risk factors, designed to inform important policy issues relevant to elder mistreatment prevention and treatment, should be conducted.

It is logistically feasible to add elder mistreatment case screening or detection modules to existing, comprehensive geographic health and social surveys, including longitudinal studies of aging populations, and attempts should be made to further this application. Those surveys that have access to frail, vulnerable elders and that contain study variables related to the risk or outcomes of elder mistreatment are the ones most likely to be fruitful. Such piggybacking of elder mistreatment items and instruments could also serve as a test bed for developing methodology intended for national surveys.

In addition to improved household and geographically referent sampling techniques, new methods of sampling and identifying elder mistreatment victims in the community should be developed in order to improve the validity and comprehensiveness of elder mistreatment occurrence estimates. It is likely that household sampling, while extremely useful, will be incomplete to some degree because of difficulty in gaining access to those households and respondents most at risk of elder mistreatment. A particular problem is accessing and characterizing the wide variety of assisted living and related residential facilities where many vulnerable elders are located. Developing additional ways to approach and access these populations may require other sampling techniques, such as through social networks and institutions, or the health care system.

The clinical course, antecedents, and outcomes of the various types of elder mistreatment occurrence are poorly understood, necessitating more longitudinal investigations, including follow-up studies of the clinical, social, and psychological outcomes of elder mistreatment cases detected. Many elder mistreatment situations are recurrent and may have various incarnations over long periods, making the definition of an elder mistreatment “event” difficult to define. Thus, further work on the nature, periodicity, variation, and triggers for elder mistreatment are needed and will require longitudinal investigations. Furthermore, the health and social outcomes of elder mistreatment are not well studied and require further investigation, an absolute requisite for prevention and intervention research.

The occurrence of elder mistreatment in the institutional setting, including hospitals, long-term care and assisted living situations, is all but uncharacterized and needs new study sampling and detection methods. Sampling and surveillance techniques may be different from those employed in community-based elder mistreatment detection, and considerable innovation may be required.

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