Pertinent types of harm to older persons include physical injury, emotional injury, and financial harm. Physical harm is the most straightforward, since its presence typically can be assessed reliably through examination, through laboratory tests (e.g., X-rays), or upon forensic assessment. Examples of physical harm include lacerations, burns, fractures, bruises, malnutrition, and others (Dyer et al., in this volume). Similarly, financial harm can typically be assessed reliably if access to the older person’s financial records is available. Emotional harm is more difficult to assess. This may take on the form of mental distress and other psychological responses, post-traumatic symptomatology (social withdrawal, reexperiencing traumatic events, trouble sleeping or eating, etc.), or the onset (at times recurrence) of a psychiatric disorder, such as major depression, post-traumatic stress disorder, panic disorder, agoraphobia, among others. Measurement of harm must be able to determine the presence or absence of different consequences in the various domains above. Since many harms may not be anticipated prior to the initiation of the research, the measurement method must be general and flexible so as to detect a wide range of consequences that may be specific to the specific elder-trust relationship, and to the setting involved (home, hospital, long-term care etc.). The measurement method must also evaluate temporal aspects of the consequences (onset, frequency, duration) and quantify the severity of these consequences.
A key methodological issue in the measurement of consequences is that some of the harms involved are not always accessible to direct measurement. This is true for several reasons. First, in many cases, harms are transient and remit by the time an assessment occurs, as in the case of a bruise or a laceration. Second, many older persons who are mistreated are cognitively impaired and cannot recall past harms. Third, many older people are reluctant to report conduct of others who may have harmed them or that may constitute mistreatment out of embarrassment or for other reasons. Fourth, often the only other source of information about past harms may be the other person in the trust relationship, who has a conflict of interest regarding disclosure of the harm. Therefore, the best a researcher can do, as is customary when latent variables are being investigated, is to employ methods of assessment that are multimodal (e.g., self-report, observer report, data review, direct examination, laboratory studies, forensic assessment) and that are repeated with sufficient frequency to minimize the likelihood that relevant consequences are missed. The corollary to this is that measurement methods should include checks and balances so that false positives are minimized as well.
In general, methods to assess the presence or absence of physical injury, emotional disturbance, or financial injury are available and have been adapted to the elder mistreatment context. These methods generally are able to evaluate the presence or absence of injury (harm) and are also able