RISK MODEL OF ELDER MISTREATMENT IN DOMESTIC SETTINGS

Here we would like to propose, as a first approximation, a theoretical sketch for the study of elder mistreatment that in our view could help to codify the findings already in hand and to provide a framework within which to organize future research efforts.1 It is offered in the spirit of starting a conversation about theoretically meaningful next steps rather than as a fully fleshed-out theoretical model. It draws its inspiration from George L. Engels’s (1977) challenge to the reigning biomedical model of the time. He proposed a biopsychosocial model explicitly encompassing psychological and social factors in explaining biophysiological conditions, such as disease or aging processes. It has attracted increasing attention, most recently providing the framework within which a task force of the Institute of Medicine organized its discussion of sexually transmitted diseases (Institute of Medicine, 1997; see also Laumann et al., 1994:3-34, 541-548; Ensel and Lin, 2000). In Engels’s view, the narrow biomedical model, with its highly individualistic, clinically centered presumptions, should be expanded to incorporate a multiperson interactional scheme with three sets of interrelated factors: the physiological, the psychological, and the social. What is missing from Engels’s model is a fuller consideration of the environing cultural and social contexts in which these microprocesses are embedded.

The definition of elder mistreatment in Chapter 2 stipulates both a victim of mistreatment (the focal subject) and a responsible actor (a trusted other, typically the caregiver) that together lie at the center of analytic attention. The interaction between the characteristics of the potential victim of mistreatment (e.g., his or her changing health status, dependency, competencies) and those of the responsible actor (e.g., his or her care burden, stress, financial dependence) must be an essential feature of any analysis. In addition, contextual risk factors, such as those referring to location (type of institution, at home, etc.), social relationship (e.g., spousal, adult child caregiver, formal role caregiver like lawyer, nurse), and the broader sociocultural context (defined by race, ethnicity, religion, region, urban/ rural location, and socioeconomic status), may set different generic levels of risk for the individuals embedded in them.

Figure 3-1 provides a bird’s eye overview of the generic factors in the model of the risks for elder mistreatment, while Figure 3-2 presents a

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Several other theoretical sketches have been proposed in the research literature, including Ansello (1996); Phillips (1983); Schiamberg and Gans (1999); and Wolf and Pillemer (1989). The current framework attempts to be more comprehensive, including mistreatment both in domestic and institutional settings. In addition, it is applicable to multiple types of mistreatment. The sketches in the literature, however, are completely consistent in spirit and thrust with it.



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