That is, case-control studies have not found a direct relationship between elder mistreatment and functional impairment or poor health. Reis and Nahmiash (1998) did not find impairment in activities of daily living to be associated with elder abuse. Neither Cooney and Mortimer (1995), Paveza et al. (1992), Bristowe and Collins (1989), nor Phillips (1983) in case-comparison studies found functional impairment to be a risk factor for abuse by caregivers. Lachs et al. (1997a) found that impairment in activities of daily living was associated with being an abuse victim, but the researchers acknowledged that the dependent variable—protective services intervention for elder abuse—may have led to these results, and that findings may differ for elder mistreatment that is not detected by an agency.

There is as yet no evidence as to whether this pattern of nonfindings holds for all types of mistreatment. In the only study to address this issue Wolf and Pillemer (1989) found that victims of elder neglect were more likely to be impaired than victims of either physical or psychological abuse.

Victim Dependence and Caregiver Stress

If there can be said to be a “traditional” view in the field of elder mistreatment, then it can be summed up in the following way. Elderly people become frail, difficult to care for, and sometimes demanding. These characteristics cause stress for their caregivers; as a result of this stress, the caregivers become abusive or neglectful toward the elder. In this view, elder mistreatment is seen as an outgrowth of the aging process, which leads to the need for care by others. Much early writing emphasized the dependence of the elderly person and resulting caregiver stress as the pre-dominant (and sometimes sole) cause of elder abuse (Davidson, 1979; Hickey and Douglass, 1981; Steinmetz, 1988).

However, there is a lack of evidence that an older person’s need for assistance or that caregiver stress in fact lead to greater risk for elder mistreatment. First, it is clear from the gerontological and geriatric literature that a substantial number of elderly persons are dependent on relatives for some degree of care. However, findings about the prevalence of elder mistreatment indicate that only a small minority of the elderly is mistreated. Since abuse occurs in only a small proportion of families, no direct correlation can be assumed between the dependence of an elderly person and abuse, as sometimes has been done.

Second, case-comparison studies have generally failed to find either higher rates of elder dependence or greater caregiver stress in elder abuse situations. Bristowe and Collins (1989), Homer and Gilleard (1990), Phillips (1983), Pillemer (1985), Wolf and Pillemer (1989), Pillemer and Finkelhor (1989), Pillemer and Suitor (1992), and Reis and Nahmiash (1997) did not find greater dependence or caregiver stress among victims

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