inclusion of long-term care service use and the various forms of residential and assisted living that contain chore or clinical services, as delineated by Hawes (this volume), few elder mistreatment victims would be outside the reach of some type of screening, and most could be identified if accurate, inexpensive, and comprehensive methods were available.

As case detection and epidemiological research on elder mistreatment proceed, the importance of some basic public health notions becomes clear. It is important to distinguish between screening, where-by someone is put into an “elevated probability” group for further evaluation, and case finding, where-by an actual designation of elder mistreatment is made. Both in research and practice, the two approaches encompass different levels of rigor and investigation (see Chapter 6 for further discussion). Any substantial increase in either activity could lead to increased elder mistreatment detection rates and could lead to spuriously increased population occurrence rates; community-based elder mistreatment prevention and treatment programs should be alert for this. Screening research could usefully be applied to many settings, including all types of medical care sites, social service and adult protective service settings, and the legal and judicial systems. As this research progresses, it would also seem to be of value to monitor the extent of overall community elder mistreatment screening and case finding, to better understand whether observed changes in elder mistreatment secular trends may be due to variation in surveillance intensity. There may also be long-term variation in the propensity of elders to verbalize and report mistreatment.

Attention should also be given to the potential role of using existing or newly developed injury surveillance systems to measure and monitor trends in certain types of elder mistreatment. For example, violent deaths of elders will be included in a new National Violent Death Reporting System that will provide much richer information than is currently available from existing data sources on homicides and suicides (see Institute of Medicine, 1999). While current surveillance of nonfatal injuries is limited, even the existing data collected in emergency departments and through hospitals are not very sensitive for elder mistreatment. The panel encourages the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC) to study ways of enhancing the utility of existing injury surveillance systems for identifying elder mistreatment and of incorporating it into newly developed systems. Other types of public health surveillance could also be useful in measuring the occurrence of elder mistreatment. In many jurisdictions the public health system provides various levels of preventive and medical care, often emphasizing vulnerable populations, as well as inspecting and licensing long-term care institutions. Research on surveillance efficacy in these settings may also be of value.

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