investigation and designation. Research assessing the capacity of older persons with cognitive impairments to provide accurate testimony is needed for improving the accuracy of case identification, not only in clinical settings, but also in legal settings, including prosecutorial decision making and formal adjudication.
Research on the effects of elder mistreatment interventions is urgently needed. Existing interventions to prevent or ameliorate elder mistreatment should be evaluated, and agencies funding new intervention programs should require and fund a scientifically adequate evaluation as a component of each grant. Specifically:
Research is needed on reporting practices and on the effects of reporting, taking maximum advantage of the opportunity for comparisons of practices and outcomes in states with and without mandated reporting.
Research is needed on the effectiveness of adult protective services interventions, ideally in study designs that compare outcomes in cases in which services were provided with those in which eligible recipients declined offered services or other cases in which mistreatment of an equivalent nature has been identified.
Intervention or prevention research in existing health care environments that come into contact with mistreated elders, such as hospitals, emergency departments, and emergency response services, should be a priority, as it takes advantage of the existing expertise and resources of these services.
The development of adult protective services/university research teams should be encouraged in order to evaluate existing data, recommend improvements in the collection of data, analyze incident reports, and design the studies of outcomes urged in this report.
Investigators and institutional review boards (IRBs) need clearer guidance (without rigid rules) concerning two issues that tend to recur in elder mistreatment research: conditions under which research can properly go forward with participants whose decisional capacity is impaired, and the proper responses to evidence of mistreatment elicited during the course of the study. In the absence of better guidance, IRBs are left setting their own criteria, leading to inconsistencies and confusion. Cooperative research between agencies or organizations is also difficult, if not impossible, since different IRBs often take different positions on these issues, including what information must be disclosed to obtain informed consent.
As a first step in this direction, the panel has sought to clarify some of the issues in these two areas and to provide some needed guidance. Eventually, the National Institute on Aging, in consultation with the Office of Human Research Protections and other federal partners, should take steps to promote further clarification, thereby helping investigators and IRBs to