(Lachs and Pillemer, 1995). Examples of geriatric syndromes include falls, urinary incontinence, and functional decline.

Geriatric syndromes share several characteristics: environmental factors play an important role; interventions must be multifaceted and directed at both specific pathophysiological problems as well as at contributing factors in the environment; and such syndromes are often underdiagnosed and undermanaged by health and social service providers. Elder mistreatment shares these characteristics of a geriatric syndrome. Most important for the purposes of this chapter, contributing etiologies can be related to the relative (or person in a trust relationship), to the elder, or to the environment. Thus, the search for risk factors is both complex and challenging and necessarily must look for sources of risk in the host (the elderly person), the agent (the perpetrator), and the environment. As well, it must study the interplay of factors in these three domains in affecting the risk of elder mistreatment.

Weaknesses of Existing Studies

The first major limitation of previous risk factor research results from unclear definition of the object of study. Findings from most studies are confused in that they do not differentiate the various types of abuse and neglect articulated earlier in this report. It is likely that the etiology of these elder mistreatment types differs. Second, different criteria have been used to determine the population at risk of elder mistreatment. Some researchers have included persons under age 60 in their studies, while most others have chosen 60 or 65 as the entry point. Some researchers have restricted their studies to caregivers of elderly persons or to persons sharing a residence, while others have included all categories of elderly people.

Third, studies of risk factors have employed widely differing sampling methods, including random sample surveys, interviews with patients in medical practices or caregivers in support programs, and reviews of agency records. Fourth, few studies that have purported to address risk factors have in fact included control groups in their designs. In the absence of controls, the validity of associations between elder mistreatment and putative risk factors cannot be assessed. Furthermore, even those studies that have included control groups have often failed to ascertain that the controls were actually free of elder mistreatment. Fifth, a number of studies have not employed reliable and valid measurement of the indicators of risk.

Sixth, with one exception (Lachs et al., 1994, 1997a), prospective studies of elder mistreatment do not exist. As Lachs and colleagues (1994) point out, retrospective research designs contain several potential biases: recall bias—the respondent reinterpreting key facts or feelings from a later vantage point; information bias—the respondent (especially if cognitively



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