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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
point of view for several reasons. Their identification is crucial to the detection of who is at risk for mistreatment so that preventive interventions can be applied. As well, their identification promotes understanding of the mechanisms leading to mistreatment. Because vulnerabilities associated with aging (and with disabilities) are of special concern in the fields of elder mistreatment and adult protective services, these risk factors require careful attention. (Research on risk and protective factors is discussed in Chapter 5.)
The final element in the box relates to the outcomes and consequences of mistreatment. Mistreatment has been associated with a series of consequences and adverse outcomes. For example, mistreatment can cause physical and mental morbidity that is at times sustained. It can lead to serious financial strain. As well, social isolation, loss of dignity, impaired quality of life can result. Research on the consequences of mistreatment is critical to understanding its individual and societal impact and to targeting and assessing the benefit of interventions. (A theoretical model linking mistreatment to its outcomes is discussed in Chapter 3.)
With this overview in mind, the discussion now turns specifically to the measurement of several of the elements involved in research on mistreatment as identified in Box 2-2.
If an age cutoff is to be used, then the operationalization and measurement of who is an older person are straightforward and merit no further discussion. If, however, the definition is broadened to include other groups of vulnerable adults, operational definitions and specific measurement methods may be needed. For example, if the definition is broadened to include “adults with developmental disabilities,” or “adults with mental illness,” or “adults with physical disabilities,” then a definition of each of these terms is necessary for research to go forward, as is a method of determining whether a specific individual meets the definition. It seems fair to assume that definitions and measurements for various types of disabilities exist in the relevant fields and can be imported with appropriate modification to research on elder mistreatment.
The panel favors specific definitions of disability if the population being studied is chosen on this basis, rather than use of a generic and vague category of all “vulnerable adults.” Objective criteria of inclusion, such as cognitive impairment or frailty or disability impairing locomotion, should be used. However, if the study population is defined by age (e.g., everyone over 18 or 40 or 55, etc)., then the elements of vulnerability can be defined empirically according to the personal characteristics that emerge as risk factors for mistreatment.