Index

A

Abandonment, 36, 184, 188, 199, 216, 222, 225, 236, 357

screening and case identification, 112-113

Abrasions and lacerations, 54, 118, 119, 340, 344-345, 359, 360, 361, 372, 449, 454

Abuse, see Child abuse and neglect;

Definitional issues;

Domestic violence;

Emotional abuse;

Exploitation;

Financial abuse;

Self-abuse/self-neglect;

Sexual abuse

Academic research, 6, 13, 60, 139, 521

Acierno, Ronald, 77, 78, 79, 81, 255, 261-302

Activities of daily living (ADLs), 10, 11, 98

adult protective services, 125

nursing homes, 452, 479

residential care facilities, 466, 469, 479

screening and case identification, 105, 270-271

Administration on Aging, 21-22, 132, 151, 246, 266-267

National Center on Elder Abuse, 15, 22-23, 132, 265-266, 385, 389-390

Administration on Developmental Disabilities and Rehabilitation Research, 7, 150, 152

Adult children of elderly persons, 11, 91, 95, 96-97, 168, 274, 293-302 (passim), 401

intergenerational transmission of mistreatment, 99

Adult Protective Service Reports, 167

Adult protective services, 6, 22, 23, 24-25, 27, 32, 42, 50, 80, 82, 101, 245, 332, 505

cost factors, 126, 239

criminal justice system and, 124-125, 126, 127-128, 129

evaluation of effectiveness, 6, 32, 122, 124-127, 139, 506

financial abuse, 390, 394, 405(n.25), 417, 436, 437

funding, 14, 126, 239, 240, 418-419

gender factors, 96

historical perspectives, 13-15, 17, 238-240, 506

legislation, 27, 28, 115, 124, 181-182, 185, 189, 411-412, 418-419, 505, 506-507

nursing homes and, 456-460

racial/ethnic factors, 97



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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Index A Abandonment, 36, 184, 188, 199, 216, 222, 225, 236, 357 screening and case identification, 112-113 Abrasions and lacerations, 54, 118, 119, 340, 344-345, 359, 360, 361, 372, 449, 454 Abuse, see Child abuse and neglect; Definitional issues; Domestic violence; Emotional abuse; Exploitation; Financial abuse; Self-abuse/self-neglect; Sexual abuse Academic research, 6, 13, 60, 139, 521 Acierno, Ronald, 77, 78, 79, 81, 255, 261-302 Activities of daily living (ADLs), 10, 11, 98 adult protective services, 125 nursing homes, 452, 479 residential care facilities, 466, 469, 479 screening and case identification, 105, 270-271 Administration on Aging, 21-22, 132, 151, 246, 266-267 National Center on Elder Abuse, 15, 22-23, 132, 265-266, 385, 389-390 Administration on Developmental Disabilities and Rehabilitation Research, 7, 150, 152 Adult children of elderly persons, 11, 91, 95, 96-97, 168, 274, 293-302 (passim), 401 intergenerational transmission of mistreatment, 99 Adult Protective Service Reports, 167 Adult protective services, 6, 22, 23, 24-25, 27, 32, 42, 50, 80, 82, 101, 245, 332, 505 cost factors, 126, 239 criminal justice system and, 124-125, 126, 127-128, 129 evaluation of effectiveness, 6, 32, 122, 124-127, 139, 506 financial abuse, 390, 394, 405(n.25), 417, 436, 437 funding, 14, 126, 239, 240, 418-419 gender factors, 96 historical perspectives, 13-15, 17, 238-240, 506 legislation, 27, 28, 115, 124, 181-182, 185, 189, 411-412, 418-419, 505, 506-507 nursing homes and, 456-460 racial/ethnic factors, 97

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America reporting practices, 27, 28, 115, 122, 167, 261, 267, 383-384, 411-412, 417, 456-460 residential care facilities, 465 response time, 124, 129-130 risk factors, 96, 97, 98 screening and case identification, 104, 105-106, 115-116, 124, 167, 261 267, 277, 365 self-abuse and neglect, 126-127 theoretical models, 60, 65 Advisory Board on Child Abuse and Neglect, 16 Advocacy, 14, 15, 17, 130, 136, 239, 251, 256, 316, 356, 388, 418, 419, 422, 423, 429, 430, 489, 490, 505-506, 516 African Americans, 97, 269, 390-391, 466 Age Discrimination in Employment Act, 42 Age factors, 171, 175, 176, 268-269 attitudes about aging and the elderly, 63, 168, 242, 264-265, 271-272, 276, 296, 299, 400, 406 definitional issues, 41-42, 43, 90, 115, 124, 181-237 (passim), 246 financial abuse, perpetrators, 401 forensics, 341, 344-360 (passim) long-term care settings, 447 nursing homes, 452 perceptions of behavior, 168 population, aging of, xiii, 9-10, 78, 152 screening and case identification, 115, 294 state legislation, 27, 28, 115, 124, 181-182, 185 vulnerability, general, 41-42, 43 Agency for Healthcare Research and Quality, 12, 152 AIDS, 69 Alabama, 21, 181-182, 394, 424 Alaska, 182 Alcohol abuse, 21, 91, 94, 95, 242, 270, 282, 293, 294, 296, 299, 355, 357, 398 Alzheimer’s disease, see Dementia American College of Emergency Response, 170 American Medical Association (AMA), 104, 109, 342, 365, 402 Arizona, 183, 433 Arkansas, 183-184 Assessment, see Evaluation of interventions; Screening and case identification Assessment Protocol for Physicians, 365 Assisted-living settings, 4-5, 10-11, 62, 64, 80, 86, 133, 134, 467, 469 Attitudes, 242, 264, 278-279, 284, 296, 297, 299, 503 see also Depression; Emotional abuse; Trust relationships about aging and the elderly, 63, 168, 242, 264-265, 271-272, 276, 296, 299, 400, 406 financial abuse, 391-392, 396, 399-402, 404, 406, 407, 414, 415, 429, 438 long-term care settings, 10, 446-447 screening and case identification, 109, 242, 264-265, 271-272, 276, 278-279, 284, 293, 294, 296, 299, 396 sexual abuse, 264, 278 stigma, 69, 242, 243, 264, 278-279, 332, 415, 429, 503 Attorneys, 304 see also Guardianship and power of attorney financial abuse, 52, 390, 398, 411-412, 413, 423, 433-434 reporting of abuse, 52, 123, 390, 411-412, 413 B Banks and banking, 130, 388, 396, 398, 426 incidence and prevalence research, 73, 244 prevention of abuse, 132, 296, 414, 430, 431-433, 435, 437 reporting practices, 411(n.36), 412, 421 Bedsores, see Decubiti Belmont Report, 303-304, 305, 306, 309, 311, 316-318, 319-320, 321, 327, 334 Benjamin Rose Institute, 239 Biomarkers, 3, 23, 74, 84, 101-102, 340, 360-362 Blacks, see African Americans Blenkner, Margaret, 239, 243 Block grants, 14

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Board and care homes, see Residential care facilities Brief Abuse Screen for the Elderly, 100-111, 366 Bruises, 20, 49, 54, 114, 116, 117, 119, 120, 127, 166, 183, 186, 216, 340, 342-343, 345-347, 454 Bureau of Justice Statistics, 268 Burns, 20, 54, 119, 120, 166, 183, 186, 216, 226, 340, 343, 353-354, 371-372 C California, 127, 184-185 Canada financial abuse, 390, 394 incidence and prevalence, 74, 390 legislation, 506 Caregiver abuse and neglect, xiii, 7, 11, 15, 17, 26, 30, 33, 42, 44, 122, 240 see also Assisted-living settings;Institutional settings; Long-term care settings; Medical interventions; Nurses and nursing; Nursing homes; Restraints; Trust relationships Alzheimer’s patients, 10, 92, 93-95 child abuse model, 403 definitional issues, 1, 39, 40-41, 44, 49, 51-53, 61, 181-237 (passim), 342 ethical issues, research, 322, 333-334 informed consent, 143, 147-148, 311, 314-315, 333-334 financial, 40-41, 65, 385, 388, 395, 397-400, 435-436 forensics, 342, 343-381 (passim) incidence and prevalence, 73, 74, 76, 261, 270-273 respite care, 93, 94-95, 125, 130, 270 risk factors, 93-95, 98-103 screening and case identification, 104-120, 166-167, 242, 270, 271-277, 293-302 (passim), 504-505 institutional staff, 100, 134-135, 490, 504-505 theoretical models, 61, 63, 64-65, 69-70 Caregiver Abuse Screen (CAS), 112-113, 271 Case-control studies, see Controlled studies Case management, 4-5, 105-106, 116, 277 see also Screening and case identification Center for Mental Health Services, 152 Centers for Disease Control and Protection (CDC), 80, 306-307 Centers for Medicare and Medicaid Services (CMS), 152, 448, 457-459, 460-462, 479 see also Health Care Financing Administration (HCFA) Medicaid, 128, 134, 448, 451, 457, 466, 479 Medicare, 294, 448, 451, 456-457 Child abuse and neglect, 126, 277-281, 339-340 cognitive status of children, 116-117, 404-406 community-level factors, 16, 126, 505, 510-516 criminal justice system, 116-117, 280-281, 507 financial abuse models, 402-408 forensics, 339-340, 360-361 historical perspectives, 12-13, 14, 16-17, 18-19, 126, 339, 383, 501, 506 hospitals, 503, 504 incidence and prevalence research, 13, 277-281, 287 informed consent, 143 intergenerational transmission of mistreatment, 99 international perspectives, 13, 506 isolation, 35, 36, 52, 56, 448, 450 legislation, 13, 14, 506, 507-510 LONGSCAN, 329, 330, 331, 333 public education, 267-268, 505, 517-518 reporting practices, 13, 123, 329(n.6), 330 research ethics, 143, 315-316, 329-331, 333 research methodology, general, xiii-xiv, 18-19, 23, 26-27, 245, 262-263, 267, 268 risk factors, 88, 91, 99, 103, 242, 503-504 screening and case identification, 116-117, 119, 267, 273, 403-404, 503-505 sentinel reports, 267, 268

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Child Abuse Prevention and Treatment Act, 13 Children, adult, see Adult children of elderly persons; Household settings Civil justice interventions, 28, 32, 130, 131, 134, 145, 221, 251, 255, 324, 341, 342, 343, 362, 374, 421, 423-429 Clinical practices and research, 4, 5, 25, 45, 334-381 see also Ethical issues; Forensics; Medical interventions; Screening and case identification guidelines for measurement, 45, 144 incidence and prevalence of mistreatment, 71, 76 measures of mistreatment, table, 166-167 Coalition of Advocates for the Rights and Interest of the Elderly (CARIE), 136-137, 489 Cognitive impairments, 6, 14, 76, 125, 169, 262-263, 264, 340 see also Dementia; Guardianship and power of attorney, 76, 83, 270-272, 273, 284 child abuse, general, 404-406 child abuse witnesses, 116-117 definitional issues, 35, 36, 50, 406 financial abuse, 391-392, 393, 395, 396, 397, 404-406, 407, 413, 421, 422, 433-434, 435, 438 forensics, 343, 354-357, 360, 366-367, 371-372 incidence and prevalence research, 76, 83, 270-272, 273, 284, 286, 287, 451 informed consent, 6, 140, 141-143, 309-311, 312, 314-317 long-term care settings, 446, 451, 452, 465, 466, 467, 482 medications, effects of, 264, 406(n.29) nursing homes, 451, 452, 482 prospective studies, 90-91 recall problems, 90-91, 264 residential care facilities, 465, 466, 467, 482 screening and case identification, 76, 83, 105, 109, 114, 116-117, 270-272, 273, 284, 314, 366-367, 396, 397 state legislation, 35, 36, 184, 405, 406 theoretical models, 66, 70 Cohort studies, see Longitudinal studies Colleges and universities, see Academic research Colorado, 186-187 Common Rule, see Federal Policy for the Protection of Human Subjects Community Based Education Model for Identification and Prevention of Elder Abuse, 277 Community-level factors, 2, 3, 4, 7, 24, 91, 122, 151, 170, 522 see also Adult protective services; Assisted-living settings; Criminal justice system; Families and households; Hospitals; Local government child protection, 16, 126, 505, 510-516 domestic violence, 505, 510, 510-516 evaluation of interventions, 122, 128 financial abuse, 430-432, 436 incidence and prevalence data, xiii, 71, 80, 86, 87 interdisciplinary approaches, 131-132 professional specialization and collaboration, 130-133 screening and case identification, 104, 106, 107, 109, 114, 115 Competence With Compassion, 136-137 Comprehensive Drug Abuse Prevention and Control Act, 145-146 Comprehensive Geriatric Assessment, 364 Computer applications, 169, 170 financial abuse, 392, 395, 398, 431 forensics, 362 OSCAR database, 457, 471, 476-477, 478 residential care databases, 471, 476-477, 478 screening and case identification, 108-109 telephone interviews, 281, 283, 285-286, 287 Confidentiality, 33, 83, 145-147, 304, 308-309, 312, 323-324, 328, 329-330, 334, 411 Confinement, see Isolation and confinement; Restraints Conflicts Tactics Scale (CTS), 20, 26-27, 55, 85, 166-167, 244, 271, 274-275, 300-302

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Connecticut, 187 Connolly, Marie-Therese, 255-256, 339-381 Controlled studies, 2, 25, 72, 90, 91, 168, 174 abuser dependency, 96, 241 adult protective services, 239 alcohol abuse, 95 disabled persons, 98-99 household settings, 137-138 screening and case identification, 110-111 Cost factors, xiii, 286 see also Funding adult protective services, 126, 239 community-level programs, 510 evaluation of interventions, 121, 126 financial abuse, legal interventions, 422, 429, 434-435 incidence and prevalence data, 80, 265, 282, 286, 287 interventions, general, 18, 282, 286, 287, 510 interviews, 18, 282, 286, 287, 510 research ethics, evaluation, 313, 321, 322 residential care facilities, 467 risk factors and, 89 screening and case identification, 104, 106, 120, 267, 282 sentinel reports, 267 Criminal justice system, 15, 28, 55, 245-246 see also Forensics; Legislation; Police adult protective services and, 124-125, 126, 127-128, 129 child abuse, 116-117, 280-281, 507 evaluation of, 32, 122, 127-128, 129-130, 131 Federal Bureau of Investigation (FBI), 268, 269, 284, 285-286 financial abuse, 392, 393, 400, 411-412, 420-423 historical perspectives, 15, 240, 506 incidence and prevalence research, 71, 77, 261, 264, 267-269, 280, 284, 287 institutional inspections, 137 police, 16, 21, 60, 73, 81, 93, 104, 122, 123, 125, 127, 129, 131, 138, 269, 282, 341, 422 professional education, 127-131 (passim) protective orders, 418, 425 reporting practices, 123, 267-269, 279 screening and case identification, 104, 105-106, 115, 116-117, 127-128 theoretical models, 65 witnesses, 116-117, 127-128, 129-130, 421 Cross-sectional studies, 72, 169 Cultural factors, see Sociocultural factors D Deaths, see Fatalities Decubiti, 340, 343, 348, 349-350, 360, 372 Definitional issues, 3, 30, 34-59, 61, 133, 150, 238, 244, 245, 384, 448-450 age factors, 41-42, 43, 90, 115, 124, 181-237 (passim), 246 caregiver abuse and neglect, general, 1, 39, 40-41, 44, 49, 51-53, 61, 181-237 (passim), 342 cognitive impairments, 35, 36, 50, 406 disabled persons, 35, 36, 37, 50, 188 elder mistreatment, general, 1, 2, 4, 19-21, 30, 73, 108, 114-115 emotional abuse, 28, 35, 36, 54-55, 448, 449 epidemiology, 72, 73, 75-77, 85, 87, 266, 278, 280 ethics, research, 306, 307, 308, 310 expert judgment, 45-47 families, 35, 36, 181-237 (passim), 244-246 forensics, 341, 342, 343, 344, 364 harm, general, 1, 3, 28, 34, 39, 40 guidelines for measurement, 48, 53-55, 56-58 institutional settings, general, 35, 36, 37, 187-188, 194, 196, 201, 202, 209, 214, 215, 217, 218, 220, 221, 222, 223, 225-226, 233, 235 isolation and confinement, 35, 36, 181-237 (passim) medications, 35, 52, 56, 81 mental illness, 50 neglect, 19, 20-21, 34-37 (passim), 39, 41, 44, 181-237 (passim), 342, 449-450 guidelines for measurement, 44, 56

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America older person, 47-48, 50, 343 operational, 42-45, 47-59, 75, 108 protective factors, 48, 49, 50, 58 psychological factors, 50, 448 residential care facilities, 4, 465, 475 risk factors, 5, 20-21, 35, 72, 89 guidelines for measurement, 48, 49-50, 58, 81-82, 85 screening and case identification, 108, 114-115, 266, 278 self-abuse and neglect, 35, 36, 40, 41, 81 guidelines for measurement, 44 sexual abuse, 35, 49, 183-237 (passim), 280, 281 state legislation, 13, 28, 34-39, 44, 60, 181-237, 384, 385, 400 strangers, abuse by, 35, 40, 44, 52 trust relationships, 39, 40-41, 43, 44, 61, 238, 384-385 guidelines for measurement, 44, 47-48, 51-53, 57 vulnerability, general, 39, 41-42, 43, 50, 182-237 (passim), 246-247 Dehydration, 119, 166, 183, 186, 272, 340, 351-352, 372, 448, 463 Delaware, 187-188 Dementia, 126, 152, 168, 175, 516-517 see also Guardianship and power of attorney financial guardianship, 53 forensics, 355, 356-357, 362-363, 366 incidence and prevalence and, 10, 246, 262, 270, 276, 286, 451, 452 nursing homes, 451, 452, 482, 485, 486 research, informed consent, 6, 140, 141-143 residential care facilities, 469, 482 risk factors, 92, 93-94, 451 screening and case identification, 114, 116-117, 270, 276, 277, 366 theoretical models, 66 Demographic factors, 168 see also Geographic factors; Marriage and marital status; Race/ethnicity; Rural areas; Sociocultural factors; Socioeconomic status; Urban areas adult children, 11 aging of general population, xiii, 9-10, 78, 152 incidence of mistreatment, xiii, 73, 86, 266, 269 nursing homes, 452 residential care facilities, 465 Denmark, 74 Department of Health and Human Services (DHHS), 304 see also Administration on Aging Agency for Healthcare Research and Quality, 12, 152 Centers for Disease Control and Protection (CDC), 80, 306-307 Centers for Medicare and Medicaid Services (CMS), 152, 448, 457-459, 460-462, 479 ethical issues, research, confidentiality, 33, 145, 146-147, 323 Federal Policy for the Protection of Human Subjects (Common Rule), 304, 305, 306, 307-309, 312, 314, 319, 323, 325-326, 332, 334 informed consent, 149, 315, 316(n.4) Food and Drug Administration (FDA), 140, 307-308 forensics, 341, 363 Health Care Financing Administration (HCFA), 152, 448, 457-459 National Institute on Aging (NIA), 2, 6-7, 11, 12, 24-25, 95, 144, 149, 150, 151, 243, 483 National Institutes of Health (NIH), 12 confidentiality, 33, 145, 146-147 informed consent, 149 nursing homes, 457, 479 Office of the Assistant Secretary for Planning and Evaluation, 3, 479-480 Department of Justice, 132, 151 Bureau of Justice Statistics, 268 forensics, 341 National Institute of Justice, 7, 131, 137-138, 150 Department of Veterans’ Affairs, 431 Depression, 54, 64, 66, 69, 94-95, 100, 117, 242, 243, 366 financial abuse, 392 forensics, 355, 357, 362-363, 366 Descriptive studies, 27, 44, 53, 55, 87, 168-177 (passim), 359, 365, 371

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Detection and Treatment of Elderly Abuse and Neglect , 277 Diagnosis, see Forensics; Screening and case identification Disabled persons, 7, 11, 42, 97-98, 100-101, 150, 171, 241-242 see also Activities of daily living (ADLs); Cognitive impairments; Dementia; Long-term care settings; Nursing homes definitional issues, 35, 36, 37, 50, 188 emotional abuse, 28 evaluation of interventions, 124 financial abuse, 391-392, 395, 401, 406, 409, 422, 435 forensics, 343 incidence and prevalence, 10, 11, 264, 265, 270-271, 285 residential care facilities, 465, 466 screening and case identification, 109, 114, 117, 270-271, 294 state law, 35, 36, 37, 124, 181-237 theoretical models, 64, 70 Diagnostic and Treatment Guidelines on Elder Abuse and Neglect (AMA), 104, 109 Diseases and disorders, 11, 97-98 see also Dementia; Disabled persons; Fatalities; Forensics; Long-term care settings; Medical interventions; Mental illness; Nursing homes AIDS, 69 financial abuse, 399, 409 geriatric syndrome, 89-90 historical perspectives, 14, 61, 69 incidence and prevalence of mistreatment and, 10, 76, 79, 81 religious/spiritual treatment, state law, 35, 200, 202, 204, 206, 214, 220, 228, 236 residential care facilities, 471 screening and case identification, 105, 108, 109, 117 theoretical models, 61, 66, 68, 69 District of Columbia, 189 Domestic violence, 15, 501-522 see also Child abuse and neglect; Families and households; Intimate partner mistreatment; Marriage and marital status intergenerational transmission of mistreatment, 99 Dresser, Rebecca, 140, 141, 148, 256, 303-338 Drug abuse, see Substance abuse Drugs, see Medications Duress, see Undue influence and duress Dyer, Carmel Bitondo, 79, 256, 339-381 E Economic factors, 16 see also Cost factors; Financial abuse; Funding; Socioeconomic status incidence and prevalence research, 79, 81-82, 87, 270, 280 institutional mistreatment, 66, 67 research ethics, 313, 321, 322 status inequality, theoretical models, 61, 62, 63, 64, 241 theoretical models, other, 66, 67 victim compensation, 130, 419-420 Education and training, see Professional education; Public education Elder Abuse Attitudes and Behavior Intention Scale, 276 Elder Abuse Detection Indicators, 277 Elder Abuse Screening Test, see Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) Elder Assessment Instrument (EAI), 112-113, 166-167, 272, 294-295, 365 Emergency departments/response services, 23-24, 170, 243 committee recommendations, 6, 139 evaluation of effectiveness, 124, 128, 139 financial abuse reporting, 416(n.39) incidence and prevalence data, 79, 471, 472-473 reporting practices, 472-473 screening and case identification, 107, 109 Emotional abuse, 3 see also Isolation and confinement definitional issues, 28, 35, 36, 54-55, 448, 449 financial abuse, impacts of, 391, 392, 399, 409 forensics, 340 incidence and prevalence, 74, 275, 284, 451, 454-455 institutional settings, general, 99

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America nursing homes, 448, 449, 451, 454-455, 462 research ethics, 322 screening and case identification, 105, 109, 110-111, 117, 166-167, 275, 295, 296 social embarrassment, 57, 339-340 state law, definitional issues, 35, 36, 181-237 (passim) theoretical models, 63, 64 Epidemiology, 24-25, 71, 75-84, 261-302 see also Demographic factors; Incidence and prevalence; Population-based studies; Reporting practices; Risk factors definitional issues, 72, 73, 75-77, 85, 87, 266, 278, 280 forensics and, 371, 373-374 screening and case identification, 107 surveillance, 4, 42, 46, 59, 75, 79, 80, 87 Established Population for Epidemiologic Studies in the Elderly (EPESE), 24-25 Ethical issues see also Informed consent caregiver abuse and neglect, 322, 333-334 informed consent, 143, 147-148, 311, 314-315, 333-334 child abuse and neglect, 315-316, 329-331, 333 confidentiality, 33, 83, 145-147, 304, 308-309, 312, 323-324, 328, 329-330, 334, 411 cost factors, 313, 321, 322 definitional issues, 306, 307, 308, 310 Department of Health and Human Services (DHHS), Federal Policy for the Protection of Human Subjects (Common Rule), 304, 305, 306, 307-309, 312, 314, 319, 323, 325-326, 332, 334 informed consent, 149, 315, 316(n.4) families, 322, 324 informed consent, 143, 147-148, 311, 314-315 harm, general, 311, 319, 321-322, 324-326, 329 institutional review boards (IRBs), 304, 308-309, 313, 319-321, 323-324, 331 informed consent, 142, 143, 148-149, 304, 316(n.4), 317-319, 323 interviews, 311, 312, 323 National Bioethics Advisory Commission (NBAC), 306, 312, 313, 320-322, 326, 331, 334 private sector, 307, 323-324 research, general, 6, 32-33, 140-149, 303-338, 482-483 funding, 305, 307, 321, 323, 327 sampling, 144 socioeconomic status, 327 Ethnicity, see Race/ethnicity Evaluation of interventions, xiii, 2, 5, 6, 12, 17-18, 25, 32, 121-139, 285 see also Ethical issues; Outcome measures; Reporting practices adult protective services, 6, 32, 122, 124-127, 139, 506 child and domestic abuse, 501-525 community-level factors, 122, 128 cost factors, 121, 126 criminal justice system, 32, 122, 127-128, 129-130, 131 emergency medical services, 124, 128, 139 ethical issues, 303, 305 informed consent, 6, 140, 141-143 financial abuse, 418-429 funding, 121, 131, 137-138 guidelines for measurement, 46-47 Expertise, 169, 170 see also Interdisciplinary approaches; Professional education; specific disciplines and specific expertise committee biographical sketches, 249-259 definitional issues, 45-47 financial abuse, criminal investigation, 421 forensics, 366, 369-370, 373, 375 guidelines for measurement, 45-47, 57-58 peer review, 18, 74, 152, 321 specialists, 130-131, 132-133, 272; see also specific experts Exploitation, 1, 9, 11, 13, 14, 18, 25, 28 see also Financial abuse

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America F Families and households, 18, 24, 133, 137-138, 173, 176, 177, 342, 384-385, 501-522 (passim) see also Adult children of elderly persons; Child abuse and neglect; Intimate partner mistreatment; Marriage and marital status committee research recommendations, 4, 7, 70 Conflicts Tactics Scale (CTS), 20, 26-27, 55, 85, 166-167, 244, 271, 274-275, 300-302 ethical issues, research, 322, 324 financial abuse, 40-41, 96, 382, 385, 392, 395, 397, 398, 399, 414, 415, 438 preventive measures, 430-431, 437 historical perspectives, 12, 14, 15, 240, 501, 502 home health workers, 52, 127-128 incidence and prevalence research, 74, 76, 85, 86, 261, 262, 264-267, 268-269, 270-273, 274-275, 284 informed consent, research, 143, 147-148, 311, 314-315 intergenerational transmission of mistreatment, 99 nursing homes, 453-454, 462, 482 reporting practices, 122, 123, 414, 453-454, 462, 473-474 residential care facilities, 467, 473-474, 482 risk factors, 88, 91, 92, 96, 98-99, 100, 242 screening and case identification, 104, 113-114, 270, 271, 273, 293, 294, 295-297 state law, definitional issues, 35, 36, 181-237 (passim), 244-246 theoretical models, 62, 63, 70, 138 Fatalities, 239 see also Forensics child abuse, 340 financial abuse, 392, 393 incidence and prevalence data, 76, 78, 80, 243 interdisciplinary investigation, 132 long-term care settings, 447 suicide, 78 Federal Bureau of Investigation (FBI), 268, 269, 284, 285-286 Federal government, 6-7, 239-240 see also Funding; Legislation; specific agencies and departments funding ethical guidelines, 32-33 protective measures, 14, 18 research, 1-2, 6-7, 11-12, 21-22, 24-25, 33 historical perspectives, 12-15 National Bioethics Advisory Commission (NBAC), 306, 312, 313, 320-322, 326, 331, 334 nursing homes, 449-450 reporting requirements, 125 residential care facilities, 464-465 Federal Policy for the Protection of Human Subjects (Common Rule), 304, 305, 306, 307-309, 312, 314, 319, 323, 325-326, 332, 334 Fiduciaries, 28, 41, 132, 385, 389, 390, 403, 419, 426(n.49), 427, 428 preventive measures, 434-435, 436 state legislation, definitions, 190-191, 192, 197, 203, 206, 211, 218, 219 Financial abuse, 167, 359-360, 382-445 see also Banks and banking; Fiduciaries; Guardianship and power of attorney abuser dependency, 96, 241, 242, 270, 293, 296, 300, 387(n.11) adult protective services, 390, 394, 405(n.25), 417, 436, 437 attitudes and, 391-392, 396, 399-402, 404, 406, 407, 414, 415, 429, 438 attorneys, 52, 390, 398, 411-412, 413, 423, 433-434 caregiver abuse and neglect, 40-41, 65, 385, 388, 395, 397-400, 435-436 child abuse models, 402-408 cognitive impairments, 393, 395, 396, 397, 404-406, 407, 413, 421, 422, 433-434, 435, 438 community-level factors, 430-432, 436 computer technology, 392, 395, 398, 431 cost factors, legal interventions, 422, 429, 434-435

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America criminal justice system, 392, 393, 400, 411-412, 420-423 definitional issues, 35, 38, 40-41, 382(n.1), 385-386, 388-389, 409, 415, 420-421 guidelines for measurement, 51-53, 54-55 disabled persons, 391-392, 395, 401, 406, 409, 422, 435 emotional impacts of, 391, 392, 399, 409 families, 40-41, 96, 382, 385, 392, 395, 397, 398, 399, 414, 415, 438 preventive measures, 430-431, 437 forensics, 340 fraud, 131, 132, 134, 185, 207, 210, 211, 213, 216, 221, 227, 231, 236, 340, 359, 360, 372, 385, 387, 400, 404-405 gender factors, 394-395 incidence and prevalence, 1, 9, 11, 74, 243-244, 274, 389-391, 401, 437-438 inheritance, 392, 399, 403(n.22) international perspectives, 390, 394 intimate partners, 394, 401, 402-403, 408-410 isolation and, 393, 395, 397, 402, 435 marriage and marital status, 394, 401, 402-403, 408-410 medical services, 397, 399, 416, 435-436 mental illness, 397, 399 neglect, 387, 395, 409 professional education, of specialists, 130, 131, 132, 419, 432, 436, 437 protective orders, 418, 425 psychological factors, 391, 392, 399, 401, 409 race/ethnicity factors, 388, 390-391, 394 reporting requirements, 123, 383, 391, 393, 410-418 research recommendations, 3, 7, 436-439 risk factors, 92, 96, 393-402 screening and case identification, 110-113, 166-167, 274, 293, 295, 300, 382, 421, 429-436, 438 self-abuse and neglect, 397, 414 sociocultural factors, 388, 393, 395, 397, 417, 438 preventive measures, 430-431, 435 socioeconomic status, 394 state law, definitional issues, 35, 38, 181-237 (passim), 247 state programs, 14 strangers, 52, 110-113, 261, 384, 400 theoretical models, 65 trust relationships, 382, 385, 387, 392, 393, 395, 401-402, 415 undue influence and duress, 131, 192, 195, 197, 203, 206-207, 210, 211, 212, 219, 222, 226, 231, 233, 237, 304, 309, 312, 386, 387, 389, 400, 404, 405, 407, 425 Finland, 244 Florida, 125, 189-191 Food, see Nutrition Food and Drug Administration (FDA), 140, 307-308 Foreign countries, see International perspectives; specific countries Forensics, 65, 101-102, 119-120, 129, 132, 339-381 abrasions and lacerations, 54, 118, 119, 340, 344-345, 359, 360, 361, 372, 454 age factors, 341, 344-360 (passim) biomarkers, 3, 23, 74, 84, 101-102, 340, 360-362 bruises, 20, 49, 54, 114, 116, 117, 119, 120, 127, 166, 183, 186, 216, 340, 342-343, 345-347, 454 burns, 119, 120, 340, 343, 353-354 caregiver abuse and neglect, 342, 343-381 (passim) centers, 368-369, 375 child abuse and neglect, 339-340, 360-361 cognitive impairments, 343, 354-357, 360, 366-367, 371-372 computer applications, 362 decubiti, 340, 343, 348, 349-350, 360, 372 definitional issues, 341, 342, 343, 344, 364 dementia, 355, 356-357, 362-363, 366 depression, 355, 357, 362-363, 366 emotional abuse, , 340 epidemiology, 371, 373-374

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America fractures, 20, 79, 114, 118, 119, 120, 127, 166, 183, 255, 340, 342-343, 347-348, 360, 362, 371, 372, 373, 448(n.2), 454, 471, 472 interdisciplinary approaches, 366, 369-370, 375 medications, use of, 340, 343, 352-353 mental illness, 340, 355, 357, 362-363, 366, 371-372 neglect, 342, 343, 372 dehydration, 119, 340, 351-352, 372, 448, 463 hygiene, 340, 350, 357-358, 360, 448, 463 malnutrition, 340, 350-351, 448, 464 restraints, 340, 348-349 self-abuse and neglect, 343 sexual abuse, 340, 358-359, 372 standards, 363-364, 370, 372 violence, physical, 340, 342-343, 360-362 Fractures, 20, 79, 114, 118, 119, 120, 127, 166, 183, 255, 340, 342-343, 347-348, 360, 362, 371, 372, 373, 448(n.2), 454, 471, 472 Fraud, 131, 132, 134, 185, 207, 210, 211, 213, 216, 221, 227, 231, 236, 340, 359, 360, 372, 385, 387, 400, 404-405, 412-413, 422-423, 424, 438 Medicaid, 456 Fulmer Restriction Scale, 167 Funding, 1-2, 11-12, 27, 42, 150 adult protective services, 14, 126, 239, 240, 418-419 block grants, 14 ethical issues, research, 305, 307, 321, 323, 327 evaluation of interventions, 121, 131, 137-138 forensics, 341 incidence and prevalence and, 3-4, 71, 84-86, 244 interdisciplinary approaches, 131 Medicaid, 128 population-based studies, 3, 84-85 prevention, 121, 131, 418-419 professional education, 32, 132, 133, 151 protective care, 14, 126, 239, 240, 418-419 research, general, 1-2, 6-7, 11-12, 21-22, 24-25, 33, 42, 71, 95, 140, 150, 151-152, 521-522 screening and case identification, 105 G Gender factors, 60, 96, 168, 176, 242-243, 294 see also Intimate partner mistreatment; Marriage and marital status; Sexual abuse financial abuse, 394-395 institutional settings, 100 long-term care settings, 447 violent crime victims, 269 General Accounting Office, 413 Georgia, 191-192 Geographic factors, 4 see also Community-level factors; Urban areas; specific states and countries incidence and prevalence and, 72, 79, 81-82, 86, 283, 284 rural areas, 61, 66, 67 screening and case identification, 104, 106, 107 telephone interviews, 283 theoretical models, 61, 62, 66, 67 Geriatric syndrome, 89-90 Government role, see Federal government; Local government; State government Guardianship and power of attorney, 13, 51, 239 financial abuse, 40-41, 184, 191, 192, 200, 210, 212, 227, 389, 398-399, 413, 418, 426-429, 433 preventive measures, 431 forensics, 341, 344 informed consent for research participation, 314, 315-316, 321, 328 professional education, 130, 131 reporting requirements, 123 state legislation, 137, 182, 184, 191, 192, 200, 210, 211, 212, 213, 217, 222, 227, 234 Guidelines for Defining Public Health Research and Public Health Non-Research, 306-307

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Medical interventions, 79-80, 150-151 see also Clinical practices and research; Emergency departments/response services; Forensics; Nurses and nursing; Physicians biomarkers, 3, 23, 74, 84, 101-102, 340, 360-362 community-level programs, 510-512 evaluation of interventions, 122, 127-129 financial abuse, 397, 399, 416, 435-436 Medicaid, 128, 134, 448, 451, 457, 466, 479 Medicare, 294, 448, 451, 456-457 screening during, 75, 104, 108, 127-128 state legislation, 181-237 (passim) Medicare, 294, 448, 451, 456-457 Medications cognitive effects, 264, 406(n.29) definition of maltreatment, 35, 52, 56, 81 financial abuse, 406(n.29) forensics, 340, 343, 352-353 residential care facilities, 466, 467, 468-469 restraints, 52, 448, 466, 468-469 screening and case identification, 108, 293, 295 Mental illness, 12, 50 see also Cognitive impairments; Dementia; Depression alcohol abuse, 21, 91, 94, 95, 242, 270, 282, 293, 294, 296, 299, 355, 357, 398 financial abuse and, 397, 399 forensics, 340, 355, 357, 362-363, 366, 371-372 incidence and prevalence of mistreatment and, 87, 270, 282 informed consent, 6, 140, 141-143 reporting requirements, 122 residential care facilities, 465, 466, 467 as risk factor, general, 94-95, 242 screening and case identification, 109, 117, 270, 282, 294, 296 substance abuse, 94, 95, 145-146, 242, 366, 398, 399 theoretical models, 63, 64, 240-241 Michigan, 203-204, 473 Minimum Data Set (MDS), 479 Minnesota, 125, 205-207 Minorities, see Race/ethnicity Mississippi, 207-208 Missouri, 208-210 Mistreatment, see Child abuse and neglect; Definitional issues; Domestic violence; Emotional abuse; Exploitation; Financial abuse; Self-abuse/self-neglect; Sexual abuse Models and modeling, see Definitional issues; Theory and theoretical models Montana, 210-211 Mortality, see Fatalities Mount Sinai/Victim Services Agency Elder Abuse Project Questionnaire, 365 Multidisciplinary approaches, see Interdisciplinary approaches N National Association of Adult Protective Services Administrators, 126 National Bioethics Advisory Commission (NBAC), 306, 312, 313, 320-322, 326, 331, 334 National Center for Injury Prevention, 80 National Center on Elder Abuse (NCEA), 15, 22-23, 132, 265-266, 385, 389-390 National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 315-316, 319-320, 327 National Crime Victimization Survey (NCVS), 268-269 National Elder Abuse Incidence Study (NEAIS), 263, 266-267, 277, 286 financial abuse, 383, 394, 401, 412, 417, 432, 437 National Incident Based Reporting System (NIBRS), 268, 269 National Institute of Justice, 7, 131, 137-138, 150 National Institute on Aging (NIA), 2, 6-7, 11, 12, 24-25, 95, 144, 149, 150, 151, 243, 483 National Institutes of Health (NIH), 12 confidentiality, 33, 145, 146-147 informed consent, 149 National Long Term Care Survey, 11

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America National Mortality Followback Survey, 447 National Ombudsman Reporting System (NORS), 457 National Survey of Adolescents, 279, 285 National Violent Death Reporting System, 80 National Women’s Study, 279, 280-281, 285 Nebraska, 211 Neglect, general, xiii, xiv, 5, 11, 12, 13, 14, 17, 22-23, 95, 168 see Child abuse and neglect; Isolation and confinement; Nutrition; Restraints; Self-abuse/self-neglect abandonment, 36, 184, 188, 199, 216, 222, 225, 236, 357 community-level programs, 510 decubiti, 340, 343, 348, 349-350, 360, 372 definitional issues, 19, 20-21, 34-37 (passim), 39, 41, 44, 181-237 (passim), 342, 449-450 guidelines for measurement, 44, 56 dehydration, 119, 166, 183, 186, 272, 340, 351-352, 372, 448, 463 financial, 387, 395, 409 forensics, 342, 343, 372 hygiene, 136, 169, 192, 217, 218, 340, 350, 357-358, 360, 448, 463 incidence and prevalence, 74, 81, 173, 274, 462-464 malnutrition, 340, 350-351, 448, 464 nursing homes, 449-450, 462-464, 469 residential care facilities, 467-468 restraints, 340, 348-349 screening and case identification, 110-113, 118, 119, 274, 293-302 (passim) state law, 124, 387 Nevada, 212-213 New Hampshire, 213 New Jersey, 213-214 New Mexico, 214-215 New York, 216-217, 432 North Carolina, 217-219 North Dakota, 219 Nurse Aid Registry, 471 Nurses and nursing, 21, 22, 41, 52, 60, 61, 73, 169, 272 adult protective services and, 456-460 cognitive impairments, 451, 452, 482 communication deficits of residents, 452, 462 definition of abuse, 448-449 financial abuse, 435 home health workers, 52, 127-128 neglect, 449-450, 462-464, 469 reporting practices, 460-462, 470, 472-473, 474-476 research ethics, 313 residential care facilities, 470, 472-473, 485-487, 490 staff, 134-135, 136-137, 448-449, 455, 456, 459, 460-464, 485-487, 490 registries, 460-462, 483, 484, 485-487, 490-491 Nursing homes, 11, 13-14, 176, 351, 447, 450-464 activities of daily living (ADLs), 452, 479 adult protective services and, 13-14, 239, 243 cognitive impairments, 313, 333, 351 decubiti, 345 definition of mistreatment, 18, 51, 52, 448-450 dementia, 451, 452, 482, 485, 486 demographics, 11, 447 emotional abuse, 448, 449, 451, 454-455, 462 evaluation of interventions, 125, 133-137 (passim) families and, 453-454, 462, 482 financial abuse, 51, 52, 384, 385, 389, 411, 412, 414 forensics, 347, 350, 351-352, 359, 364, 367, 371, 375 incidence and prevalence of mistreatment, xiii, 77, 79-80, 86, 99, 176, 447, 450-464, 471, 477-483 isolation and confinement, 448, 450, 454 number of elderly in, 10-11, 151, 447 nutrition, 350, 351-352 preventive measures, 7, 151, 152, 455, 489-491 reporting practices, 446-447, 450-464, 471 research ethics, 313, 333, 482-483 risk factors, 64, 66, 99, 100, 102, 451-453, 479, 483-491

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America sampling, 478-481 screening and case identification, 104, 109, 113, 117, 119, 357, 488 sexual abuse, 359, 451, 452, 485 state government, general, 200, 208, 448, 457, 460-462 state legislation, definitional issues, 200, 208, 448 theoretical models, 62, 64, 66 violent abuse, 448-450, 451, 452-454, 455 Nutrition dehydration, 119, 166, 183, 186, 272, 340, 351-352, 372, 448, 463 Elder Assessment Instrument (EAI), 166-167, 272, 294, 365 forensics, 340, 350-351, 360, 448, 464 nursing homes, 350, 351-352 weight loss, 340, 350-351, 448, 464 O Occurrence of mistreatment, see Incidence and prevalence Office for Human Research Protections, 6-7, 33, 149, 151 Office of Behavioral and Social Science Research on Women’s Health, 12 Office of the Assistant Secretary for Planning and Evaluation, 3, 479-480 Ohio, 219-221 Oklahoma, 221-222 Older Americans Act, 15, 42, 131, 240 Ombudsmen, 25, 122, 123, 125, 131, 134, 137, 169, 170, 366, 373, 448, 450, 453, 456-460, 463, 467, 468, 470, 471, 473-474, 485, 488-489 Omnibus Budget Reconciliation Act, 450, 451 Online Survey Certification and Reporting System (OSCAR), 471 Oregon, 223 OSCAR database, 457, 471, 476-477, 478 Outcome measures, 3, 4, 5-6, 78-79, 86-87, 243, 284 see also Fatalities adult protective services, 126 committee recommendations, 4-6 (passim), 45, 137-139 guidelines for measurement, 45, 50 screening and case identification, 108 strangers, abuse by, 261 theoretical models, 62-64 P Pennsylvania, 21, 223-234 Pepper, Claude, 14-15, 18, 239, 240 Pharmaceuticals, see Medications Physical abuse, see Restraints; Sexual abuse; Violence, physical abuse Physicians, 13, 21, 41, 60, 109, 123, 127, 170, 175, 199 reporting practices, 472 research ethics, 313 screening and case identification, 278, 293, 365 Police, 16, 21, 60, 73, 81, 93, 104, 122, 123, 125, 127, 129, 130, 132, 137, 138, 269, 282 financial abuse, 422 forensics, 341 Political and policy issues, 1, 7, 14-15, 18, 238-240, 262(n.1), 303-338 see also Ethical issues; Federal government; Funding; Legislation; Local government; Standards; State government advocacy, 14, 15, 17, 130, 136, 239, 251, 256, 316, 356, 388, 418, 419, 422, 423, 429, 430, 489, 490, 505-506, 516 Population-based studies, xiv, 2, 23-24, 73, 74, 76-77 biomarkers and, 84 committee recommendations, 3, 30-31 funding, 3, 84-85 Power of attorney, see Guardianship and power of attorney Prevalence, see Incidence and prevalence Preventive interventions, 2, 12, 285, 517-519 see also Adult protective services; Professional education; Public education; Screening and case identification child abuse and domestic violence, 501-522 (passim) committee recommendations, 4, 6, 139, 151

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America financial abuse, 418-419, 429-436, 437 banks and banking, 132, 296, 414, 430, 431-433, 435, 437 funding, 121, 131, 418-419 historical perspectives, 12, 15 incidence and prevalence and, 71, 78, 86 institutional settings, 13 nursing homes, 7, 151, 152, 455, 489-491 research, ethical guidelines, 144, 306-307 residential care facilities, 489-491 risk factors and, 88-89 theoretical models, 69-70 Privacy, see Confidentiality Private sector, 7, 32, 151, 152 see also Attorneys; Banks and banking financial abuse, 433 incidence and prevalence and funding, 71 research ethics, 307, 323-324 Professional education, 32 adult protective services, 126 criminal justice system, 127-131 (passim) financial abuse, 130, 131, 132, 419, 432, 436, 437 funding, 32, 132, 133, 151 guardianship and power of attorney, 130, 131 institutional staff, 115, 127-128, 134, 136-137, 485-487, 488, 517, 518 interdisciplinary approaches, 130-131 reporting requirements, 123, 266-267 screening and case identification, 115, 127-128 sentinels, 22-23, 55, 74, 77, 128, 172, 244, 246, 261, 262, 266-268, 277, 278, 284, 286, 287, 394 specialists, general, 130-131, 132-133 Prospective studies, 2, 24-25, 90-91, 334 see also Ethical issues Protective factors, 101-103 see also Interventions definitional issues, 48, 49, 50, 58 disabled persons, 98 incidence and prevalence and, 71, 73, 76, 79-80 Protective orders, 418, 425 Protective services, see Adult protective services Protocol for Health Care Professionals, 277 Psychological factors, 24, 97 see also Attitudes; Cognitive impairments; Emotional abuse; Isolation and confinement; Mental illness community-level programs, 510-512 definitional issues, 50, 448 effects of mistreatment, 3, 4, 35, 58, 64, 78, 79, 87, 279, 284, 391 financial abuse, 391, 392, 399, 401, 409 nursing homes, 448 theoretical models, 63, 64, 66, 68, 69, 240-241 trust relationships, 2, 3 Public education, 267-268, 517-518 child abuse, 267-268, 505, 517-518 mass media, 15, 519 reporting practices, 123, 267-268 screening and case identification, 105, 107 Public Health Service Act, 145, 146, 323 Q QUALCARE Scale, 166-167, 173, 174 Questionnaires see also specific instruments and surveys incidence and prevalence of abuse, 74, 86, 270-277, 280-281, 287 screening and case identification, 110-113, 120, 166-173 (passim), 270-277, 280-281, 293-302, 365, 366, 504 R Race/ethnicity, 97, 171 African Americans, 97, 269, 390-391, 466 financial abuse, 388, 390-391, 394 incidence and prevalence and risk factors, 82, 269 informed consent, language issues, 312 nursing homes, 451, 452 residential care facilities, 465 screening and case identification, 114 theoretical models, 61, 62, 64 Records and record-keeping, 21, 22, 23, 35, 45, 46, 53, 55, 71, 74, 78 see also Reporting practices computer applications, 108-109, 120

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America ethical issues, 308, 324 financial, 54 incidence and prevalence, 83-84, 261, 262, 265-266, 267, 269, 286, 287 linkages, 3, 5, 25, 75, 83-84, 108-109, 120, 267, 286 screening and case identification, 108-109, 120, 261, 262, 265-266, 267 Registries, 107, 125, 135, 482, 483, 484, 485-487, 490-491 nursing homes, 450, 460-462 residential care facilities, 470, 474-476 Regulatory issues, 133 see also Institutional review boards (IRBs); Legislation; Standards assisted-living settings, 133 hospital accreditation, 128 institutional facilities, 7, 66, 133-134, 490-491 inspection of, 80, 134, 137 licensing, 80, 134, 316(n.4), 411 research ethics, 27, 140, 303-309, 315-319, 328 Belmont Report, 303-304, 305, 306, 309, 311, 316-318, 319-320, 321, 327, 334 Federal Policy for the Protection of Human Subjects (Common Rule), 304, 305, 306, 307-309, 312, 314, 319, 323, 325-326 Religious institutions, 243 screening and case identification, 114 state law, definitional issues, 35, 200, 202, 204, 206, 214, 220, 228, 236 Remedial interventions, 2, 12 see also Adult protective services; Criminal justice system; Medical interventions case management, 4-5, 105-106, 116, 277 civil justice interventions, 28, 32, 130, 131, 134, 145, 221, 251, 255, 324, 341, 342, 343, 362, 374, 421, 423-429 committee recommendations, 4, 6 epidemiology, 78 financial abuse, 418-429 informal, 93, 123 screening and case identification, 105 victim compensation, 130, 419-420 victim services networks, 365, 419-420 victim/witness assistance, 129-130 Reporting practices, 76, 122-124, 126, 175, 177, 264, 265-268, 269, 383 see also Confidentiality; Records and record-keeping; Registries adult protective services, 27, 28, 115, 122, 167, 261, 267, 383-384, 411-412, 417, 456-460 attorneys, 52, 123, 390, 411-412, 413 child abuse, 13, 16, 123, 329(n.6), 330 committee recommendations, 6, 33, 139 emergency medical services, 472-473 ethical issues, 324, 328-333, 334-335 evaluation of, 122-124 families, 122, 123, 414, 453-454, 462, 473-474 financial abuse, 123, 383, 391, 393, 410-418 banks and banking, 411(n.36), 412, 421 forensics, 374-375 guardianship and power of attorney, 123 guidelines for measurement, 55 nurses, 460-462, 470, 472-473, 474-476 nursing homes, 446-447, 450-464, 471 professional accounts, 21-23 professional education, 123, 266-267 public education, 123, 267-268 sentinel reports, 22-23, 55, 74, 77, 128, 172, 244, 246, 261, 262, 266- 268, 277, 278, 284, 286, 287, 394 state government, general, 122-126, 144-148, 286, 328-329, 448, 471-472, 476-477, 482-483 state legislation, 13, 18, 33, 60, 122-124, 267, 410-418 surveillance, 4, 42, 46, 59, 75, 79, 80, 87 Residential care facilities, 4, 464-469 see also Assisted-living settings; Institutional settings; Long-term care settings; Nursing homes; Respite care activities of daily living (ADLs), 466, 469, 479 cognitive impairments, 465, 466, 467, 482 databases, 471, 476-477, 478

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America definitional issues, 4, 465, 475 state legislation, 198, 210, 237 disabled persons, 465, 466 evaluation of interventions, 122, 126, 133-134, 137 families and, 467, 473-474, 482 financial abuse, 384 forensics, 344, 372, 375 historical perspectives, 468-469 incidence and prevalence of mistreatment, 80, 86, 464-483 isolation, 466-467 medications, 466, 467, 468-469 mental illness, 465, 466, 467 neglect, 467-468 number of elderly in, 10 nurses, 470, 472-473, 485-487, 490 reporting practices, 470-477 research ethics, 303, 313, 482-483 restraints, 466, 468-469 risk factors, 465-468, 479, 483-491 sampling, 478-481 screening and case identification, 114, 488 sociocultural factors, 466-467 socioeconomic status, 466, 467, 480 standards, 464-465 Respite care, 93, 94-95, 125, 130, 270 Restraints, 36, 52, 448, 455 chemical, 52, 448, 466, 468-469 forensics, 340, 348-349 state law, legal definitions, 181-237 (passim), 469 Retrospective studies, see Controlled studies; Longitudinal studies Rhode Island, 224-226 Risk factors, 1, 14, 88-103, 124, 170, 241-242, 262-263, 284-285 see also Epidemiology; Forensics; Incidence and prevalence; Screening and case identification; Vulnerability, general abuser dependency, 96, 241, 242, 270, 293, 296, 300 adult protective services, 96, 97, 98 caregivers, general, 93-95, 98-103 child abuse and domestic violence, 88, 91, 99, 103, 242, 503-504 definitional issues, 5, 20-21, 35, 72, 89 guidelines for measurement, 48, 49-50, 58, 81-82, 85 dementia, 92, 93-94, 451 families, 88, 91, 92, 96, 98-99, 100, 242 geriatric syndrome, 89-90 incidence and prevalence and, 71, 72, 81-82, 85, 86-87, 261-302 isolation, 91, 93, 241, 270, 293, 294, 300 nursing homes, 64, 66, 99, 100, 102, 451-453, 479, 483-491 race/ethnicity, 82, 269 research ethics, 309-310, 311, 313, 319, 320-326, 329-334 see also Informed consent research recommendations, 3, 5, 31, 489 residential care facilities, 465-468, 479, 483-491 sociocultural, 88, 91, 241, 270 theoretical models, 60-70, 87 Risk of Future Abuse instrument, 170 Rural areas, theoretical models, 61, 66, 67 S Sampling, 4-5, 22-23, 24-25, 27, 90, 124, 168-177 (passim) ethical guidelines, 144 incidence and prevalence of abuse, 74, 86, 87, 282, 283, 284, 286 long-term care facilities, 478-481 Screening and case identification, 23-24, 65, 76-77, 88, 104-120, 166-167, 169, 242, 503-505 see also Forensics; Professional education; Reporting practices; Risk factors abandonment, 112-113 activities of daily living (ADLs), 105, 270-271 adult protective services, 104, 105-106, 115-116, 124, 167, 261, 267, 277, 365 attitudinal factors, 109, 242, 264-265, 271-272, 276, 278-279, 284, 293, 294, 296, 299, 396 biomarkers, 3, 23, 74, 84, 101-102, 340, 360-362 caregivers, 104-120, 166-167, 242, 270, 271-277, 293-302 (passim), 504-505 child abuse and domestic violence, 116-117, 119, 267, 273, 403-404, 503-505

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America cognitive impairments, 76, 83, 105, 109, 114, 116-117, 270-272, 273, 284, 314, 366-367, 396, 397 committee recommendations, 3, 4, 5-6, 31 community-level factors, 104, 106, 107, 109, 114, 115 computer applications, 108-109 cost factors, 104, 106, 120, 267, 282 criminal justice system, 104, 105-106, 115, 116-117, 127-128 dementia, 114, 116-117, 270, 276, 277, 366 disabled persons, 109, 114, 117, 270-271, 294 diseases and disorders, 105, 108, 109, 117 emergency medical services, 107, 109 emotional abuse, 105, 109, 110-111, 117, 166-167, 275, 295, 296 epidemiology, 107 expertise, 45-47, 57-58 families, 104, 113-114, 270, 271, 273, 293, 294, 295-297 financial abuse, 132, 396-399, 419, 403-404, 432, 436-437 forensics, 363-368, 370, 372, 375 funding, 105 geographic factors, 104, 106, 107 historical perspectives, 73 hospitals, 105, 503, 504 incidence and prevalence of abuse, 74-77, 79-80, 270-273 institutional staff, screening of, 100, 134-135, 490, 504-505 interdisciplinary approaches, 131-132 interviews, 110-113, 115, 120, 166-173 (passim), 270-276, 277, 281-283 medical care specialists, 75, 104, 108, 127-128 medications, 108, 293, 295 mental illness, 109, 117, 270, 282, 294, 296 neglect, 110-113, 118, 119, 274, 293-302 (passim) state law, 124, 387 nursing homes, 104, 109, 113, 117, 119, 357, 488 physicians, 278, 293, 365 prescreening, 5, 107, 120 professional education, 115, 127-128 public education, 105, 107 questionnaires, 110-113, 120, 166-173 (passim), 270-277, 280-281, 293-302, 365, 366, 504 records and record-keeping, 108-109, 120, 261, 262, 265-266, 267 registries, 107 religious institutions, 114 research, informed consent, 6, 141 residential care facilities, 108, 114-115, 266, 278 sociocultural factors, 114, 270, 280, 293-296 (passim) socioeconomic status, 114 standards, 106-107, 112, 113-114, 115, 116-118, 363-364, 370, 372 state government, 115, 488 statistical analysis 107-108, 110-113, 270-272, 273, 277 time factors, 105, 106, 107, 113, 114, 115, 238, 243, 282, 296, 365, 367 trust relationships, general, 109, 113, 114, 118, 293 violence, physical, 110-113, 114, 117, 118-120, 273-276, 278, 283-284, 293, 294, 297, 403 Screening Protocol for Identification of Abuse and Neglect of the Elderly, 277 Self-abuse/self-neglect, 1, 19 adult protective services, 126-127 definitional issues, 35, 36, 40, 41, 81 guidelines for measurement, 44 state law, 35, 36 financial abuse and, 397, 414 forensics, 343 Sentinel reports, 22-23, 55, 74, 77, 128, 172, 244, 246, 261, 262, 266-268, 277, 278, 284, 286, 287, 394 child abuse and neglect, 267, 268 Sex differences, see Gender factors Sexual abuse, 16-17, 127, 280, 281 see also Intimate partner mistreatment definitional issues, 35, 49, 183-237 (passim), 280, 281 forensics, 340, 358-359, 372 incidence and prevalence, 75, 78, 275, 276, 280, 284 nursing homes, 359, 451, 452, 485 state law, definitional issues, 35, 183-237 (passim) stigma, 264, 278

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Social Security Act, 13, 14, 239 Social Security Administration, 431 Sociocultural factors see also Demographic factors; Ethical issues; Families and households; Institutional settings; Isolation and confinement; Race/ethnicity; Religious institutions financial abuse, 388, 393, 395, 397, 417, 438 preventive measures, 430-431, 435 incidence and prevalence and, 79, 81-82, 87, 270, 280 residential care facilities, 466-467 risk factors, 88, 91, 241, 270 screening and case identification, 114, 270, 280, 293-296 (passim) stigma, 69, 242, 243, 264, 278-279, 332, 415, 429, 503 theoretical models, 60, 61, 62-64, 67, 68, 91, 240 Socioeconomic status, 171 ethical research, 327 financial abuse, 394 incidence and prevalence research, 81-82, 262, 282-283 Medicaid, 128, 134, 448, 451, 457, 466, 479 residential care facilities, 466, 467, 480 screening and case identification, 114 telephone interviews, 282-283 theoretical models, 61, 62, 63, 64, 241 South Carolina, 226-227 South Dakota, 227-228 Spouses, see Intimate partner mistreatment; Marriage and marital status Standards, 6, 27, 45, 56, 342 see also Definitional issues; Ethical issues; Institutional review boards; Regulatory issues financial abuse, proof of, 423-424 forensics, 363-364, 370, 372 guidelines for measurement, 45-47, 56, 58-59 hospital accreditation, 128 informed consent, 6, 140, 141-143, 309-311 LEAD methodology, 45-47, 59, 106-107, 115, 118 residential care facilities, 464-465 screening and case identification, 106-107, 112, 113-114, 115, 116-118, 363-364, 370, 372 Supplemental Security Income (SSI), 466, 467 State government see also Criminal justice system; specific states adult protective services, 14, 18, 124, 167, 239 child abuse legislation, 13, 123, 506, 507-508 confidentiality, 33, 304 disabled persons, definitional issues, 35, 36, 37, 124, 181-237 (passim) elder abuse legislation, 14, 19, 28, 130, 143, 144, 245 adult protective services, 27, 28, 115, 124, 181-182, 185, 189, 411- 412, 417, 418-419, 505, 506-507 age factors, 27, 28, 115, 124, 181-182, 185 cognitive impairments, 35, 36, 184, 405, 406 definitional issues, 13, 28, 34-39, 44, 60, 181-237, 384, 385, 400 fiduciaries, 190-191, 192, 197, 203, 206, 211, 218, 219 financial abuse, 13, 14, 18, 28, 184-236 (passim), 384, 386-387, 405, 406, 410-418, 422, 423-429, 433, 439 fraud, 185, 207, 210, 211, 213, 216, 221, 227, 231, 236, 387 forensics, 343-344 guardianship and power of attorney, 137, 182, 184, 191, 192, 200, 210, 211, 212, 213, 217, 222, 227, 234 individual statutes, 181-237 informed consent, 142-143, 145-148, 314 institutional settings, general, 35, 36, 37, 187-188, 194, 196, 201, 202, 209, 214, 215, 217, 218, 220, 221, 222, 223, 225-226, 233, 235 medical care, 181-237 (passim) neglect, 34-37, 44, 124, 181-237 (passim), 387 nursing homes, 200, 208, 448

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America religious institutions, 35, 200, 202, 204, 206, 214, 220, 228, 236 reporting requirements, 13, 18, 33, 60, 122-126, 144-148, 267, 286, 328-329, 410-418, 448 residential care, 13, 28, 34-39, 44, 60, 198, 210, 237 screening and case identification, 115-116, 124 sexual abuse, 35, 183-237 (passim) vulnerability, 39, 41-42, 43, 50, 182-237 (passim), 246-247 financial abuse, 137, 182, 184-236 (passim), 384, 386-387, 390, 405, 406, 410-418, 419, 422-429 funding, 7, 14, 419 historical perspectives, 13, 14 institutional settings, inspections, 80, 84, 134, 137; see also Institutional review boards (IRBs) nursing homes, 200, 208, 448, 457, 460-462 reporting practices, 122-126, 144-148, 286, 328-329, 448, 471-472, 476-477, 482-483 residential care facilities, 469, 470, 471, 476-477 screening and case identification, 115, 488 theoretical models, 66 Statistical analyses, 170-174 screening and case identification, 107-108, 110-113, 270-272, 273, 277 Strangers, abuse by, 1 definitional issues, 40 guidelines for measurement, 44, 52 state law, definitional issues, 35 financial, 52, 110-113, 261, 384, 400 incidence and prevalence, 74, 261, 283, 284 Substance abuse, 94, 95, 145-146, 242, 366, 398, 399 Suicide, 78 Sullivan, Louis, 240 Supplemental Security Income (SSI), 466, 467 Surgeon General, 240 Surveillance, 4, 42, 46, 59, 75, 79, 80, 87 Surveys, xiii, 2, 75, 79, 82-83, 84-86, 168-177 (passim), 243-244 see also Interviews, Questionnaires community, 23, 81 criminal justice, 268-269 harm measurement, 53 mail, 21 Medical Expenditure Panel Survey (MEPS), 479 National Crime Victimization Survey (NCVS), 268-269 National Elder Abuse Incidence Study (NEAIS), 263, 266-267, 277, 286 financial abuse, 383, 394, 401, 412, 417, 432, 437 National Long Term Care Survey, 11 National Mortality Followback Survey, 447 National Survey of Adolescents, 279, 285 National Women’s Study, 279, 280-281, 285 nursing homes, 464 Online Survey Certification and Reporting System (OSCAR), 471 population-based, 3, 4, 11, 24, 45, 30, 82-83 of professionals, 21, 23 screening and case identification, 115 telephone, 73-74, 82, 243, 261, 280, 281-283, 285-286, 287, 481 victims and family members, 26 Sweden, 74 T Telephone computer applications, 281, 283, 285-286, 287 hotlines, 75, 124, 167, 168, 270 surveys, 73-74, 82, 243, 261, 280, 281-283, 285-286, 287, 481 telemarketing fraud, 438 Temporal factors, see Time factors Tennessee, 228 Texas, 228-229 Theory and theoretical models, 60-70, 87, 91, 240-241, 271, 283 see also Definitional issues adult protective services, 60, 65 caregiver abuse and neglect, general, 61, 63, 64-65, 69-70 cognitive impairments, 66, 70 dementia, 66 disabled persons, 64, 70 diseases and disorders, 61, 66, 68, 69

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America emotional abuse, 63, 64 families, 62, 63, 70, 138 geographic factors, 61, 62, 66, 67 historical perspectives, 61, 240-241 individual personal factors, 61, 62, 63, 67, 91 institutional review boards (IRBs), 62, 64, 66-69 isolation, 64, 91 lacking, 2, 27, 521 longitudinal research, 30, 87 mental illness, 63, 64, 240-241 nursing homes, 62, 64, 66 psychological factors, 63, 64, 66, 68, 69, 240-241 race/ethnicity factors, 61, 62, 64 risk factors, 60-70, 87 rural areas, 61, 66, 67 sociocultural factors, 60, 61, 62-64, 67, 68, 91, 240 socioeconomic status, 61, 62, 63, 64, 241 state government, 66 trust relationships, 63, 66, 91 urban areas, 61, 67 Time factors, 3 see also Longitudinal studies adult protective services, response time, 124, 129-130 agency/researcher cooperation, 26 child abuse, 280, 281, 510 community-level programs, 510 criminal justice system, 129-130 epidemiology, 72, 77, 78, 87, 238, 243, 282 financial abuse investigations, 422 financial abuse reporting, 411 guidelines for measurement, 47, 54-55, 87 household settings, 137-138 intensity of abuse, 5 nursing home use, 447 remission, 5 residential care facilities, family visit intervals, 467 risk factors, 5, 65, 69 screening and case identification, 105, 106, 107, 113, 114, 115, 238, 243, 282, 296, 365, 367 Trust relationships, general, 2, 3, 58 see also Caregiver abuse and neglect; Guardianship and power of attorney definitional issues, 39, 40-41, 43, 44, 61, 238, 384-385 guidelines for measurement, 44, 47-48, 51-53, 57 financial abuse, 382, 385, 387, 392, 393, 395, 401-402, 415 incidence and prevalence of abuse, 74, 77 risk factors, 88, 91 screening and case identification, 109, 113, 114, 118, 293 theoretical models, 63, 66, 91 U Understanding Child Abuse and Neglect, xiii-xiv Undue influence and duress, 131, 192, 195, 197, 203, 206-207, 210, 211, 212, 219, 222, 226, 231, 233, 237, 304, 309, 312, 386, 387, 389, 400, 404, 405, 407, 425 Uniform Crime Reports (UCR), 268, 269, 284, 285-286 United Kingdom, 244 Universities and colleges, see Academic research Urban areas, 512 incidence and prevalence, 73, 269, 275 theoretical models, 61, 67 Utah, 229-230 V Vermont, 230-231 Veteran’s Administration, 431 Victim services networks, 365, 419-420 Victims of Crime Act, 419-420 Violence, physical abuse, 78, 168, 173, 245-246 see also Child abuse and neglect; Criminal justice system; Sexual abuse abrasions and lacerations, 54, 118, 119, 340, 344-345, 359, 360, 361, 372, 449, 454 adult protective services, 125 alcohol abuse, 95 Alzheimer’s patients, 93-94

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America bruises, 20, 49, 54, 114, 116, 117, 119, 120, 127, 166, 183, 186, 216, 340, 342-343, 345-347, 454 burns, 20, 54, 119, 120, 166, 183, 186, 216, 226, 340, 343, 353-354, 371-372 Conflicts Tactics Scale (CTS), 20, 26-27, 55, 85, 166-167, 244, 271, 274-275, 300-302 definitional issues, 35, 36, 238, 244, 342, 448-450 guidelines for measurement, 48-49, 54-55, 56, 57 state statutes, 35, 36, 181-237 (passim) financial abuse and, 403, 404, 409-410, 419 forensics, 340, 342-343, 360-362 fractures, 119, 120, 127, 166, 183, 255, 340, 342-343, 347-348, 360, 362, 371, 372, 373, 448(n.2), 454, 471, 472 gender of violent crime victims, 269 incidence and prevalence, 74, 76, 79, 81, 85, 262, 273-276, 278, 283-285, 287, 451, 452-453, 455 institutional settings, 99-100, 181-237 (passim) intergenerational transmission of mistreatment, 99 intimate partner violence, 41, 55, 63, 65, 99, 241-242, 261-262(n.1), 271, 274, 300-302, 409-410, 502-503, 504-522 (passim) measures of mistreatment, table, 20, 26-27, 55, 85, 166-167, 262, 273-276, 278, 283-284, 285 nursing homes, 448-450, 451, 452-454, 455 screening and case identification, 110-113, 114, 117, 118-120, 273-276, 278, 283-284, 293, 294, 297, 403 Virginia, 231-232 Vulnerability, general, 100-101 adult protective services, 124 age factors, 41-42, 43 definitional issues, 39, 41-42, 43, 50, 182-237 (passim), 246-247 financial abuse, 401 theoretical models, 64 W Washington, D.C., see District of Columbia Washington, 232-234 Weight loss, 340, 350-351, 448, 464 West Virginia, 234 Wisconsin, 125, 234-236 Witnesses, criminal justice system, 116-117, 127-128, 129-130, 421 Wolf, Rosalie, 238-248, 257 Wolfe, David, 127, 257, 501-525 Wyoming, 236-237