bruises elsewhere on her body, when might it be concluded that the same caregiver striking her at other times caused these other bruises? As should be apparent, the causal inference connecting conduct to consequences in many instances necessitates a judgment on the part of the researcher. Thus, for some studies, the researcher may have to specify an operational definition of causality and a process by which the determination of causality is made.

The next item in the box deals with the evaluation of information from the previous items in judging whether or not the combination of conduct and harm constitutes mistreatment. This requires operational definitions of the types of mistreatment against which the specific circumstances can be assessed. The panel encourages researchers to be as specific as possible in identifying which combinations of conduct and harm are being defined as mistreatment for purposes of the study. It may be helpful to define the category of mistreatment separately for (1) physical mistreatment, (2) sexual mistreatment, (3) emotional mistreatment (including isolation), (4) financial exploitation, and (5) failure to provide needed care, including abandonment.

As explained earlier, the panel recommends that researchers try to avoid stand-alone, unmodified use of the terms “abuse” and “neglect” because these terms require legal interpretations and community value judgments that inevitably vary across states and localities. In addition, it should be recognized that whether a case is found by the applicable authorities to constitute abuse or neglect also depends on the purpose of the intervention in a particular case and other aspects of the social context. In some situations, for example, the question being asked is whether an intervention or treatment might be implemented to help the elder. In other situations, however, a determination of abuse or neglect might lead to criminal prosecution of the perpetrator. These determinations are all rooted in value judgments made initially by the examining clinicians and subsequently by public officials and courts. These judgments are themselves subject to empirical study. In such investigations, what must be defined and measured are the variety of possible clinical, social, and legal responses that might be made to particular cases. If this type of research were added to the box, the question of interest would be “Was this combination of conduct and harm characterized as ‘abuse’ or ‘neglect’ by the relevant decision-makers?”

The sixth element in the box involves the operationalization and measurement of factors that increase or decrease the likelihood of elder mistreatment. Measurement of risk and protective factors is as important as measurement for mistreatment itself. Risk factors are factors that increase the probability of mistreatment, while protective factors are ones that decrease its probability. Their measurement is critical from the public health



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