The Elder Mistreatment Prevention Consensus Workshop generated 41 recommendations covering 14 domains. From this information, the roundtable discussion refined the list to 10 priorities for research that participants believe would lead to improved prevention of elder mistreatment. In some cases, these recommendations reflected primary prevention – ways of preventing the first incident of mistreatment. In other cases, recommendations centered on secondary and tertiary prevention – that is, preventing reoccurrence of mistreatment or its negative outcomes. It is important to note that what distinguishes these recommendations is that they were generated by practitioners based on their exposure to elder mistreatment research and dialogue with scientific experts on the topic. We review the areas recommended for research and provide additional detail on specific research questions that were suggested.
Ten priority areas for research on elder mistreatment were identified: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, utilizing existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training.
Recommendation 1: Improve the definition and classification of what constitutes elder abuse
Over the past 20 years, efforts have been made to clarify the definition of elder mistreatment. However, practitioners continue to grapple with the question of what, precisely, falls under this term. Participants raised the issue of whether all crimes against older people constitute elder mistreatment, asking to what degree a difference exists between elder abuse victims and crime victims. They also expressed uncertainty regarding the issue of the relationship of perpetrator to victim: Is it elder abuse if the mistreatment is caused by a stranger, rather than by a relative or other person in a position of trust? Further, who can be considered in a “position of trust,” and under what circumstances?
Another issue raised by participants relates to the question: At what age are people considered to be “older” adults? For example, in some states a person is considered an older adult at age 60, whereas in other states a person is considered an older adult at age 65. They noted that there is no standard age cut-off for “elder” mistreatment, and that it would be helpful if there were one. In addition, they asked: Should we even use age as a way to determine elder status or instead consider other characteristics such as functional status to determine the at-risk population?
The consensus workshop participants recommended that researchers work to resolve the definitional issue and attempt to achieve some form of consensus for empirical studies. They noted that their own attempts to apply research findings to practice are hindered by the definitional disarray in published articles, and that this makes it difficult to draw conclusions from research. At a minimum, researchers should be extremely careful in detailing how elder mistreatment is defined, and they should attempt to adhere to standard definitions (e.g., that used in the National Research Council report) to the greatest degree possible.
Recommendation 2: Create mechanisms whereby researchers can gain access to victims and abusers for research purposes
It was acknowledged that one of the most significant barriers to better elder mistreatment research is lack of access to victims and abusers. Often victims and abusers are socially isolated, “suffering in silence” until the problem is discovered by a health or social service professional. Elder victims may not want the abuse discovered for fear that they will be removed from their own home and placed in a nursing home. Victims may be frail, cognitively impaired, and not receptive to investigation or treatment. They may be accompanied to the doctor by their abuser and thus may try to hide their abuse during a potential screening. Further, agency administrators often are concerned that research may violate their clients’ privacy or be disturbing to them (or to an abusive family member).
Thus, researcher access to victims and abusers for studies has been limited. This situation is in contrast to the fields of child abuse and intimate partner abuse, in which researchers have had much greater ability to conduct interview studies (in part through obtaining samples from treatment programs). The result of the lack of access has been the proliferation of studies that rely on agency records or on surveys of service providers in the elder abuse field.
The consensus workshop recommended much closer interaction between researchers and service providers. It is interesting that the practitioners rated this recommendation very highly, acknowledging that assistance in obtaining research participants is a key to improving empirical studies. They suggested that graduate students in training to be researchers intern at local elder mistreatment service programs, so that they can gain first-hand experience in front-line elder abuse work. Trainees would thereby both gain experience in coordinating with service providers and gain access to elder abuse victims and abusers.
Recommendation 3: Determine the best approaches for use when intervening with abusers
In the field of intimate partner abuse, interventions are common with abusers. The participants noted that such is clearly not the case with elder mistreatment. Only one major intervention study with alleged abusers has been conducted in the field of elder mistreatment, and this study had surprisingly negative outcomes (Davis and Medina-Ariza, 2001
). This is clearly a line of research that must be pursued.
The consensus workshop acknowledged that programs for elder abusers require careful evaluation before they can be promoted as prevention strategies. They suggested testing a range of services, including having support groups in which perpetrators receive counseling and learn anger management and coping strategies. Such programs, they recommended, could take place in conjunction with support (and possibly emergency shelter) for the victims. Another important issue identified by the consensus workshop was intervention strategies targeting grandchildren who are mistreating grandparents (a phenomenon perceived as on the rise in urban environments).
Recommendation 4: Determine how to best utilize existing data sets to understand elder mistreatment
The consensus workshop participants recommended that researchers should exploit existing data sets to study elder mistreatment. In doing so, they acknowledged the expense and time required to collect original data on this topic. Practitioners noted that police departments may have data, as do numerous municipal and state agencies. Researchers must work closely with government officials and agency practitioners, such that agency officials understand the need for the data and how it will be used. Potentially complex human subjects approval issues also will need to be addressed in such efforts.
Recommendation 5: Identify risk factors for elder mistreatment
Although research has identified several risk factors (Pillemer, Mueller-Johnson, Mock, Suitor, & Lachs, 2006
), practitioners argued that more work was necessary. The consensus workshop participants noted that their work greatly would be facilitated by improved risk profiles for both victims and abusers. Further, prevention programs are difficult to plan in the absence of meaningful risk factor data.
Recommendation 6: Examine how culture affects elder abuse
Participants argued that cultural groups may differ in how they define, excuse, or prohibit elder abuse. They suggested that much greater knowledge is needed about the nature and dynamics of elder abuse in minority communities. Ethnic and racial minority elders are often at a greater risk of poor health, social isolation, and poverty, which may increase their risk of elder abuse. Because the number of ethnic and racial minority persons in the older population is growing (especially in urban areas), it is increasingly important that cultural considerations in the delivery of services to elder mistreatment victims be understood. In addition, the group recommended that researchers develop and test culturally-specific public awareness and educational campaigns, to discover what the best ways are to promote help-seeking behaviors among minority victims and their families.
Recommendation 7: Develop and improve evaluation strategies for elder mistreatment programs
The consensus workshop participants endorsed the use of evidence-based strategies for preventing and treating elder mistreatment. However, they noted that there is a near absence of rigorously tested elder mistreatment interventions. They strongly recommended that intensive evaluation research be conducted to determine what kinds of programs work. Further, they recommended that researchers examine what types of programs work best with specific categories of older people (e.g., young-old versus old-old, disabled versus nondisabled), so that interventions can be targeted better. It also was recommended that cost-benefit analysis needs to be done to determine the effectiveness of programs. In particular, they suggested studying the cost-effectiveness of publicly-funded programs across the nation.
Recommendation 8: Conduct research on how cognitive impairment affects elder mistreatment investigation
Practitioners noted a cognitive impairment as a key issue that arises in many cases of elder mistreatment, and in particular around investigation of suspected mistreatment situations. They pointed out that their investigations rely on the testimony of victims; however, the individuals who are providing the accounts or accusations of elder mistreatment may have sometimes significant cognitive impairment. Therefore, determining the accuracy of the memory of suspected elder mistreatment victims is a critical component of investigation, as is that of the possible abuser. This is, of course, true in legal settings, but also for social workers, medical professionals, and others who screen for or investigate mistreatment. Practitioners expressed frustration at the lack of tools or methods for determining the validity of older persons’ reports of elder mistreatment, and suggested this be a high priority for research.
Recommendation 9: Use financial and medical forensics to detect elder mistreatment
Participants suggested that research and evidence-based techniques used in forensics be applied to elder mistreatment. First, they suggested that investigators develop software programs and algorithms in collaboration with the financial services industry to alert appropriate individuals to the possibility that an older adult is being financially exploited. The recommendation derived from the fact that cases of financial exploitation often are discovered long after the older person’s resources have been depleted. In terms of medical forensics, participants also agreed on the need for a better understanding as to whether or not certain injuries could reflect abuse or neglect with a more robust scientific foundation. Examples include fractures that could have resulted from a fall versus assault, or malnutrition or dehydration that could have resulted from chronic or acute illnesses, rather than intentional neglect.
Recommendation 10: Develop evidence-based methods of improving training for professionals in detecting and reporting elder mistreatment
Participants recommended that training programs be developed and carefully evaluated to determine if: a) training improves the effectiveness of professionals and gatekeepers to detect and help victims; and b) if training about cognitive impairment in older adults improves elder abuse investigations. In addition, participants recommended that researchers create and test new training methods.