Chapter 5 delineates much of what is known about risk factors for elder mistreatment, and these are not reviewed here. Chapter 5 and the paper by Acierno make the important point that risk factors may be related to the environment or to the characteristics of the perpetrator, not only to those of the victim. Acierno also notes that some elder mistreatment research projects use “known” risk factors for case definition, such as dimensions of dependence and vulnerability, possibly limiting the ability to study these factors or to identify related risk factors. Investigators should be alert to this issue when conducting community surveys. For example, if an elder mistreatment case definition demands the presence of frailty or vulnerability, then risk factors for elder mistreatment that may be associated with more robust older victims cannot easily be explored.
A related issue is the problem of applying clinical risk factors to case definitions of elder mistreatment. Older persons, particularly frail elders, have many clinical problems and dysfunctions, and from both conceptual and statistical perspectives it may be challenging to use these risk factors for case ascertainment. For example, among general, community-dwelling populations over age 65, over half may have at least one chronic illness and at least one physical limitation or dependence. In addition, general symptoms such as pain, fatigue, and sleep problems abound, as well as organ-specific complaints, related, for example, to the skin and or the gastrointestinal tract. Thus, the specificity of these factors for case designation may be lower than hoped. This is discussed more fully in Chapter 6 on case ascertainment in the clinical setting.
It may also be useful to distinguish between a risk factor, for which a causal association to elder mistreatment is being sought, such as the social isolation of a victim, from a risk indicator, a certain characteristic that is associated with elder mistreatment but is not thought to be causal. An example of the latter is an environmental (contextual) factor, such as living in a community in which the police make frequent domestic violence calls. It is also possible that some putative risk factors, such as cognitive or other functional impairment, may in some instances result from elder mistreatment as well as being potential causes, as these impairments may be due to head trauma, misuse of medications, or some forms of bodily neglect. This is another reason why understanding the clinical course of elder mistreatment is critical to its detection. It may also be worth restating here that some risk factors may only be relevant to certain forms of elder mistreatment, and not to all of its forms and manifestations.
There still is a large amount of work to be done in defining risk factors for elder mistreatment. More community-based and institution-based studies are needed, and they should be done in geographically, economically,