enter into formal professional relationships with an older person. The case for a legal guardian should be obvious. Similarly, paid professionals, whether they be clinicians, attorneys, financial advisers, or accountants, enter into trust relationships by virtue of their professional activities. It should be apparent that relationships with paid professionals in all health care settings, such as hospitals, nursing homes, assisted living homes, adult day care programs, and the like, enter into trust relationships when they come into contact with older people. This includes not only licensed professionals such as doctors or nurses but also personal care workers (nursing aides), janitorial staff, escort staff, etc.
In other circumstances, whether a particular relationship amounts to a trust relationship for purposes of elder mistreatment research may be unclear. In the first instance, researchers should make every effort to determine the point of view of the older person regarding their trust relationships. In some situations, this may be determinative. However, in many situations, the elder person’s point of view will not be ascertainable or will be superseded by social conventions or legal duties. For example, the older person may be suspicious of, and have no expectation of protection from, a home health care aide who has assumed a caregiving obligation. Conversely, the older person may develop a trusting relationship with a door-to-door vacuum cleaner salesman who, by law and social convention, bears no obligation to protect the older person’s interests. Accordingly, applying the concept ultimately requires objective assessment and judgment.
In sum, empirical knowledge is lacking about the kinds of trust relationships that older persons enter into, the other parties involved in these relationships, the foundations of these relationships, and their association with different types of mistreatment. Therefore, an early priority of research in the field ought to be the conceptual and empirical development of different operational definitions of trust relationships.
The relevant conduct of the other party that may be of interest includes direct physical contact (hitting, pushing, shoving, etc.), verbal mistreatment (yelling, threatening verbally, criticism, etc.), placing restrictions on the older person (isolating to a room, unnecessary use of physical or chemical restraints), social embarrassment (berating the elder in public), depriving the older person of material possessions (restricting access to money, stealing from the elder, etc.), not providing necessary care (e.g., not providing medications, bathing infrequently, feeding a limited diet), and many more. The challenge for researchers is to define the conduct with maximum possible specificity to facilitate analysis and interpretation. Whether any such conduct amounts to mistreatment requires a value judgment based on con-