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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
sumed fiduciary obligations for elders with diminished capacity for financial decisions. As noted above, however, it does not include exploitation by other predatory parties; these victimizations would amount to legal harms (financial injuries) but not to mistreatment.
By contrast, if the presenting condition relates to the elder’s unmet needs, a de facto caregiving relationship (or expectation of care) is required in order to preserve the boundary between neglect by responsible others (mistreatment) and self-neglect. Professionals who are clinicians, such as physicians, nurses, psychologists, or social workers, are de facto in trust relationships with elders for whom they care. In this context, the relevant relationships include only those people who have assumed the responsibility for caregiving or are expected to do so. Obviously this characterization ultimately depends on highly contextual social facts that are not easily ascertained in surveys or observations.
Vulnerability Associated with Aging
Vulnerability is another core concept in elder mistreatment. Its importance can be seen by asking whether intimate partner violence constitutes elder mistreatment simply because the victim is older than a designated age (e.g., 65). In the panel’s view, the answer is “no” (although the issues may overlap when the victim is older and vulnerable). A predicate feature of elder mistreatment is that the victim has a diminished capacity for self-care or self-protection. Thus, a chronic pattern of intimate partner violence that has persisted into older age is not, by itself, “elder mistreatment.” Conversely, if violence against an intimate partner is initiated or becomes more frequent or severe due to the older partner’s age-associated vulnerability, then it is properly characterized as “elder mistreatment.”
Although vulnerability is a core concept in the definition of elder mistreatment, the panel concluded that further specification would be premature at this time. Some aspects of vulnerability are indisputable, including financial dependence and impairments of mobility (being wheelchair-bound) or cognition (dementia). However, other factors that diminish capacity for self-care or self-protection have not been well characterized. For this reason, the panel regards the meaning of vulnerability as an empirical question—as a referent for the cluster of clinical or psychosocial risk factors associated with increased likelihood of mistreatment. For most research purposes, vulnerability should not be used as a selection criterion; instead, data bearing on vulnerability should be routinely collected and analyzed in most studies of elder mistreatment.
Finally, another boundary issue relates to the age cut off for being an elder. This is a complicated issue. Conceptually speaking, vulnerability, not age, is the determinative concept. There seems to be no important