Understanding the Clinical Course and Outcomes of Elder Mistreatment

As noted above, clinical observation suggests that elder mistreatment may take place over a long period of time, and that only at certain times, such as when a severe injury or evidence of willful neglect increases, will the situation become clinically, socially, or legally apparent. As pointed out by Acierno (this volume) and suggested in other studies of later-life suicide attempts (Dube et al., 2001) and victimization from sexual or physical abuse (Cold et al., 2001), for some elder mistreatment victims the origins may reach back to youth or young adulthood, or they have been in place within a family relationship for many years, although the causal mechanisms are unclear. Ascertaining multiple events over long periods, particularly in retrospect, can understandably be extremely difficult. However, not only for defining the start of an “incident” elder mistreatment event, but more importantly for understanding the causes and trajectory of elder mistreatment, a broad, sometimes lifelong view of the problem seems essential. This amplifies the plea for more longitudinal studies of elder mistreatment. It is possible, for example, that retrospective medical record review, when available, may identify early elder mistreatment events that were unrecognized at the time. In medical parlance, it seems likely that many cases of elder mistreatment are remittent or recurrent but, with few exceptions (Lachs et al., 1997b), there is little quantitative work on this issue.

A similar issue relates to the short- and long-term impact of elder mistreatment on victims. A critical question that is almost unanswered is how elder mistreatment relates to the clinical, social, institutional, financial, psychological, and mortal outcomes of elder mistreatment victims and the overall impact of elder mistreatment on elder population health. For example, an important issue in gerontological public health is whether the mobility and functional status of elders in the United States has been improving, paralleling the increasing longevity seen in the latter part of the twentieth century (Manton et al., 1997; Freedman and Martin, 1999; Schoeni et al., 2001). This is important for forecasting and planning future health care and fiscal needs. Given the evidence that at least some population functional improvement has occurred, evidence to explain this phenomenon should be sought, in order to enhance preventive and therapeutic practice. It is at least a hypothesis that knowledge of elder mistreatment occurrence rates over time could be helpful in understanding secular trends in the prevalence and outcomes of elder population disability. In fact, elder mistreatment may be important and common enough to also consider when planning and evaluating long-term disease and disability prevention and treatment trials targeting vulnerable, dependent, and frail elders.

Clinical, functional, and population elder mistreatment outcomes could



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