Studies are greatly needed that examine risk indicators and risk and protective factors for different types of elder mistreatment. It may make little conceptual sense to combine, for example, physical violence and neglect as subsets of the same phenomenon. Because of the relatively larger number of case-control studies focusing on physical violence, more reliable information regarding risk factors has emerged for that manifestation of elder mistreatment. Research is needed on risk factors for neglect, psychological mistreatment, sexual abuse, and financial abuse. Further, studies of the co-occurrence of different abuse types, and risk factors for such co-occurrence, are needed. This research should not neglect the study of protective factors for elder mistreatment. A particularly critical need exists for studies of risk factors for elder mistreatment in institutional settings.

Research on risk factors should be expanded to take into consideration the clinical course of elder mistreatment. Although longitudinal data are absent, it seems probable that elder abuse situations may follow a pattern similar to disease progression, which would include lead time prior to the manifestation of active signs and symptoms of mistreatment; periods of “remission”; and critical points in which mistreatment becomes more intensive or acute. Some have speculated that mistreatment typically increases in severity and intensity over time, but no empirical data demonstrate this pattern or individual differences in progression. Clinical accounts suggest that situations of mistreatment include cases that resolve on their own, cases in which mistreatment intensifies, and cases in which the situation remains abusive but stable. It is therefore both possible and important to identify risk factors for an increase or intensification in mistreatment. For these reasons, cohort studies are of great importance in determining risk factors for elder mistreatment.

Substantial research is needed to improve and develop new methods of screening for possible elder mistreatment in a range of clinical settings. These methods should be able to detect a broad range of categories of mistreatment and be highly accurate and efficiently deployed. Candidate techniques might include improved questionnaire designs; record linkage to other clinical, public health, social, and legal databases; automated alerts based on concurrent clinical records; and previously defined risk status based on prescreening methods. Special attention should be placed on the predictive value of various clinical injuries and other relevant clinical findings as indicators of mistreatment for therapeutic, social, and forensic reasons.

Research is needed on the process of designating cases as incidents of mistreatment in order to improve criteria, investigative methods, decision-making processes, and decision outcomes. The absence of a gold standard for case identification, and the momentous consequences of inaccurate decisions, highlight the need for studying and improving the process of case



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