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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
stress on the caregiver, who feels captive to a deteriorating, “no-win” situation. He reacts with frustration and anger, finally physically hitting her in response to a “petty” demand for attention—an act that never occurred before in their many years of marriage. The figure attempts to identify the set of variables and their probable causal order; it also stresses the interactive character of the process over time. It should help guide the selection and measurement of the pertinent variables in evaluating this account of elder mistreatment risk.
The problem of identifying rare events like elder mistreatment is made more difficult because of its strong social stigmatization. It is quite analogous to the problem faced in studying AIDS infection in the population. AIDS is such a rare event (0.61 percent prevalence rate in the United States) that it is prohibitively expensive to get a sample size large enough to recruit sufficient cases for statistical analysis, even if one could assume that people would willingly disclose their infection status. Instead, analysis has focused on the prevalence of sexually transmitted diseases (STDs) inclusively defined, which have an estimated prevalence of 18 percent in the U.S. adult population age 18 to 59 (see Laumann and Youm, 2001:339), a much more workable situation from a statistical point of view. This could be done because the mechanisms implicated in STD transmission approximate fairly closely those implicated in AIDS transmission in the United States. A similar strategy could be undertaken for elder mistreatment, in which we could identify more broadly inclusive adverse events, for example, frequent and intense verbal arguments between the elder person and the caregiver, which are likely to include the events that meet a stricter definition of elder mistreatment.
The objective of this discussion has been to provide a comprehensive, flexible theoretical framework within which to organize research efforts employing qualitative as well as quantitative methodologies. Appropriately deployed in systematic empirical research, these methodologies can illuminate the fundamental processes generating the differential risks of elder mistreatment for both the elder population at large and for those who perform caregiving roles. Armed with a better understanding of the underlying processes, we will be in a much better position to devise more effective intervention strategies to reduce these risks.
In sum, we are unlikely to obtain much information relevant to prevention and post-mistreatment intervention in cases of elder mistreatment until the field moves toward a program of research that is grounded in an understanding of the everyday lives of older people in relation to their intimate partners and their other caregivers; the experience (phenomenology) of