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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Suggested Citation:"Index." National Research Council. 2003. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: The National Academies Press. doi: 10.17226/10406.
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Index A Administration on Developmental Disabilities and Rehabilitation Abandonment, 36, 184, 188, 199, 216, Research, 7, 150, 152 222, 225, 236, 357 Adult children of elderly persons, 11, 91, screening and case identification, 112- 95, 96-97, 168, 274, 293-302 113 (passim), 401 Abrasions and lacerations, 54, 118, 119, intergenerational transmission of 340, 344-345, 359, 360, 361, mistreatment, 99 372, 449, 454 Adult Protective Service Reports, 167 Abuse, see Child abuse and neglect; Adult protective services, 6, 22, 23, 24-25, Definitional issues; Domestic 27, 32, 42, 50, 80, 82, 101, 245, violence; Emotional abuse; 332, 505 Exploitation; Financial abuse; cost factors, 126, 239 Self-abuse/self-neglect; Sexual criminal justice system and, 124-125, abuse 126, 127-128, 129 Academic research, 6, 13, 60, 139, 521 evaluation of effectiveness, 6, 32, 122, Acierno, Ronald, 77, 78, 79, 81, 255, 261- 124-127, 139, 506 302 financial abuse, 390, 394, 405(n.25), Activities of daily living (ADLs), 10, 11, 98 417, 436, 437 adult protective services, 125 funding, 14, 126, 239, 240, 418-419 nursing homes, 452, 479 gender factors, 96 residential care facilities, 466, 469, 479 historical perspectives, 13-15, 17, 238- screening and case identification, 105, 240, 506 270-271 legislation, 27, 28, 115, 124, 181-182, Administration on Aging, 21-22, 132, 151, 185, 189, 411-412, 418-419, 246, 266-267 505, 506-507 National Center on Elder Abuse, 15, 22- nursing homes and, 456-460 23, 132, 265-266, 385, 389-390 racial/ethnic factors, 97 527

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

INDEX 529 Board and care homes, see Residential care Case management, 4-5, 105-106, 116, 277 facilities see also Screening and case identification Brief Abuse Screen for the Elderly, 100-111, Center for Mental Health Services, 152 366 Centers for Disease Control and Protection Bruises, 20, 49, 54, 114, 116, 117, 119, (CDC), 80, 306-307 120, 127, 166, 183, 186, 216, Centers for Medicare and Medicaid Services 340, 342-343, 345-347, 454 (CMS), 152, 448, 457-459, 460- Bureau of Justice Statistics, 268 462, 479 Burns, 20, 54, 119, 120, 166, 183, 186, see also Health Care Financing 216, 226, 340, 343, 353-354, Administration (HCFA) 371-372 Medicaid, 128, 134, 448, 451, 457, 466, 479 Medicare, 294, 448, 451, 456-457 C Child abuse and neglect, 126, 277-281, 339-340 California, 127, 184-185 cognitive status of children, 116-117, Canada 404-406 financial abuse, 390, 394 community-level factors, 16, 126, 505, incidence and prevalence, 74, 390 510-516 legislation, 506 criminal justice system, 116-117, 280- Caregiver abuse and neglect, xiii, 7, 11, 15, 281, 507 17, 26, 30, 33, 42, 44, 122, 240 financial abuse models, 402-408 see also Assisted-living settings; forensics, 339-340, 360-361 Institutional settings; Long-term historical perspectives, 12-13, 14, 16-17, care settings; Medical 18-19, 126, 339, 383, 501, 506 interventions; Nurses and hospitals, 503, 504 nursing; Nursing homes; incidence and prevalence research, 13, Restraints; Trust relationships 277-281, 287 Alzheimer’s patients, 10, 92, 93-95 informed consent, 143 child abuse model, 403 intergenerational transmission of definitional issues, 1, 39, 40-41, 44, 49, mistreatment, 99 51-53, 61, 181-237 (passim), 342 international perspectives, 13, 506 ethical issues, research, 322, 333-334 isolation, 35, 36, 52, 56, 448, 450 informed consent, 143, 147-148, legislation, 13, 14, 506, 507-510 311, 314-315, 333-334 LONGSCAN, 329, 330, 331, 333 financial, 40-41, 65, 385, 388, 395, public education, 267-268, 505, 517- 397-400, 435-436 518 forensics, 342, 343-381 (passim) reporting practices, 13, 123, 329(n.6), incidence and prevalence, 73, 74, 76, 330 261, 270-273 research ethics, 143, 315-316, 329-331, respite care, 93, 94-95, 125, 130, 270 333 risk factors, 93-95, 98-103 research methodology, general, xiii-xiv, screening and case identification, 104- 18-19, 23, 26-27, 245, 262-263, 120, 166-167, 242, 270, 271- 267, 268 277, 293-302 (passim), 504-505 risk factors, 88, 91, 99, 103, 242, 503- institutional staff, 100, 134-135, 504 490, 504-505 screening and case identification, 116- theoretical models, 61, 63, 64-65, 69-70 117, 119, 267, 273, 403-404, Caregiver Abuse Screen (CAS), 112-113, 503-505 271 sentinel reports, 267, 268 Case-control studies, see Controlled studies

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

INDEX 531 Connecticut, 187 protective orders, 418, 425 Connolly, Marie-Therese, 255-256, 339-381 reporting practices, 123, 267-269, 279 Controlled studies, 2, 25, 72, 90, 91, 168, screening and case identification, 104, 174 105-106, 115, 116-117, 127-128 abuser dependency, 96, 241 theoretical models, 65 adult protective services, 239 witnesses, 116-117, 127-128, 129-130, alcohol abuse, 95 421 disabled persons, 98-99 Cross-sectional studies, 72, 169 household settings, 137-138 Cultural factors, see Sociocultural factors screening and case identification, 110- 111 Cost factors, xiii, 286 D see also Funding adult protective services, 126, 239 Deaths, see Fatalities community-level programs, 510 Decubiti, 340, 343, 348, 349-350, 360, 372 Definitional issues, 3, 30, 34-59, 61, 133, evaluation of interventions, 121, 126 financial abuse, legal interventions, 422, 150, 238, 244, 245, 384, 448- 429, 434-435 450 age factors, 41-42, 43, 90, 115, 124, incidence and prevalence data, 80, 265, 282, 286, 287 181-237 (passim), 246 interventions, general, 18, 282, 286, caregiver abuse and neglect, general, 1, 39, 40-41, 44, 49, 51-53, 61, 287, 510 interviews, 18, 282, 286, 287, 510 181-237 (passim), 342 research ethics, evaluation, 313, 321, cognitive impairments, 35, 36, 50, 406 disabled persons, 35, 36, 37, 50, 188 322 residential care facilities, 467 elder mistreatment, general, 1, 2, 4, 19- risk factors and, 89 21, 30, 73, 108, 114-115 emotional abuse, 28, 35, 36, 54-55, 448, screening and case identification, 104, 106, 120, 267, 282 449 sentinel reports, 267 epidemiology, 72, 73, 75-77, 85, 87, 266, 278, 280 Criminal justice system, 15, 28, 55, 245- 246 ethics, research, 306, 307, 308, 310 see also Forensics; Legislation; Police expert judgment, 45-47 families, 35, 36, 181-237 (passim), 244- adult protective services and, 124-125, 126, 127-128, 129 246 child abuse, 116-117, 280-281, 507 forensics, 341, 342, 343, 344, 364 harm, general, 1, 3, 28, 34, 39, 40 evaluation of, 32, 122, 127-128, 129- 130, 131 guidelines for measurement, 48, 53- Federal Bureau of Investigation (FBI), 55, 56-58 institutional settings, general, 35, 36, 37, 268, 269, 284, 285-286 financial abuse, 392, 393, 400, 411-412, 187-188, 194, 196, 201, 202, 420-423 209, 214, 215, 217, 218, 220, 221, 222, 223, 225-226, 233, historical perspectives, 15, 240, 506 incidence and prevalence research, 71, 235 77, 261, 264, 267-269, 280, 284, isolation and confinement, 35, 36, 181- 237 (passim) 287 institutional inspections, 137 medications, 35, 52, 56, 81 police, 16, 21, 60, 73, 81, 93, 104, 122, mental illness, 50 neglect, 19, 20-21, 34-37 (passim), 39, 123, 125, 127, 129, 131, 138, 269, 282, 341, 422 41, 44, 181-237 (passim), 342, professional education, 127-131 449-450 guidelines for measurement, 44, 56 (passim)

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

INDEX 533 Detection and Treatment of Elderly Abuse Dresser, Rebecca, 140, 141, 148, 256, 303- and Neglect, 277 338 Diagnosis, see Forensics; Screening and case Drug abuse, see Substance abuse identification Drugs, see Medications Disabled persons, 7, 11, 42, 97-98, 100- Duress, see Undue influence and duress 101, 150, 171, 241-242 Dyer, Carmel Bitondo, 79, 256, 339-381 see also Activities of daily living (ADLs); Cognitive impairments; Dementia; Long-term care settings; Nursing E homes definitional issues, 35, 36, 37, 50, 188 Economic factors, 16 emotional abuse, 28 see also Cost factors; Financial abuse; Funding; Socioeconomic status evaluation of interventions, 124 financial abuse, 391-392, 395, 401, 406, incidence and prevalence research, 79, 409, 422, 435 81-82, 87, 270, 280 institutional mistreatment, 66, 67 forensics, 343 incidence and prevalence, 10, 11, 264, research ethics, 313, 321, 322 265, 270-271, 285 status inequality, theoretical models, 61, 62, 63, 64, 241 residential care facilities, 465, 466 screening and case identification, 109, theoretical models, other, 66, 67 114, 117, 270-271, 294 victim compensation, 130, 419-420 Education and training, see Professional state law, 35, 36, 37, 124, 181-237 theoretical models, 64, 70 education; Public education Diagnostic and Treatment Guidelines on Elder Abuse Attitudes and Behavior Intention Scale, 276 Elder Abuse and Neglect (AMA), 104, 109 Elder Abuse Detection Indicators, 277 Diseases and disorders, 11, 97-98 Elder Abuse Screening Test, see Hwalek- Sengstock Elder Abuse Screening see also Dementia; Disabled persons; Fatalities; Forensics; Long-term Test (HSEAST) care settings; Medical interventions; Elder Assessment Instrument (EAI), 112- 113, 166-167, 272, 294-295, 365 Mental illness; Nursing homes AIDS, 69 Emergency departments/response services, financial abuse, 399, 409 23-24, 170, 243 committee recommendations, 6, 139 geriatric syndrome, 89-90 historical perspectives, 14, 61, 69 evaluation of effectiveness, 124, 128, incidence and prevalence of 139 financial abuse reporting, 416(n.39) mistreatment and, 10, 76, 79, 81 religious/spiritual treatment, state law, incidence and prevalence data, 79, 471, 35, 200, 202, 204, 206, 214, 220, 472-473 reporting practices, 472-473 228, 236 residential care facilities, 471 screening and case identification, 107, screening and case identification, 105, 109 Emotional abuse, 3 108, 109, 117 theoretical models, 61, 66, 68, 69 see also Isolation and confinement District of Columbia, 189 definitional issues, 28, 35, 36, 54-55, 448, 449 Domestic violence, 15, 501-522 see also Child abuse and neglect; financial abuse, impacts of, 391, 392, Families and households; Intimate 399, 409 forensics, 340 partner mistreatment; Marriage and marital status incidence and prevalence, 74, 275, 284, intergenerational transmission of 451, 454-455 institutional settings, general, 99 mistreatment, 99

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

INDEX 535 F Federal Bureau of Investigation (FBI), 268, 269, 284, 285-286 Families and households, 18, 24, 133, 137- Federal government, 6-7, 239-240 138, 173, 176, 177, 342, 384- see also Funding; Legislation; specific 385, 501-522 (passim) agencies and departments see also Adult children of elderly funding persons; Child abuse and neglect; ethical guidelines, 32-33 Intimate partner mistreatment; protective measures, 14, 18 Marriage and marital status research, 1-2, 6-7, 11-12, 21-22, 24- committee research recommendations, 4, 25, 33 7, 70 historical perspectives, 12-15 Conflicts Tactics Scale (CTS), 20, 26-27, National Bioethics Advisory 55, 85, 166-167, 244, 271, 274- Commission (NBAC), 306, 312, 275, 300-302 313, 320-322, 326, 331, 334 ethical issues, research, 322, 324 nursing homes, 449-450 financial abuse, 40-41, 96, 382, 385, reporting requirements, 125 392, 395, 397, 398, 399, 414, residential care facilities, 464-465 415, 438 Federal Policy for the Protection of Human preventive measures, 430-431, 437 Subjects (Common Rule), 304, historical perspectives, 12, 14, 15, 240, 305, 306, 307-309, 312, 314, 501, 502 319, 323, 325-326, 332, 334 home health workers, 52, 127-128 Fiduciaries, 28, 41, 132, 385, 389, 390, incidence and prevalence research, 74, 403, 419, 426(n.49), 427, 428 76, 85, 86, 261, 262, 264-267, preventive measures, 434-435, 436 268-269, 270-273, 274-275, 284 state legislation, definitions, 190-191, informed consent, research, 143, 147- 192, 197, 203, 206, 211, 218, 148, 311, 314-315 219 intergenerational transmission of Financial abuse, 167, 359-360, 382-445 mistreatment, 99 see also Banks and banking; Fiduciaries; nursing homes, 453-454, 462, 482 Guardianship and power of reporting practices, 122, 123, 414, 453- attorney 454, 462, 473-474 abuser dependency, 96, 241, 242, 270, residential care facilities, 467, 473-474, 293, 296, 300, 387(n.11) 482 adult protective services, 390, 394, risk factors, 88, 91, 92, 96, 98-99, 100, 405(n.25), 417, 436, 437 242 attitudes and, 391-392, 396, 399-402, screening and case identification, 104, 404, 406, 407, 414, 415, 429, 113-114, 270, 271, 273, 293, 438 294, 295-297 attorneys, 52, 390, 398, 411-412, 413, state law, definitional issues, 35, 36, 423, 433-434 181-237 (passim), 244-246 caregiver abuse and neglect, 40-41, 65, theoretical models, 62, 63, 70, 138 385, 388, 395, 397-400, 435-436 Fatalities, 239 child abuse models, 402-408 see also Forensics cognitive impairments, 393, 395, 396, child abuse, 340 397, 404-406, 407, 413, 421, financial abuse, 392, 393 422, 433-434, 435, 438 incidence and prevalence data, 76, 78, community-level factors, 430-432, 436 80, 243 computer technology, 392, 395, 398, interdisciplinary investigation, 132 431 long-term care settings, 447 cost factors, legal interventions, 422, suicide, 78 429, 434-435

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

INDEX 537 fractures, 20, 79, 114, 118, 119, 120, research, general, 1-2, 6-7, 11-12, 21-22, 127, 166, 183, 255, 340, 342- 24-25, 33, 42, 71, 95, 140, 150, 343, 347-348, 360, 362, 371, 151-152, 521-522 372, 373, 448(n.2), 454, 471, screening and case identification, 105 472 interdisciplinary approaches, 366, 369- 370, 375 G medications, use of, 340, 343, 352-353 mental illness, 340, 355, 357, 362-363, Gender factors, 60, 96, 168, 176, 242-243, 294 366, 371-372 neglect, 342, 343, 372 see also Intimate partner mistreatment; dehydration, 119, 340, 351-352, Marriage and marital status; Sexual abuse 372, 448, 463 hygiene, 340, 350, 357-358, 360, financial abuse, 394-395 448, 463 institutional settings, 100 long-term care settings, 447 malnutrition, 340, 350-351, 448, 464 restraints, 340, 348-349 violent crime victims, 269 self-abuse and neglect, 343 General Accounting Office, 413 Georgia, 191-192 sexual abuse, 340, 358-359, 372 standards, 363-364, 370, 372 Geographic factors, 4 violence, physical, 340, 342-343, 360- see also Community-level factors; Urban areas; specific states and countries 362 Fractures, 20, 79, 114, 118, 119, 120, 127, incidence and prevalence and, 72, 79, 166, 183, 255, 340, 342-343, 81-82, 86, 283, 284 rural areas, 61, 66, 67 347-348, 360, 362, 371, 372, 373, 448(n.2), 454, 471, 472 screening and case identification, 104, Fraud, 131, 132, 134, 185, 207, 210, 211, 106, 107 telephone interviews, 283 213, 216, 221, 227, 231, 236, 340, 359, 360, 372, 385, 387, theoretical models, 61, 62, 66, 67 400, 404-405, 412-413, 422-423, Geriatric syndrome, 89-90 Government role, see Federal government; 424, 438 Medicaid, 456 Local government; State Fulmer Restriction Scale, 167 government Guardianship and power of attorney, 13, Funding, 1-2, 11-12, 27, 42, 150 adult protective services, 14, 126, 239, 51, 239 240, 418-419 financial abuse, 40-41, 184, 191, 192, 200, 210, 212, 227, 389, 398- block grants, 14 ethical issues, research, 305, 307, 321, 399, 413, 418, 426-429, 433 323, 327 preventive measures, 431 forensics, 341, 344 evaluation of interventions, 121, 131, 137-138 informed consent for research forensics, 341 participation, 314, 315-316, 321, 328 incidence and prevalence and, 3-4, 71, 84-86, 244 professional education, 130, 131 interdisciplinary approaches, 131 reporting requirements, 123 state legislation, 137, 182, 184, 191, Medicaid, 128 population-based studies, 3, 84-85 192, 200, 210, 211, 212, 213, prevention, 121, 131, 418-419 217, 222, 227, 234 Guidelines for Defining Public Health professional education, 32, 132, 133, 151 Research and Public Health Non- protective care, 14, 126, 239, 240, 418- Research, 306-307 419

538 INDEX H Home health workers, 52, 127-128 Hospitals, 4, 6, 128, 139, 371 Hafemeister, Thomas, 256, 382-445 see also Emergency departments/ HALF (health, attitudes toward aging, living response services arrangements, and finances), 271- child abuse and domestic violence, 503, 272, 298-302 504 Handicapped persons, see Disabled persons definition of abuse, 56 Harm, general incidence and prevalence data, 79, 268- see also Emotional abuse; Financial 269, 471 abuse; Risk factors; Violence, screening and case identification, 105, physical abuse 503, 504 definitional issues, 1, 3, 28, 34, 39, 40 theoretical models, 65 guidelines for measurement, 48, 53- Hotlines, 75, 124, 167, 168, 270 55, 56-58 Household settings, see Families and informed consent, 311 households; Marriage and marital intent to, 56-57 status research ethics, 311, 319, 321-322, 324- Hwalek-Sengstock Elder Abuse Screening 326, 329 Test (HSEAST), 110-111, 112, Hawaii, 192-193 166-167, 172, 271, 273-274, Hawes, Catherine, 133-134, 137, 256, 446- 293, 366 500 Hygiene, 136, 169, 192, 217, 218, 340, Health Care Financing Administration 350, 357-358, 360, 448, 463 (HCFA), 457 decubiti, 340, 343, 348, 349-350, 360, Centers for Medicare and Medicaid 372 Services (CMS), 152, 448, 457- 459, 460-462, 479 Medicaid, 128, 134, 448, 451, 457, 466, I 479 Medicare, 294, 448, 451, 456-457 Idaho, 193 Health factors, see Activities of daily living; Illinois, 193-195, 246-247, 390 Disabled persons; Diseases and Improving the Quality of Long-Term Care, disorders; Medical interventions 133 Heirs, see Inheritance Incidence and prevalence, xiii, 1, 9, 13-14, Historical perspectives, 12-18, 72-73, 88, 71-87, 169, 170, 172, 177, 243- 238-240, 501 245, 383-384 adult protective services, 13-15, 17, 238- see also Reporting practices; Surveys 240, 506 caregiver abuse and neglect, general, 73, aging of general population, xiii, 9-10, 74, 76, 261, 270-273 78, 152 child abuse, 13, 278-281, 287 child abuse and neglect, 12-13, 14, 16- cognitive impairments, 76, 83, 270-272, 17, 18-19, 126, 339, 383, 501, 273, 284, 286, 287, 451 506 dementia and, 10, 246, 262, 270, criminal justice system, 15, 240, 506 276, 286, 451, 452 diseases and disorders, general, 14, 61, 69 community-level factors, xiii, 71, 80, 86, family factors, 12, 14, 15, 240, 501, 502 87 forensics, 339 cost of research, 80, 265, 282, 286, incidence and prevalence and, 72-73, 287 383-384 criminal justice system, 71, 77, 261, research on abuse, 11-12, 23, 24-25, 90- 264, 267-269, 280, 284, 287 91, 383 definitional issues, 20-21, 71, 75-84 residential care facilities, 468-469 dementia and, 10, 246, 262, 270, 276, theoretical models, 61, 240-241 286, 451, 452

INDEX 539 demographic factors, general, xiii, 73, Indicators of Abuse Screen (IOA), 110-111, 86, 266, 269 167, 270-271, 296-297 disabled persons, 10, 11, 264, 265, 270- Individual personal factors, 5, 89, 97, 242, 271, 285 266, 284 diseases and disorders and, 137-138, see also Alcohol abuse; Diseases and 150 disorders; Gender factors; economic factors, 79, 81-82, 87, 270, Psychological factors; Race/ 280 ethnicity emergency medical services data, 79, theoretical models, 61, 62, 63, 67, 91 471, 472-473 Informed consent, 6, 140-143, 145-147, emotional abuse, 74, 275, 284, 451, 309-319, 323, 328, 332-334 454-455 see also Guardianship and power of families, general, 74, 76, 85, 86, 261, attorney 262, 264-267, 268-269, 270-273, child abuse and neglect, 143 274-275, 284 cognitive impairments, 6, 140, 141-143, forensics and, 371, 373-374 309-311, 312, 314-317 funding to assess, 3-4, 71, 84-86, 244 mental illness, 6, 140, 141-143 geographic factors, 72, 79, 81-82, 86, families, 143, 147-148, 311, 314-315 283, 284 financial abuse, 405 historical perspectives, 72-73, 383-384 guardianship, informed consent for hospitals, 79, 268-269, 471 research, 314, 315-316, 321, 328 international perspectives, 73-74, 243- institutional review boards (IRBs), 142, 245 143, 148-149, 304, 316(n.4), interviews, 74, 76, 83, 243-244, 261, 317-319, 323 264-265, 270-277, 278, 281-283, interviews, 311, 312 285-287 language issues, 312 long-term care facilities, 133-134 standards, 6, 140, 141-143, 309-311 mental illness and, 87, 270, 282 Inheritance, 392, 399, 403(n.22) neglect, 74, 81, 173, 274, 462-464 Iowa, 195-197 protective factors and, 71, 73, 76, 79-80 Inspection of institutional facilities, 80, 84, questionnaires, 74, 86, 270-277, 280- 134, 137 281, 287 Institutional review boards (IRBs), 6, 7, 27, race/ethnicity factors, 82, 269 32-33, 140, 143-145, 148-149 research methodology, general, 2-5, 10, licensing, 80, 134, 316(n.4), 411 22-23, 24, 30-31, 71-87, 243- research ethics, 304, 308-309, 313, 319- 245, 261-302 321, 323-324, 331 sampling, 74, 86, 87, 282, 283, 284, informed consent, 142, 143, 148- 286 149, 304, 316(n.4), 317-319, 323 sexual abuse, 75, 78, 275, 276, 280, 284 theoretical models, 62, 64, 66-69 sociocultural factors, 79, 81-82, 87, 270, Institutional settings 280 see also Adult protective services; socioeconomic status, 81-82, 262, 282- Assisted-living settings; Hospitals; 283 Long-term care settings; Nursing strangers, abuse by, 74, 261, 283, 284 homes theoretical models, 60, 87 evaluation of interventions, 122, 128, trust relationships, general, 74, 77 133-137 urban areas, 73, 269, 275 financial abuse, 385 violence, physical, 74, 76, 79, 81, 85, incidence and prevalence and, 73, 76, 262, 273-276, 278, 283-285, 77, 79, 82, 83, 384 287, 451, 452-453, 455 inspections, 80, 134, 137 Indiana, 195-196, 473 medications, 36

540 INDEX population-based studies, 3, 73 Intimate partner mistreatment, 17, 18, 26- professional education for staff, 115, 27, 91, 96-97 127-128, 134, 136-137, 485-487, see also Marriage and marital status 488, 517, 518 community-level factors, 505, 510-516 record linkage, 83 definitional issues, 402(n.20) restraints, 36, 52 financial abuse, 394, 401, 402-403, 408- risk factors, 99-100, 102 410 screening and case identification, 104, 109 intergenerational transmission of state law, definitional issues, 35, 36, 37, mistreatment, 99 187-188, 194, 196, 201, 202, 209, interventions, 501-525 (passim) 214, 215, 217, 218, 220, 221, 222, violent, 41, 55, 63, 65, 99, 241-242, 223, 225-226, 233, 235 261-262(n.1), 271, 274, 300-302, violent abuse, 99-100, 181-237 (passim) 409-410, 502-503, 504-522 Instrumental activities of daily living (passim) (IADLs), 10, 11 Isolation and confinement, 166-167, 293, Interdisciplinary approaches, 7, 32, 130- 294, 300 133, 366 see also Restraints adult protective services, 126, 138 definitional issues, 35, 36, 52, 56, 448, community-level factors, 131-132 450 forensics, 366, 369-370, 375 financial abuse, 393, 395, 397, 402, 435 inspection of institutions, 137 institutional settings, 100 professional education, 130-131 nursing homes, 448, 450, 454 International perspectives, 14, 506 residential care facilities, 466-467 see also specific countries risk factors, 91, 93, 241, 270, 293, 294, child abuse prevention, 13, 506 300 financial abuse, 390, 394 state law, definitional issues, 35, 36, incidence and prevalence, 73-74, 243-245 181-237 (passim) International Society for Prevention of Child theoretical models, 64, 91 Abuse and Neglect, 13 Interventions, 4, 6, 14 see also Evaluation of interventions; J Preventive interventions; Remedial interventions; Screening Joint Commission on Accreditation and Health Care Organizations, 128, and case identification child abuse and domestic violence, 501- 363-364 525 (passim) Journal of the American Medical Association, 13 committee recommendations, 4, 6 cost factors, 18, 282, 286, 287, 510 geriatric syndrome, 90 intimate partner abuse, 501-525 (passim) K theoretical models, 69-70 Kansas, 197-198 Interviews, 176 Kentucky, 198-199 see also Questionnaires; Telephone ethical issues, 323 informed consent, 311, 312 L incidence and prevalence, 74, 76, 83, 243-244, 261, 264-265, 270-277, Lacerations, see Abrasions and lacerations 278, 281-283, 285-287 Language issues long-term care staff/ residents, 481-482 informed consent, 312 screening and case identification, 110- nursing homes, communication deficits, 113, 115, 120, 166-173 (passim), 452, 462 270-276, 277, 281-283

INDEX 541 Law enforcement, see Criminal justice incidence and prevalence research, 133- system; Police 134 Lawyers, see Attorneys research recommendations, 4, 5, 7, 65, LEAD methodology, 45-47, 59, 106-107, 72, 78, 86-87 115, 118 theoretical models, 65 Legal issues, general, 262(n.1), 328-329 LONGSCAN, 329, 330, 331, 333 see also Criminal justice system; Ethical Long-Term Care Ombudsman program, issues; Fiduciaries; Forensics; 457 Guardianship and power of Long-term care settings, 4-5, 10-11, 18, attorney; Informed consent; 150-151, 176, 446-500 Legislation; Regulatory issues see also Assisted-living settings; civil justice interventions, 28, 32, 130, Institutional settings; Nursing 131, 134, 145, 221, 251, 255, homes; Residential care facilities 324, 341, 342, 343, 362, 374, attitudes, 10, 446-447 421, 423-429 cognitive impairments, 446, 451, 452, confidentiality, 33, 83 465, 466, 467, 482 financial abuse, cost factors, 422, 429, definitional issues, 203, 448-450 434-435 forensics, 371, 488 historical perspectives, 12-13, 239, 240 incidence and prevalence, 4-5, 450-483, screening and case identification, 106 487-489 Legislation, 42, 125, 240 ombudsmen, 25, 122, 123, 125, 131, see also Regulatory issues; State 134, 137, 169, 170, 366, 373, government 448, 450, 453, 456-460, 463 Age Discrimination in Employment Act, sexual abuse, 452 42 Louisiana, 199-200 child abuse and domestic violence, 13, 14, 506, 507-510 Child Abuse Prevention and Treatment M Act, 13 Comprehensive Drug Abuse Prevention MacArthur Risk Assessment, 333 Maine, 200-201 and Control Act, 145-146 financial abuse, 386, 418 Malnutrition, see Nutrition Older Americans Act, 15, 42, 131, 240 Maltreatment, see Child abuse and neglect; Definitional issues; Domestic Omnibus Budget Reconciliation Act, 450, 451 violence; Emotional abuse; Public Health Service Act, 145, 146, 323 Exploitation; Financial abuse; Self-abuse/self-neglect; Sexual reporting requirements, 125 Social Security Act, 13, 14, 239 abuse Victims of Crime Act, 419-420 Marriage and marital status, 168, 242, 296 see also Intimate partner abuse Local government see also Adult protective services; financial abuse, 394, 401, 402-403, 408- Community-level factors; 410 residential care facilities, 465 Criminal justice system financial abuse, 436 theoretical models, 63 institutional inspections, 137 Massachusetts, 202-203, 246, 405 Mass media, 15, 519 screening and case identification, 115, 436 Longitudinal studies, 4, 72, 78, 86, 102, McFeeley, Patricia, 256-257, 339-381 170, 171, 194-195 Medicaid, 128, 134, 448, 451, 457, 466, 479 clinical studies, 5, 86-87, 243 ethical issues, 329, 330-331, 333 Medical Expenditure Panel Survey (MEPS), informed consent, 313 479

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

INDEX 543 National Mortality Followback Survey, 447 communication deficits of residents, 452, National Ombudsman Reporting System 462 (NORS), 457 definition of abuse, 448-449 National Survey of Adolescents, 279, 285 financial abuse, 435 National Violent Death Reporting System, home health workers, 52, 127-128 80 neglect, 449-450, 462-464, 469 National Women’s Study, 279, 280-281, reporting practices, 460-462, 470, 472- 285 473, 474-476 Nebraska, 211 research ethics, 313 Neglect, general, xiii, xiv, 5, 11, 12, 13, 14, residential care facilities, 470, 472-473, 17, 22-23, 95, 168 485-487, 490 see Child abuse and neglect; Isolation staff, 134-135, 136-137, 448-449, 455, and confinement; Nutrition; 456, 459, 460-464, 485-487, 490 Restraints; Self-abuse/self-neglect registries, 460-462, 483, 484, 485- abandonment, 36, 184, 188, 199, 216, 487, 490-491 222, 225, 236, 357 Nursing homes, 11, 13-14, 176, 351, 447, community-level programs, 510 450-464 decubiti, 340, 343, 348, 349-350, 360, activities of daily living (ADLs), 452, 372 479 definitional issues, 19, 20-21, 34-37 adult protective services and, 13-14, (passim), 39, 41, 44, 181-237 239, 243 (passim), 342, 449-450 cognitive impairments, 313, 333, 351 guidelines for measurement, 44, 56 decubiti, 345 dehydration, 119, 166, 183, 186, 272, definition of mistreatment, 18, 51, 52, 340, 351-352, 372, 448, 463 448-450 financial, 387, 395, 409 dementia, 451, 452, 482, 485, 486 forensics, 342, 343, 372 demographics, 11, 447 hygiene, 136, 169, 192, 217, 218, 340, emotional abuse, 448, 449, 451, 454- 350, 357-358, 360, 448, 463 455, 462 incidence and prevalence, 74, 81, 173, evaluation of interventions, 125, 133- 274, 462-464 137 (passim) malnutrition, 340, 350-351, 448, 464 families and, 453-454, 462, 482 nursing homes, 449-450, 462-464, 469 financial abuse, 51, 52, 384, 385, 389, residential care facilities, 467-468 411, 412, 414 restraints, 340, 348-349 forensics, 347, 350, 351-352, 359, 364, screening and case identification, 110- 367, 371, 375 113, 118, 119, 274, 293-302 incidence and prevalence of (passim) mistreatment, xiii, 77, 79-80, 86, state law, 124, 387 99, 176, 447, 450-464, 471, 477- Nevada, 212-213 483 New Hampshire, 213 isolation and confinement, 448, 450, New Jersey, 213-214 454 New Mexico, 214-215 number of elderly in, 10-11, 151, 447 New York, 216-217, 432 nutrition, 350, 351-352 North Carolina, 217-219 preventive measures, 7, 151, 152, 455, North Dakota, 219 489-491 Nurse Aid Registry, 471 reporting practices, 446-447, 450-464, Nurses and nursing, 21, 22, 41, 52, 60, 61, 471 73, 169, 272 research ethics, 313, 333, 482-483 adult protective services and, 456-460 risk factors, 64, 66, 99, 100, 102, 451- cognitive impairments, 451, 452, 482 453, 479, 483-491

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

INDEX 545 financial abuse, 418-419, 429-436, 437 Protocol for Health Care Professionals, 277 banks and banking, 132, 296, 414, Psychological factors, 24, 97 430, 431-433, 435, 437 see also Attitudes; Cognitive funding, 121, 131, 418-419 impairments; Emotional abuse; historical perspectives, 12, 15 Isolation and confinement; incidence and prevalence and, 71, 78, 86 Mental illness institutional settings, 13 community-level programs, 510-512 nursing homes, 7, 151, 152, 455, 489- definitional issues, 50, 448 491 effects of mistreatment, 3, 4, 35, 58, 64, research, ethical guidelines, 144, 306- 78, 79, 87, 279, 284, 391 307 financial abuse, 391, 392, 399, 401, 409 residential care facilities, 489-491 nursing homes, 448 risk factors and, 88-89 theoretical models, 63, 64, 66, 68, 69, theoretical models, 69-70 240-241 Privacy, see Confidentiality trust relationships, 2, 3 Private sector, 7, 32, 151, 152 Public education, 267-268, 517-518 see also Attorneys; Banks and banking child abuse, 267-268, 505, 517-518 financial abuse, 433 mass media, 15, 519 incidence and prevalence and funding, reporting practices, 123, 267-268 71 screening and case identification, 105, 107 research ethics, 307, 323-324 Public Health Service Act, 145, 146, 323 Professional education, 32 adult protective services, 126 criminal justice system, 127-131 Q (passim) financial abuse, 130, 131, 132, 419, QUALCARE Scale, 166-167, 173, 174 432, 436, 437 Questionnaires see also specific instruments and surveys funding, 32, 132, 133, 151 guardianship and power of attorney, incidence and prevalence of abuse, 74, 130, 131 86, 270-277, 280-281, 287 screening and case identification, 110- institutional staff, 115, 127-128, 134, 136-137, 485-487, 488, 517, 518 113, 120, 166-173 (passim), 270- interdisciplinary approaches, 130-131 277, 280-281, 293-302, 365, 366, 504 reporting requirements, 123, 266-267 screening and case identification, 115, 127-128 sentinels, 22-23, 55, 74, 77, 128, 172, R 244, 246, 261, 262, 266-268, Race/ethnicity, 97, 171 277, 278, 284, 286, 287, 394 African Americans, 97, 269, 390-391, 466 specialists, general, 130-131, 132-133 financial abuse, 388, 390-391, 394 Prospective studies, 2, 24-25, 90-91, 334 incidence and prevalence and risk see also Ethical issues factors, 82, 269 Protective factors, 101-103 informed consent, language issues, 312 see also Interventions nursing homes, 451, 452 definitional issues, 48, 49, 50, 58 residential care facilities, 465 disabled persons, 98 screening and case identification, 114 incidence and prevalence and, 71, 73, theoretical models, 61, 62, 64 76, 79-80 Records and record-keeping, 21, 22, 23, 35, Protective orders, 418, 425 45, 46, 53, 55, 71, 74, 78 Protective services, see Adult protective see also Reporting practices services computer applications, 108-109, 120

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

INDEX 547 definitional issues, 4, 465, 475 families, 88, 91, 92, 96, 98-99, 100, 242 state legislation, 198, 210, 237 geriatric syndrome, 89-90 disabled persons, 465, 466 incidence and prevalence and, 71, 72, evaluation of interventions, 122, 126, 81-82, 85, 86-87, 261-302 133-134, 137 isolation, 91, 93, 241, 270, 293, 294, families and, 467, 473-474, 482 300 financial abuse, 384 nursing homes, 64, 66, 99, 100, 102, forensics, 344, 372, 375 451-453, 479, 483-491 historical perspectives, 468-469 race/ethnicity, 82, 269 incidence and prevalence of research ethics, 309-310, 311, 313, 319, mistreatment, 80, 86, 464-483 320-326, 329-334 isolation, 466-467 see also Informed consent medications, 466, 467, 468-469 research recommendations, 3, 5, 31, 489 mental illness, 465, 466, 467 residential care facilities, 465-468, 479, neglect, 467-468 483-491 number of elderly in, 10 sociocultural, 88, 91, 241, 270 nurses, 470, 472-473, 485-487, 490 theoretical models, 60-70, 87 reporting practices, 470-477 Risk of Future Abuse instrument, 170 research ethics, 303, 313, 482-483 Rural areas, theoretical models, 61, 66, 67 restraints, 466, 468-469 risk factors, 465-468, 479, 483-491 sampling, 478-481 S screening and case identification, 114, 488 sociocultural factors, 466-467 Sampling, 4-5, 22-23, 24-25, 27, 90, 124, 168-177 (passim) socioeconomic status, 466, 467, 480 standards, 464-465 ethical guidelines, 144 Respite care, 93, 94-95, 125, 130, 270 incidence and prevalence of abuse, 74, 86, 87, 282, 283, 284, 286 Restraints, 36, 52, 448, 455 chemical, 52, 448, 466, 468-469 long-term care facilities, 478-481 forensics, 340, 348-349 Screening and case identification, 23-24, 65, 76-77, 88, 104-120, 166-167, state law, legal definitions, 181-237 (passim), 469 169, 242, 503-505 Retrospective studies, see Controlled see also Forensics; Professional education; Reporting practices; studies; Longitudinal studies Rhode Island, 224-226 Risk factors Risk factors, 1, 14, 88-103, 124, 170, 241- abandonment, 112-113 activities of daily living (ADLs), 105, 242, 262-263, 284-285 see also Epidemiology; Forensics; 270-271 Incidence and prevalence; adult protective services, 104, 105-106, 115-116, 124, 167, 261, 267, Screening and case identification; Vulnerability, general 277, 365 abuser dependency, 96, 241, 242, 270, attitudinal factors, 109, 242, 264-265, 271-272, 276, 278-279, 284, 293, 296, 300 adult protective services, 96, 97, 98 293, 294, 296, 299, 396 caregivers, general, 93-95, 98-103 biomarkers, 3, 23, 74, 84, 101-102, 340, 360-362 child abuse and domestic violence, 88, 91, 99, 103, 242, 503-504 caregivers, 104-120, 166-167, 242, 270, definitional issues, 5, 20-21, 35, 72, 89 271-277, 293-302 (passim), 504- 505 guidelines for measurement, 48, 49- 50, 58, 81-82, 85 child abuse and domestic violence, 116- dementia, 92, 93-94, 451 117, 119, 267, 273, 403-404, 503-505

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

INDEX 549 Social Security Act, 13, 14, 239 screening and case identification, 106- Social Security Administration, 431 107, 112, 113-114, 115, 116- Sociocultural factors 118, 363-364, 370, 372 see also Demographic factors; Ethical Supplemental Security Income (SSI), 466, issues; Families and households; 467 Institutional settings; Isolation State government and confinement; Race/ethnicity; see also Criminal justice system; specific Religious institutions states financial abuse, 388, 393, 395, 397, adult protective services, 14, 18, 124, 417, 438 167, 239 preventive measures, 430-431, 435 child abuse legislation, 13, 123, 506, incidence and prevalence and, 79, 81-82, 507-508 87, 270, 280 confidentiality, 33, 304 residential care facilities, 466-467 disabled persons, definitional issues, 35, risk factors, 88, 91, 241, 270 36, 37, 124, 181-237 (passim) screening and case identification, 114, elder abuse legislation, 14, 19, 28, 130, 270, 280, 293-296 (passim) 143, 144, 245 stigma, 69, 242, 243, 264, 278-279, adult protective services, 27, 28, 115, 332, 415, 429, 503 124, 181-182, 185, 189, 411- theoretical models, 60, 61, 62-64, 67, 412, 417, 418-419, 505, 506-507 68, 91, 240 age factors, 27, 28, 115, 124, 181- Socioeconomic status, 171 182, 185 ethical research, 327 cognitive impairments, 35, 36, 184, financial abuse, 394 405, 406 incidence and prevalence research, 81- definitional issues, 13, 28, 34-39, 44, 82, 262, 282-283 60, 181-237, 384, 385, 400 Medicaid, 128, 134, 448, 451, 457, 466, fiduciaries, 190-191, 192, 197, 203, 479 206, 211, 218, 219 residential care facilities, 466, 467, 480 financial abuse, 13, 14, 18, 28, 184- screening and case identification, 114 236 (passim), 384, 386-387, 405, telephone interviews, 282-283 406, 410-418, 422, 423-429, theoretical models, 61, 62, 63, 64, 241 433, 439 South Carolina, 226-227 fraud, 185, 207, 210, 211, 213, South Dakota, 227-228 216, 221, 227, 231, 236, 387 Spouses, see Intimate partner mistreatment; forensics, 343-344 Marriage and marital status guardianship and power of attorney, Standards, 6, 27, 45, 56, 342 137, 182, 184, 191, 192, 200, see also Definitional issues; Ethical 210, 211, 212, 213, 217, 222, issues; Institutional review 227, 234 boards; Regulatory issues individual statutes, 181-237 financial abuse, proof of, 423-424 informed consent, 142-143, 145-148, forensics, 363-364, 370, 372 314 guidelines for measurement, 45-47, 56, institutional settings, general, 35, 36, 58-59 37, 187-188, 194, 196, 201, 202, hospital accreditation, 128 209, 214, 215, 217, 218, 220, informed consent, 6, 140, 141-143, 309- 221, 222, 223, 225-226, 233, 311 235 LEAD methodology, 45-47, 59, 106- medical care, 181-237 (passim) 107, 115, 118 neglect, 34-37, 44, 124, 181-237 residential care facilities, 464-465 (passim), 387 nursing homes, 200, 208, 448

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

INDEX 551 emotional abuse, 63, 64 definitional issues, 39, 40-41, 43, 44, families, 62, 63, 70, 138 61, 238, 384-385 geographic factors, 61, 62, 66, 67 guidelines for measurement, 44, 47- historical perspectives, 61, 240-241 48, 51-53, 57 individual personal factors, 61, 62, 63, financial abuse, 382, 385, 387, 392, 67, 91 393, 395, 401-402, 415 institutional review boards (IRBs), 62, incidence and prevalence of abuse, 74, 64, 66-69 77 isolation, 64, 91 risk factors, 88, 91 lacking, 2, 27, 521 screening and case identification, 109, longitudinal research, 30, 87 113, 114, 118, 293 mental illness, 63, 64, 240-241 theoretical models, 63, 66, 91 nursing homes, 62, 64, 66 psychological factors, 63, 64, 66, 68, 69, 240-241 U race/ethnicity factors, 61, 62, 64 risk factors, 60-70, 87 Understanding Child Abuse and Neglect, rural areas, 61, 66, 67 xiii-xiv Undue influence and duress, 131, 192, 195, sociocultural factors, 60, 61, 62-64, 67, 68, 91, 240 197, 203, 206-207, 210, 211, socioeconomic status, 61, 62, 63, 64, 241 212, 219, 222, 226, 231, 233, 237, 304, 309, 312, 386, 387, state government, 66 trust relationships, 63, 66, 91 389, 400, 404, 405, 407, 425 urban areas, 61, 67 Uniform Crime Reports (UCR), 268, 269, 284, 285-286 Time factors, 3 see also Longitudinal studies United Kingdom, 244 adult protective services, response time, Universities and colleges, see Academic research 124, 129-130 agency/researcher cooperation, 26 Urban areas, 512 child abuse, 280, 281, 510 incidence and prevalence, 73, 269, 275 theoretical models, 61, 67 community-level programs, 510 criminal justice system, 129-130 Utah, 229-230 epidemiology, 72, 77, 78, 87, 238, 243, 282 financial abuse investigations, 422 V financial abuse reporting, 411 Vermont, 230-231 guidelines for measurement, 47, 54-55, 87 Veteran’s Administration, 431 household settings, 137-138 Victim services networks, 365, 419-420 intensity of abuse, 5 Victims of Crime Act, 419-420 nursing home use, 447 Violence, physical abuse, 78, 168, 173, 245- remission, 5 246 residential care facilities, family visit see also Child abuse and neglect; intervals, 467 Criminal justice system; Sexual risk factors, 5, 65, 69 abuse screening and case identification, 105, abrasions and lacerations, 54, 118, 119, 106, 107, 113, 114, 115, 238, 340, 344-345, 359, 360, 361, 243, 282, 296, 365, 367 372, 449, 454 Trust relationships, general, 2, 3, 58 adult protective services, 125 see also Caregiver abuse and neglect; alcohol abuse, 95 Guardianship and power of Alzheimer’s patients, 93-94 attorney

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

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Since the late 1970s when Congressman Claude Pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older Americans from physical, psychological, and financial abuse. Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusers—and sometimes the abused themselves—want to conceal.

Elder Mistreatment in an Aging America takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. The book includes a discussion of the conceptual, methodological, and logistical issues needed to create a solid research base as well as the ethical concerns that must be considered when working with older subjects. It also looks at problems in determination of a report's reliability and the role of physicians, EMTs, and others who are among the first to recognize situations of mistreatment.

Elder Mistreatment in an Aging America will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. It will also be of interest to researchers, research sponsors, and policy makers who need to know how to advance our knowledge of this problem.

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