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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
Elder Mistreatment Case Identification Strategy
Placement of sentinel reporters within clinical and social agencies or organizations
-May identify cases that otherwise would not be detected or come to clinical attention.
-Observers can be sensitive to case screening or detection criteria.
-May be the most effective method in long-term care settings.
-Observers are often professionals who have other obligations.
-Variation in personal powers of clinical observation.
-Ethical issues in the insertion of observers in some settings.
Acquisition of criminal justice information
-Can identify some cases that otherwise may not be subject to clinical or social service detection.
-Legal dimensions of elder mistreatment occurrence more fully documented.
-Cases likely to be a highly selective subsample of cases, more severe, and only of certain types.
-Information may not be collected in a systematic manner.
Specifying the Unit of Measurement
As Acierno (this volume) and others suggest, the elder mistreatment “event” is not always easy to characterize. Target elder mistreatment events for detection may be single or multiple occurrences, happening over short or long periods of time, and involving one or more victims (particularly in the institutional setting) or one or more perpetrators, yielding potentially diverse clinical, social, or functional outcomes. Thus, a variety of events may make up the numerator of interest: a single act by a perpetrator, a single act on a victim, a series of elder mistreatment acts by a perpetrator regardless of the number of victims, a series of acts on one victim, and so on. Similarly, the denominator used in rate calculations may vary and requires clear specification. Is it all persons in an age group, all persons in a trust relationship, all persons exposed to a potential perpetrator, or persons with a particular risk profile? Will the analysis be presented as a “person-time” calculation, in which potential victims are at risk only during specified times, such as the night shift in a long-term care institution? The complex and fluid nature of social “exposures” requires great care in specifying both the numerator and denominators in occurrence rates.