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Annual Annotated Bibliography of Elder Abuse and Neglect Publications July 2005 - June 2006

The following is an annotated bibliography of works published or appearing in print from July 2005 through June 2006.

Entries are categorized as National Center on Elder Abuse (NCEA) publications, research, scholarship, books, manuals and training resources, and hearings. The citations are alphabetized by author's name within the genre categories. A number of international references have also been included, as they contribute to the advancement of the study of elder mistreatment and the recognition of elder abuse, neglect and exploitation as a worldwide societal problem. (International entries are categorized as research, scholarship, or books and manuals; abstracts identify the originating country.)

Many readers use the CANE bibliography series to keep abreast of recently published literature in the field. As a convenience, if a citation has previously appeared in a CANE bibliography, we have indicated this with an asterisk (*) after the file number. To access the CANE Bibliography Series visit the NCEA Web site at: http://www.elderabusecenter.org/default.cfm?p=cane.cfm .

Most of these reference materials may be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the Web addresses are also included.** If you need assistance in obtaining any of these materials, please contact the CANE office at [email protected] or (302) 831-3525.

(To search for reference materials from previous years, please visit the CANE Web site at: http://db.rdms.udel.edu:8080/CANE . To access earlier annual reviews, visit the CANE Bibliography Series at: http://www.elderabusecenter.org/default.cfm?p=cane.cfm .)

**Note: Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance.

*** Although some entries have earlier publication dates, these references first appeared in print during this time frame. Such entries are noted by a triple asterisk following the CANE file number.

The National Center on Elder Abuse (NCEA) serves as a national resource for elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
  • National Association of State Units on Aging (NASUA), Lead Partner
  • American Bar Association (ABA) Commission on Law and Aging
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
  • National Adult Protective Services Association (NAPSA)
  • National Committee for the Prevention of Elder Abuse (NCPEA)
This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services.
Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.

I. Publications by the National Center on Elder Abuse (NCEA)

1. Clearinghouse on Abuse and Neglect of the Elderly (CANE) for the National Center on Elder Abuse (NCEA)
CANE Bibliography Series
National Center on Elder Abuse; Washington, D.C.; 2005-2006.
As part of its commitment to the National Center on Elder Abuse (NCEA) to promote the dissemination of current and relevant research on topics related to elder abuse, neglect, self-neglect, and exploitation, the Clearinghouse on Abuse and Neglect of the Elderly (CANE) annually produces a series of selected annotated bibliographies. Bibliographies can be accessed online at: www.elderabusecenter.org/default.cfm?p=cane.cfm . The following bibliographies were developed and posted on the NCEA web site from July 2005 through June 2006:
2. S6273-15*
National Association of State Units on Aging (NASUA) for the National Center on Elder Abuse (NCEA)
Domestic Violence in Later Life: A Guide to the Aging Network for Domestic Violence and Victim Service Programs
National Center on Elder Abuse; Washington, D.C.; Spring 2006.
As quoted from the introduction: "As the 'Baby Boom' generation born between 1946 and 1964 ages, it is likely more victims of late life violence and abuse will seek out or be referred to the specialized services provided by domestic violence programs. This potential calls for increased collaboration between aging and domestic violence networks to assure maximum support and safety for victims and survivors of abuse in later life. The national aging network of State Units on Aging, Area Agencies on Aging, Tribal and Native organizations, and direct service providers - especially long term care ombudsman programs, adult protective services, legal services, and information and referral/assistance - has a key role to play in speaking out for older victims. With this Issue Brief we hope to encourage expanded dialogue and connections with allied partners..." The publication provides an overview of the aging network, established under the Older Americans Act (OAA), and describes key entities, providers of the four broad categories of support (access services, elder rights, services in the community, and in-home services) and the key values underlying the network. A list of state and national resources is also provided. (Note: This issue brief is accessible online at: http://www.elderabusecenter.org/pdf/publication/nceaissuebrief.

3. S6149-67*
National Association of State Units on Aging (NASUA) for the National Center on Elder Abuse (NCEA)
Nursing Home Abuse Risk Prevention Profile and Checklist
National Center on Elder Abuse; Washington, DC; 2005.
This resource was designed to assist nursing home professionals in assessing the risk of resident abuse and neglect. Three major areas are considered: facility risk factors; resident risk factors; and relationship risk factors. Facility risk factors include not only staff turnover and caregiver stress, but the absence (or inadequacy) of prevention policies and training initiatives. Resident risk factors encompass behavioral symptoms related to dementia, and unmet resident needs. Relationship risk factors address not only issues related to the presence or absence of family involvement, but also interactions between residents and staff. Steps for abuse prevention planning are outlined and include an emphasis on multidisciplinary collaboration. Instructions for the use and scoring of the checklist are also provided. Finally, implementation tips generated by Minnesota's pilot testing of the tool are presented. (Note: This publication is accessible online at: http://www.elderabusecenter.org/pdf/publication/NursingHomeRisk.pdf .)

4. S6174-00
National Center on Elder Abuse (NCEA)
NCEA Webcast Archives
National Center on Elder Abuse; 2005-2006.
In an effort to promote the use of promising practices and to foster collaboration among the entities that address elder mistreatment, the NCEA produces an ongoing series of webcasts on a broad range of topics. Archives of the webcasts can be accessed from the NCEA web site at: http://www.elderabusecenter.org/default.cfm?p=eventsandwebcasts.cfm . The following webcasts were presented from July 2005 through June 2006:
5. S6136-45
Teaster, P. B., Dugar, T., Mendiondo, M., Abner, E., & Cecil, K. of the Graduate Center for Gerontology, University of Kentucky, and Otto, J. of the National Adult Protective Services Association (NAPSA), prepared for the National Center on Elder Abuse (NCEA)
Abuse of Adults Age 60+: The 2004 Survey of Adult Protective Services - Abuse of Adults 60 Years of Age and Older
National Center on Elder Abuse (NCEA); Washington, D.C.; February 2006.
This report, a follow up of the NCEA's 2000 Survey of State Adult Protective Services, describes the findings of the 2004 national survey of APS data regarding reported and substantiated cases of elder abuse and neglect from fiscal year 2003. Data was collected from all 50 states, Guam, and the District of Columbia. A total of 565,747 reports of elder and vulnerable adult abuse were made to APS during fiscal year 2003, representing a 19 percent increase since the 2000 survey; 191,908 cases of abuse across 42 states were substantiated; and self-neglect was the most commonly reported type of mistreatment, followed by caregiver neglect and financial exploitation. While all states participated in the study, only 29 states were able to separate cases involving victims aged 60 and over from vulnerable adults younger than 60. (Note: The entire report is accessible at: http://www.elderabusecenter.org/pdf/2-14-06%20FINAL%2060+REPORT.pdf . The fact sheet summarizing highlights of the study is online at: http://www.elderabusecenter.org/pdf/2-14-06%2060FACT%20SHEET.pdf . The web cast seminar highlighting the findings of this report, which includes a PowerPoint presentation, can be accessed at: http://www.visualwebcaster.com/event.asp?id=31874 .)

6. S6248-67
Wood, E., of the American Bar Association Commission on Law and Aging, prepared for the National Center on Elder Abuse (NCEA)
The Availability and Utility of Interdisciplinary Data on Elder Abuse: A White Paper for the National Center on Elder Abuse
National Center on Elder Abuse (NCEA); Washington, D.C.; May 2006.
As quoted from the Executive Summary: "There is wide consensus that currently a clear picture of the incidence and prevalence of elder abuse in the United States is sadly lacking - and that such a picture 'is essential if social policy is to be created to impact prevention and treatment' (National Institute on Aging, 2005). While the National Center on Elder Abuse (NCEA) has collected and analyzed state adult protective services data, the penumbra of additional data elements that might be available through health care, long term care, criminal justice, fiduciary, and legal services networks has remained largely unexplored. Therefore, the NCEA sought the development of a white paper examining such data elements, their scope and limitations, and outlining their potential use by the U.S. Administration on Aging (AoA), other federal agencies, and elder abuse professionals and advocates. In response, the American Bar Association Commission on Law and Aging (ABA Commission) conducted exploratory research on a wide range of possible data sources. This white paper presents and evaluates the results. (Note: This report is accessible online at: http://www.elderabusecenter.org/pdf/publication/WhitePaper060404.pdf .)

II. Research

The following publications use a scientific method to obtain results. The results are usually quantifiable, and the methodology can be replicated and tested for validity and reliability.

7. S6165-52*
Age Concern New Zealand
Age Concern Elder Abuse and Neglect Prevention Services - An Analysis of Referrals for the Period: 1 July 2002 to 30 June 2004
Age Concern New Zealand, Inc.; Wellington, NZ; November 2005.
This is an analysis of over 1200 cases of elder abuse and neglect reported to Elder Abuse and Neglect Prevention services (EANP) from July 2002 through June 2004. Among the findings, the majority of abusers (70 percent) are family members (or extended family members, known as whanau) typically sons or daughters, regardless of the client's living situation; older perpetrators (aged 65 and up) are more likely to be husbands; family violence occurs even when elders are living in residential care facilities, with two-thirds of all residential client abuse being attributed to family/whanau members; psychological abuse, including verbal intimidation and harassment, is the most frequently experienced type of abuse, followed by material or financial abuse. The researchers note that these statistics are based on reported cases only, and that international studies suggest that this only represents the "tip of the iceberg." (Note: This report is available online only at http://ageconcern.org.nz/files/file/EANP_final.pdf .) (New Zealand)

8. S6425-11
Anme, T., McCall, M. & Tatara, T.
An Exploratory Study of Abuse Among Frail Elders Using Services in a Small Village in Japan
Journal of Elder Abuse & Neglect; Vol. 17 (2), 1-20; 2005.
This exploratory study was designed to measure the incidence of elder abuse and factors associated with mistreatment among frail elderly service users in a small Japanese community. Seventy-eight participants, aged 60 and older, receiving one or more support services (such as adult day care, short-term nursing home care, visiting nurse, rehabilitation, etc.) were interviewed by health and social services professionals regarding sociodemographic information, cognitive and physical health status, functional needs, role conflict, caregiver burden, family support, and the kinds and frequency of abuse experienced. Separate interviews were conducted with caregivers. Fourteen participants (17.9 percent) were found to have been abused. The most common type of abuse identified was emotional or psychological abuse (50 percent), followed by neglect (42 percent) and financial abuse (35.7 percent). Nearly two-thirds of the abusive caregivers were daughters-in-law. Abusers were typically younger than non-abusers, experienced more health problems than non-abusers, and received comparatively less family support. Victims were more likely to have demonstrated behavioral problems than elders who were not mistreated, and they had greater needs for assistance. Cultural issues are also considered. (Japan)

9. S6180-11*
Arai, M.
Elder Abuse in Japan
Educational Gerontology; Vol. 32 (1), 13-23; 2006.
In traditional Japanese culture, the Confucian principle of filial piety implies that care for elderly parents becomes the responsibility of the oldest son; however, in reality this responsibility falls upon his wife, who becomes the caretaker for not only her in-laws but her aging spouse as well. Conflicts arising from the clash of traditional and modern influences are believed to contribute to elder abuse and neglect. One hundred women and 46 men, aged 19 to 60, were asked to provide examples of elder abuse and neglect, and to rank them according to degree of severity. Among the findings, the type of abuse most commonly viewed as extreme in nature was physical abuse, followed by neglect, blame, and psychological abuse. Physical abuse also accounted for nearly 25 percent of the examples described as moderate in degree, followed closely by neglect (21 percent of examples given), economic abuse (15 percent), and emotional abuse (12 percent). Psychological neglect and psychological abuse were perceived as the most common forms of mild mistreatment, although examples of verbal, emotional, physical abuse and neglect were also provided. (Japan)

10. S6298-25***
Bachman, R., Lachs, M. & Meloy, M.
Reducing Injury Through Self-Protection by Elderly Victims of Violence: The Interaction Effects of Gender of Victim and the Victim/Offender Relationship
Journal of Elder Abuse & Neglect; Vol. 16 (4), 1-24; 2004.
Although crime statistics suggest that older individuals are less likely to be victims of violent crimes than younger individuals, when victimized they appear to sustain more serious injuries than younger victims. In this study, data from robbery and assault cases (excluding sexual assault) reported in the National Crime Victimization Survey (NCVS, 1992 through 2000) is analyzed to understand the general effect of self-protective behaviors on the risk of injury; whether the type of self-protective behavior has an impact; and whether the effects of such behaviors vary by the type of offender involved. Physically self-protective measures included physically attacking or threatening the offender, using or threatening to use a weapon against the attacker, chasing the attacker or running away from the scene. Nonphysical resistance included stalling, arguing or reasoning with the offender, trying to get attention from others, calling the police, or screaming or yelling. Of significance, male and female elders who physically resisted known offenders (intimates and acquaintances) were more likely to sustain injuries than those who either did not resist or resisted nonphysically. Those who resisted nonphysically were more likely to avoid injury than those who resisted physically or took no self-protective action. However, when attacked by a stranger, victims who took no action were at greatest risk for injury, followed by those who resisted physically. Results suggest that nonphysical self-protective behaviors decreased the risk of injury with both known and unknown offenders, but appeared particularly effective when dealing with offending strangers.

11. S6436-11*
Bartels, S., Miles, K., Van Citters, A., Forester, B., Cohen, M. & Xie, H.
Improving Mental Health Assessment and Service Planning Practices for Older Adults: A Controlled Comparison Study
Mental Health Services Research; Vol. 7 (4), 213-223; December 2005.
Evidence-based practice
This control study measured the effectiveness of an intervention process designed to improve routine screening of a number of problem areas for geriatric clients: substance abuse; dangerousness and suicide risk; and caregiver burden and risk for elder abuse and neglect. A multidisciplinary team developed a quality improvement toolkit that incorporated standardized assessment, decision and support mechanisms, and service planning to be implemented by non-physician, home health care and community mental health providers. Forty-four clinicians from 13 agencies working with 100 clients were assigned to either the control or intervention group. Baseline assessments revealed only 20 to 25 percent of all clinicians were routinely screening for various safety issues such as caregiver burden and risk for mistreatment. Following the intervention, medical record reviews indicated that over 90 percent of the clinicians using the toolkit routinely screened for caregiver burden, risk for abuse and neglect, and other safety factors, while the control group showed no improvement. The intervention group demonstrated improvement in all screening areas. (Note: A description of this project, including the instruments utilized, is accessible online at: http://www.rwjf.org/portfolios/resources/grantsreport.jsp?filename=035254.htm&iaid=144#contents .)

12. S6422-14
Beaulieu, M. & Leclerc, N.
Ethical and Psychosocial Issues Raised by the Practice in Cases of Mistreatment of Older Adults
Journal of Gerontological Social Work; Vol. 46 (3/4), 161-186; 2006.
In this qualitative study, 16 social work practitioners working with older, mistreated adults were interviewed regarding ethical issues and other dilemmas encountered through their psychosocial practice. Complexities arise not only in response to the needs of the client, but also because the practitioner is often working with the abuser within a family context. The following five themes emerged: the need for ethical reflection and self-awareness; the need to evaluate the victim's capacity to make decisions on his or her behalf; confidentiality versus collaboration among practitioners and across agencies; social versus family responsibilities; and balancing competing values in practice. The practice continuum of psychosocial intervention ranges from negative autonomy (when the victim refuses the practitioner's proposals) to extreme measures (taken when the practitioner makes urgent decisions without the absolute consent of either the victim or abuser). Excerpts from the interviews illustrate the practical aspects of these issues. (Canada)

13. S6452-11
Bezerra-Flanders, W. & Clark, J.
Perspectives on Elder Abuse and Neglect in Brazil
Educational Gerontology; Vol. 32 (1), 63-72; 2006.
This study was designed to identify perceptions held by Brazilians regarding elder abuse and neglect. Seventy participants completed the Cross-Cultural Perspectives on Abuse survey either on the Internet or during a personal interview. Forty-four percent of those surveyed either did not feel comfortable responding to abuse items or had no awareness of abuse towards elders. Forty-one percent of the participants provided examples of mild elder abuse, 41 percent provided examples of moderate abuse, and 48 percent provided examples of extreme abuse. Of the examples provided, extreme mistreatment was most frequently characterized as neglect and abandonment; moderate was most frequently characterized as psychological abuse and psychological neglect; and mild was most commonly psychological neglect and verbal abuse. Older participants provided more examples of mistreatment than younger participants. The significance of psychological abuse and abandonment appears to reflect cultural norms and economic difficulties prevalent throughout the country. (Brazil)

14. S6480-26
Brinig, M., Jogerst, G., Daly, J., Dawson, J. & Schmuch, G.
Lawmaking by Public Welfare Professionals
Whittier Journal of Child and Family Advocacy; Vol. 5; Fall 2005.
Part of a larger research project conducted by the University of Iowa on elder abuse throughout the U.S., this study analyzes the effect of bureaucratic characteristics of adult protective services programs (APS) upon investigation and substantiation rates of elder abuse at the local level. In addition to providing data on elder abuse reports, investigations and substantiation, 1,409 APS investigators representing forty-four states and the District of Columbia completed questionnaires regarding the bureaucratic structure of their APS programs. Characteristics analyzed included whether or not abuse screens were used; whether investigators dealt with only elder abuse cases; full-time equivalents investigating child and elder abuse allegations; participant's opinion as to whether or not elders were benefited by the intervention; the department's training curriculum; minimum educational requirement for investigators; percentage of investigators with greater than the minimum educational requirement; and educational discipline. Participants who believed that elders were "better off" following intervention demonstrated higher investigation and substantiation rates. Programs where investigators addressed only elder abuse cases also appeared to be associated with higher investigation and substantiation rates. The authors suggest that this model of evaluating program efficiency could be generalized to other areas of public welfare.

15. S6456-8
Brownell, P. & Heiser, D.
Psycho-Educational Support Groups for Older Women Victims of Family Mistreatment: A Pilot Study
Journal of Gerontological Social Work; Vol. 46 (3/4), 145-160; 2006.
Evidence-based practice
This study, conducted through the Fordham University Graduate School of Social Service, evaluated a group intervention for older women who had experienced mistreatment by family members. The intervention, based upon the model program of NOVA House, an elder shelter in Manitoba, Canada, consisted of eight two-hour weekly support group sessions incorporating the use of video, discussion and exercises. It was designed to increase participants' social networks and enhance self-esteem, decrease depression and anxiety, and decrease feelings of guilt. Participants were women aged 69 to 83 who had experienced some form of mistreatment in later life (most commonly by adult sons, followed by spouses). They were solicited through various social service programs in which they were enrolled. Women were randomly assigned to the intervention group (n=9) or to the control group (n=6) and continued to receive previously initiated supportive services. Baseline measures indicated that participants of both groups demonstrated high levels of self-esteem, low levels of depression, and had supportive social networks. Post test outcome measurements revealed no significant changes among participants of either group in terms of self-esteem, depression, or social supports, although all but one intervention participant reported positive benefits resulting from the treatment. Researchers suggest a number of factors (small sample size; the fact that women were relatively high functioning at baseline; that they were previously and concurrently engaged in additional support services; and the relatively short length of the treatment intervention) that may have had an impact upon outcomes.

16. S6465-6
Burgess, A., Brown, K., Bell, K., Ledray, L. & Poarch, J.
Sexual Abuse of Older Adults: Assessing for Signs of a Serious Crime
American Journal of Nursing/AJN; Vol. 105 (10), 66-71; October 2005.
This study was designed to identify barriers to reporting sexual abuse of older adults and to identify the signs and symptoms of elder sexual abuse. Data was gathered and analyzed from a convenience sample of 125 sexual abuse cases involving women aged 61 to 98 throughout 22 states. Cognitive impairment on the part of the victim, reluctance to disclose, and erroneous assumptions by caregivers and relatives were among the barriers to reporting and prosecution. Fifty-two percent of the victims had sustained one or more signs of physical injury; 46 percent had signs of vaginal trauma; 17 percent had signs of anal trauma. Victims also reported a wide range of emotional trauma related to the assaults. The structure of the forensic interview is described with an emphasis on recording all pertinent information in the written case record.

17. S6351-9*
Butler, S. et al.
Depression and Caregiver Burden Among Rural Elder Caregivers
Journal of Gerontological Social Work; Vol. 46 (1), 47-62; 2005.
This article analyzes the results of a study addressing factors related to depression and caregiver burden among rural family caregivers of older adults. Members of the Maine Primary Partners in Caring (MPPC) project used a simple screening tool to identify those at risk for depression and caregiver burden (which not only impacts the health and well-being of the caregiver but may also have a negative impact upon the care recipient) in order to provide interventions before caregivers were in crisis. Sixty-two caregivers were identified as "at risk." Family support and knowledge regarding care provision appeared associated with decreased caregiver burden and depression, while isolation appeared associated with increased caregiver burden. Social workers can play a significant role in assisting rural caregivers in developing and expanding their support networks.

18. S6420-9
Chokkanathan, S. & Lee, A.
Elder Mistreatment in Urban India: A Community Based Study
Journal of Elder Abuse & Neglect; Vol. 17 (2), 45-61; 2005.
Observing that the culture of India is in transition from traditionalism to modernism, accompanied by changes in attitudes regarding filial responsibility and the potential for increasing vulnerability among elders, this community based study examines the scope of elder mistreatment within this context. A residential community of Chennai, India, representative of the demographics of the region, was selected for analysis. Of the 400 randomly selected elders (aged 65 and older) who participated in the study, 14 percent reported being abused or neglected during the preceding year. Chronic verbal abuse was most commonly reported, followed by financial abuse, physical abuse, and neglect. Approximately half of those reporting abuse experienced a single form of mistreatment, but 30 percent indicated they had experienced multiple types of abuse. While 15 percent of the male participants reported mistreatment, 31.5 percent of the females reported mistreatment. Perpetrators were predominantly adult children. Mistreated elders also reported more symptoms of depression.

19. S6265-5
Collins, K., & Presnell, S.
Elder Homicide: A 20-Year Study
American Journal of Forensic Medicine & Pathology; Vol. 27 (2), 183-187; June 2006.
In an effort to draw attention to the phenomenon of elder homicide and the role that forensic pathologists can play in differentiating deaths due to natural causes from those due to neglect, abuse, and other acts of violence, researchers examined the characteristics of cases referred during a 20 year period. From 1985 through 2004, 127 cases of homicide of individuals aged 65 to 94 (including 12 aged 85 and over) were referred to the Medical University of South Carolina's Forensic Section of the Department of Pathology and Laboratory Medicine. Fifty-eight percent of the victims were male, 55 percent were Black, and 45 percent were White. Thirty-one percent of the deaths were attributed to gunshot wounds, 28 percent to blunt force trauma, 22 percent to stabbing, 13 percent to asphyxia, and six percent to other causes (including four cases of neglect). Eighty-three percent of the homicides occurred in the victims' residences, including three occurring in nursing homes. Of note, more than half of the perpetrators were known to the victim: 28 percent of the perpetrators were categorized as acquaintances and 23 percent were identified as relatives. Cases involving sexual assault were also identified, but relatively few sexual assault examinations had been completed.

20. S6392-8
Cooney, C., Howard, R. & Lawlor, B.
Abuse of Vulnerable People with Dementia by their Carers: Can We Identify Those Most at Risk?
International Journal of Geriatric Psychiatry; Vol. 21 (6), 564-571; 2006.
In order to analyze possible associations among characteristics of informal carers, care recipients with dementia, and acknowledged mistreatment, 82 carers were interviewed regarding verbally and physically abusive and neglectful behaviors. Fifty-two percent of the carers acknowledged that they had demonstrated abuse towards the care recipient. Fifty-one percent of carers admitted to being verbally abusive. Twenty percent admitted to physical abuse, and four percent were neglectful. Thirty-five percent reported a mutually verbally abusive relationship with the patient, and six percent reported a mutually physically abusive relationship. Verbal abuse appeared associated with psychological problems among carers and behavioral problems among care recipients. Of note, carers who admitted to physical abuse were no more likely to report having mental health problems than those who did not report abuse, and they were more likely to rate their physical health as better. The degree of cognitive and physical impairment did not appear associated with risk for abuse. In light of the high percentage of carers admitting to abuse, the authors recommend including questions about abuse in routine assessments of patients with dementia.

21. S6276-9
Cooper, C., Katona, C., Finne-Soveri, H., Topinkova, E., Carpenter, G., & Livingston, G.
Indicators of Elder Abuse: A Crossnational Comparison of Psychiatric Morbidity and Other Determinants in the Ad-HOC Study
American Journal of Geriatric Psychiatry; Vol. 14 (6), 489-497; June 2006.
The Aged in Home Care (AdHOC) study was conducted throughout 11 European nations from 2001 through 2003 and gathered data on approximately 4,000 individuals aged 65 and older receiving community based health and social services. This aspect of the study involved crossnational analysis of indicators of elder abuse in relationship with risk factors, particularly depression, dementia, and lack of service provision. At least one indicator of abuse was reported in 4.6 percent of the respondents with highest rates being reported in Italy (12.4 percent) and Germany (9.6 percent). Nearly two-thirds of the elders screening positive for abuse also screened positive for dementia; and those with severe dementia had the highest rates of abuse overall. Individuals with mild and moderate dementia appeared to be at risk for neglect. Participants demonstrating symptoms of depression and delusions also appeared at greater risk for mistreatment. Having a formal psychiatric or dementia diagnosis, however, did not appear to correlate increased risk. Crossnational differences are discussed along with cultural implications. (France, the Netherlands, Nordic countries, Czech Republic, United Kingdom/U.K.)

22. S6343-14
Croog, S., Burleson, J., Sudilovsky, A. & Baume, R.
Spouse Caregivers of Alzheimer Patients: Problem Responses to Caregiver Burden
Aging & Mental Health; Vol. 10 (2), 87-100; March 2006.
This study examines the stress responses of 199 spousal caregivers of patients with Alzheimer's disease. Associations between specific patient problem behaviors and individual stress responses are considered along with the impact of caregivers' symptoms of anxiety and depression. Problem responses to caregiver stress were identified in three major areas: concerns regarding long-term uncertainties; issues of anger and resentment towards the patient; and concerns regarding the impact of the caregiving upon the caregiver's own life. Concerns regarding the future, including being able to continue to adequately provide for the patient, were among the most serious issues identified. Of significance, 41 percent of the participants indicated that they felt anger and/or resentment towards patients "frequently" or "sometimes". The patient's emotional lability, rather than cognitive impairment, appeared to have a greater association with all three areas of concern. The variables of age and gender are also discussed, along with implications for program implementation based upon these findings.

23. S6410-10
Daly, J. & Jogerst, G.
Definitions and Indicators of Elder Abuse: A Delphi Survey of APS Caseworkers
Journal of Elder Abuse & Neglect; Vol. 17 (1), 1-19; 2005.
This Delphi study (a method that facilitates group consensus) was designed to evaluate the definitions of different types of elder mistreatment, and to validate indicators of specific types of mistreatment. Three-hundred fifty-one adult protective services (APS) representatives throughout the country comprised the expert panel for the two phase survey, which incorporated definitions, terms and indicators of mistreatment identified most frequently in the authors' analysis of state statutes (see CANE file #P5495-21). Respondents were to draw upon clinical experience in assessing the validity of survey items. Round one generated feedback on the relevance of definitions of specific types of mistreatment. The second round involved review of the revised items. Final approval rates for each revised definition ranged from 89 percent (for sexual abuse) to 98 percent (for self-neglect), although approval of the revised definitions for neglect, physical abuse, and sexual abuse decreased during the second survey. The term "willful" was controversial; in round one respondents suggested eliminating it from definitions but in round two respondents recommended using it. Definitions derived through this process were very similar to the ones provided by the National Center on Elder Abuse (NCEA), which are accessible online at: http://www.elderabusecenter.org/default.cfm?p=basics.cfm .

24. S6394-13
Dietz, T. & Wright, J.
Age and Gender Differences and Predictors of Victimization of the Older Homeless
Journal of Elder Abuse & Neglect; Vol. 17 (1), 37-60; 2005.
In general, rates of specific crimes among the homeless differ from those among the population in general. For example, rape and homicide rates are significantly higher among the homeless. Employing the Routine Activities Perspective as a theoretical framework, this descriptive study addresses age and gender differences in criminal victimization rates of the homeless. The framework postulates that risk for criminal victimization is based upon three factors: the absence of capable guardians (such as the police); the presence of motivated offenders; and vulnerable targets. Data was drawn from the National Survey of Homeless Assistance Providers and Clients (NSHAPC). Older adults were defined as anyone aged 50 and over. Although increasing age appears to be a protective factor against criminal victimization within the general population, it does not appear to be among the homeless population; older homeless individuals reported rates of victimization consistent with younger homeless individuals. Older women were as likely as older men to report being robbed or physically assaulted. Having a variety of health problems, including mental illness and substance abuse, was also associated with greater risk for victimization.

25. S6251-9
Erlingsson, C., Carlson, S. & Saveman, B.
Perceptions of Elder Abuse: Voices of Professionals and Volunteers in Sweden - An Exploratory Study
Scandinavian Journal of Caring Sciences; Vol. 20 (2), 151-159; 2006.
This article reports the findings of a focus group study conducted among various professionals and volunteers regarding elder abuse issues in Sweden. Group interviews were conducted with representatives from police, health care, and social services systems (including caregiver support programs). Qualitative content analysis revealed many common themes across various occupational groups. In particular, four themes emerged, some that indicate that there is a tendency to blame the victim and to tolerate elder abuse. Themes include the following: good intentions in abusive situations; older generation's responsibility for mistreatment; failure to report abuse; and prevention of abuse. The concept that even abusers could be victims within the contexts of their circumstances was also considered. These perceptions appear consistent with an earlier focus group study involving elders themselves. Unclear reporting procedures were also noted as problematic. (Sweden)

26. S6426-5
Fisher, B. & Regan, S.
The Extent and Frequency of Abuse in the Lives of Older Women and Their Relationship with Health Outcomes
The Gerontologist; Vol. 46 (2), 200-209; 2006.
This cross-sectional study of community dwelling older women was designed to measure the extent of abuse experienced in later life and the health related outcomes. Eight-hundred forty-two women aged 60 and older participated in a telephone survey about the type and frequency of mistreatment they had experienced since turning 55, health status and conditions, and demographic information. The instrument, the Women's Health and Relationship Survey (WHRS), measured five types of abuse: psychological/emotional (such as being criticized, being possessive); control (such as not letting the woman work); threat (with either verbal or physical intimidation); physical (including hitting, shoving, choking, etc.); and sexual (including being pressured or physically forced to have sex). Nearly half of the women (47 percent) had experienced at least one type of mistreatment since turning 55, most commonly psychological or emotional abuse, followed by threatening behavior, control abuse, physical and sexual abuse. Between 21 and 47 percent of the victims had been repeatedly abused, depending upon the type of abuse reported. Women who had been abused also reported higher rates of health problems, including bone or joint problems, digestive problems, depression, anxiety, high blood pressure and/or heart conditions. Physicians, nurses and other health care providers are encouraged to be aware of the potential for abuse of older patients and the health implications of such abuse.

27. S6341-3
Fritsch, T., Tarima, S., Caldwell, G. & Beaven S.
Intimate Partner Violence Against Older Women in Kentucky
Journal of the Kentucky Medical Association; Vol. 103 (9), 461-463; September 2005.
This population-based, random sample survey was designed to assess the lifetime prevalence of intimate partner violence (IPV) among women aged 60 and older in Kentucky; to identify health-related consequences of the abuse; and to determine the prevalence of IPV against older women during the 12 months preceding the survey (2002-2003). Eighteen percent of women aged 60 and over at the time of the survey had experienced IPV during her lifetime. In the year preceding the survey, 0.8 percent of the older women reported experiencing IPV. Nearly all (92.7) of those victimized reported psychological stress related to the abuse and nearly three-quarters (73.3 percent) sustained physical injuries. More than half of those victimized (59.9 percent) sought medical attention and/or counseling. Based upon these findings, researchers estimate that over 3,000 older Kentucky women were threatened, physically, sexually or psychologically abused, or stalked during the year preceding the study.

28. S6414-10
Fulmer, T., Paveza, G., VandeWeerd, C., Fairchild, S., Guadagno, L., Bolton-Blatt, M. & Norman, R.
Dyadic Vulnerability and Risk Profiling for Elder Neglect
The Gerontologist; Vol. 45 (4), 525-534; 2005.
Using a risk-and-vulnerability model, this dyadic research was designed to analyze both caregiver characteristics and vulnerabilities of elders that contribute to elder neglect. Older adult emergency department patients (aged 70 and up) and their caregivers were invited to participate. During admission, elders were screened for neglect. Participants were then individually interviewed to identify vulnerability and risk factors. Information on demographics, functional status, presence of depression, health and cognitive status, perceived social support, history of childhood trauma, and personality characteristics for both elder and caregiver were collected. Data for dyads evidencing elder neglect (n=29) and those not evidencing neglect (n=136) were compared. Neglecting caregivers were more likely to have poorer functional status, to have experienced childhood trauma (particularly neglect), and to demonstrate the personality trait of openness. Neglected elders were more likely to have cognitive impairment, health problems that limited their daily activities, higher levels of unmet needs, higher levels of depression, lower levels of social support, to have experienced childhood neglect, and demonstrate neuroticism as a personality trait. (This article draws upon the same data set as that of CANE file #S6448-5.)

29. S6448-5
Fulmer, T., Paveza, G., VandeWeerd, C., Guadagno, L., Fairchild, S., Norman, R., Abraham, I. & Bolton-Blatt, M.
Neglect Assessment in Urban Emergency Departments and Confirmation by an Expert Clinical Team
Journal of Gerontology: Medical Sciences; Vol. 60A (8), 1002-1006; 2005.
This study, conducted in four emergency departments (ED) across two states, focused on the identification of elder neglect cases and the congruence in diagnosis of neglect by ED screeners and an expert clinical team. After presenting problems were addressed, researchers invited ED patients aged 70 and older to participate. Four-hundred and five patients met the inclusion criteria (lived at home, received at least 20 hours of caregiver support per week, and had a Mini-Mental Status Exam score of 18 or above) and agreed to participate. Research assistants in the ED collected demographic, health and social data and diagnosed 22 cases (5 percent) of neglect. However, the neglect assessment team (NAT) comprised of a physician, nurse and social worker, identified 86 cases (22 percent). (This article draws upon the same data set as that of CANE file #S6414.)

30. S6475-17
Furness, S.
Recognising and Addressing Elder Abuse in Care Homes: Views from Residents and Managers
Journal of Adult Protection; Vol. 8 (1), 33-49; May 2006.
This exploratory study focuses on the protection of older adults living in residential care homes in the U.K. Nineteen care managers and 19 residents were interviewed regarding their experiences. Care managers discussed all types of elder mistreatment except sexual abuse, which may have been overlooked due to age bias. Most care managers had first or second hand knowledge of elder abuse from their own work related experiences. They reported using similar strategies in addressing incidents of mistreatment. However, relatively few reported the incidents to licensing agencies or police. Of concern, only six of the residents were able to properly identify examples of abuse. The potential for licensing agencies to provide enhanced protection against elder abuse is discussed. The need to incorporate residents' views in policy planning is also emphasized, along with the need for mandatory training for managers. (Note: Portions of the interview protocol are included.) (U.K.)

31. S6119-10
Golding, J., Yozwiak, J., Kinstle, T. & Marsil, D.
The Effect of Gender in the Perception of Elder Physical Abuse in Court
Law and Human Behavior; Vol. 29 (5), 605-614; October 2005.
This article reports upon a study designed to evaluate the impact of gender on the perception of elder physical abuse in court proceedings. Two experiments were conducted eliciting responses of participants to scenarios involving a fictional criminal trial case of elder abuse. The scenarios varied according to the alleged victim's and perpetrator's gender and age. In both experiments, the majority of participants voted that the alleged perpetrator was guilty. In general, female mock jurors were more likely than men to believe the alleged victim's testimony, particularly when the alleged perpetrator was female. This finding is consistent with previous research concerning other forms of abuse.

32. S6355-18*
Harbison, J., Coughlan, S., Karbanow, J. & VanderPlaat, M.
A Clash of Cultures: Rural Values and Service Delivery to Mistreated and Neglected Older People in Eastern Canada
Practice; Vol. 17 (4), 229-246; December 2005.
In this exploratory study, the authors examine strategies for service delivery to abused and neglected older individuals from rural communities of eastern Canada. They note that the little research existing on rural victims of elder abuse tends to focus on the limits of resources available in these regions but neglects to consider the impact of cultural values that may also constitute service barriers. Health and social services professionals (including adult protective services professionals), law enforcement, and senior volunteers and advocates were interviewed. Among the themes noted across localities was the desire of older individuals in rural communities to maintain autonomy and privacy regarding family matters, including abuse. Participants echoed the desire to respect the rights and wishes of their clients while offering assistance. Collaboration across disciplines was noted as a means to enhance service provision in regions where resources were scarce. Establishing a relationship with the client was considered the most basic step in reducing resistance to help. A discussion of the legal mandate governing the reporting of elder abuse is also presented. (Canada)

33. S6455-4*
Heath, J., Brown, M., Kobylarz, F. & Castano, S.
The Prevalence of Undiagnosed Geriatric Health Conditions Among Adult Protective Service Clients
The Gerontologist; Vol. 45 (6), 820-823; 2005.
The purpose of this retrospective study was to determine the prevalence of undiagnosed health conditions among adult protective services (APS) clients from two counties in New Jersey. Two-hundred eleven clients referred to the Linking Geriatrics with Adult Protective Services (LGAPS) program were assessed by a multidisciplinary health and social service team. Dementia was diagnosed in 62 percent of the referred clients, and depression was diagnosed in 37 percent. Nutritional concerns and pain were also identified, along with 22 cases of alcohol misuse. Dementia was positively correlated with financial exploitation and caregiver neglect. The detection of many medical conditions underscores the benefits of collaborative approaches in addressing elder mistreatment. (Note: This article is based upon the same data set as CANE file # S6339-5.)

34. S6339-5*
Heath, J., Kobylarz, F., Brown, M. & Castano, S.
Interventions from Home-Based Geriatric Assessments of Adult Protective Service Clients Suffering Elder Mistreatment
Journal of the American Geriatrics Society; Vol. 53 (9), 1538-1542; September 2005.
This retrospective study describes the interventions applied in 211 cases referred to the "Linking Geriatrics with Adult Protective Services" (LGAPS) multidisciplinary assessment team (New Jersey). In this program, a geriatric health care team, in collaboration with a referring social worker, conducted comprehensive in-home medical and functional assessments of clients referred. Among those referred, many had experienced multiple categories of mistreatment, but the most common category experienced was self-neglect (76 percent), followed by caregiver neglect (47 percent), financial exploitation (29 percent) and physical abuse (15 percent). Based upon these assessments, home health services were initiated for 46 percent of the APS clients; 35 percent were placed in alternative settings (54 were placed in nursing homes, 16 in assisted living facilities, and six in other settings); and in 36 percent of the cases, mostly those involving neglect by caregivers, guardianship proceedings were initiated. Urgent pharmacological interventions were required in 25 percent of the cases, primarily due to acute pain or significantly high blood pressure. In 19 percent of the cases, hospitalization was necessary, primarily due to physical abuse. (Note: This article is based upon the same data set as CANE file #S6455-4.)

35. S6175-39
Hernández-Medina, E., Eaton, S., Hurd, D. & White, A. for the AARP Public Policy Institute
Training Programs for Certified Nursing Assistants
AARP Public Policy Institute; Washington, D.C.; March 2006.
As quoted from the AARP Public Policy Institute web site, "Certified nursing assistants (CNAs) provide most of the care received by nursing home residents. Although their work is often perceived as 'unskilled,' CNAs perform complex and important functions. Despite their title, their main role is not to assist nurses, but to assist residents. They help residents with daily activities, measure their vital signs, watch for and report changes in their conditions, and provide companionship and emotional support. Good quality care for residents and a stable CNA workforce depend on providing CNAs with the training they need to be well prepared for their jobs since inadequate training contributes to staff dissatisfaction and high turnover which adversely affect quality of care. This AARP Public Policy Institute Issue Paper adds to the literature on CNA training by examining how many hours of initial training and clinical training are needed. It focuses on state nurse aid training programs in California, Florida, Maine, Maryland, Massachusetts, Michigan, New York, Pennsylvania, Texas and Wisconsin. The study looks at pre-training screening, remedial education, training in English as a Second Language, and shadowing. CNA testing and reimbursement of CNAs for their training and testing expenses are also considered. Based on their findings, the authors make recommendations for ensuring that CNAs receive adequate training to provide good care to residents, improving student retention, and ensuring that CNAs are properly reimbursed for their training and testing expenses." (Note: This report is accessible online at: http://www.aarp.org/research/longtermcare/nursinghomes/2006_08_cna.html .)

36. S6429-11
Hightower, J., Smith, M. & Hightower, H.
Hearing the Voices of Abused Older Women
Journal of Gerontological Social Work; Vol. 46 (3/4), 205-227; 2006.
This paper reports upon research conducted in British Columbia on the abuse of women aged 50 and older. Sixty-four participants were interviewed via telephone and through group sessions regarding their experiences of domestic violence (DV). Women described examples of physical, psychological, sexual, and financial abuse, and violations of human rights. Many women described multiple experiences of abuse in numerous relationships, including lifelong histories of mistreatment. While most reports involved intimate partner abuse, a small percentage (consisting mainly of financial abuse) was perpetrated by adult children. Participants revealed physical and psychological problems related to the abuse. They expressed concern for their children, who in many instances were also involved in abusive partnerships, reflecting the theme of the intergenerational transmission of violence. Participants identified the need for shelters and housing, counseling, employment, and social support. (Note: This research design was modeled after the Australian study conducted by Morgan Disney & Associates. See CANE files P5083-103 and P5087-69.) (Canada)

37. S6178-12*
Iecovich, E.
Elder Abuse and Neglect in Israel: A Comparison Between the General Elderly Population and Elderly New Immigrants
Family Relations; Vol. 54 (3), 436-447; July 2005.
This study, based upon data gathered on the occurrence of elder abuse in Beer Sheva, a city in the southern region of Israel, focuses on the differences of the types and frequency of elder mistreatment experienced by individuals from the general elderly population and new elderly immigrants. Researchers hypothesized that immigrants would be at greater risk for all types of mistreatment, and that predictors for mistreatment would differ among these two cultural groups. The first phase of the research involved health and social care professionals and paraprofessionals completing a brief questionnaire on clients that they suspected were being victimized. The referrals were evaluated by trained social workers who followed-up on cases with strong indicators of elder mistreatment. Among the findings, 120 new cases of elder abuse and neglect were identified in this city during a one-year period, including 48 cases involving new immigrants from former Soviet Union countries. The overall incidence rate of new cases was 0.5 percent, only slightly higher among new immigrants compared to the general population. Although new immigrants were at lower risk for physical abuse, they were at significantly higher risk for neglect. The article also discusses specific sociodemographic characteristics that appear related to various types of elder mistreatment. Limited information is also provided regarding perpetrator characteristics. (Note: For additional information on the incidence study see CANE file # R6027-19.) (Israel)

38. S6337-9
Irizarry Irizarry, A.
Pilot Study of the Differences Among the Puerto Rican Aged by Gender in Opinion, Attitude and Exposure to Abuse, Mistreatment and Neglect
Puerto Rican Health Science Journal; Vol. 24 (4), 303-311; December 2005.
This study analyzed gender differences related to the knowledge and perceptions of elder mistreatment among older Puerto Ricans. Four-hundred and thirty community-dwelling individuals (60 percent female), aged 60 and older, from the area of Arecibo, participated in the survey. Regardless of gender, participants appeared to be knowledgeable about what constitutes elder mistreatment. Gender differences were detected in opinions held regarding abuse. For example, women were more likely than men to believe that abused elders suffer from fear, and that abuse victims remain silent due to feelings of fear, shame and guilt. Differences in responses to statements regarding exposure to various types of mistreatment were compared with results from previous studies conducted in Puerto Rico and the U.S. (Puerto Rico)

39. S6256-5
Jogerst, G., Daly, J., Dawson, J., Peek-Asa, C. & Schmuch, G.
Iowa Nursing Home Characteristics Associated with Reported Abuse
Journal of American Medical Directors Association/JAMDA; Vol. 7 (4), 203-207; May 2006.
This study was designed to analyze the relationship between nursing home characteristics in Iowa licensed facilities and rates of elder abuse reports made by employees. Administrators and/or directors of nursing (DON) from the 369 of the state's 409 Medicare-certified stand-alone nursing homes participated in a survey that included items relating to incidents of elder abuse, reports made to the Iowa Department of Inspections (IDIA), and substantiated cases of elder abuse during the preceding year. Information on nursing home characteristics, staffing, deficiencies, census demographics, and ownership was gathered from Medicare's Nursing Home Compare Reports, Urban Influence Codes, and county census demographics. The overall annual rate of abusive events was 20.7 per 1000 residents, with an annual rate of 18.4 events per 1000 residents reported to the authorities, and an overall substantiation rate of 5.2 per 1000. A higher number of residents and certified beds were significantly associated with higher rates of abusive incidents, reports, and substantiations. Higher incident and report rates were also found in facilities located in metropolitan areas, and higher substantiation rates were also associated with for-profit status.

40. S6358-8*
Jogerst, G., Daly, J. & Hartz, A.
Ombudsman Program Characteristics Related to Nursing Home Abuse Reporting
Journal of Gerontological Social Work; Vol. 46 (1), 85-98; 2005.
This study considered the association between ombudsman reporting of rates of abuse, gross neglect, and exploitation with public and ombudsman staff education, investigative process, program expenditures and census demographics. Data regarding reporting rates was drawn from the National Ombudsman Reporting System (NORS) from 1997 through 2002 and state census demographics were obtained from the 2000 U.S. Census. During that period, state rates of abuse, gross neglect, and exploitation ranged from 0.4 to 158 per 1,000 nursing home beds, and physical abuse and resident-to-resident abuse were the highest reported categories of mistreatment. Among the findings: "...Community education sessions presented at the state level were significantly associated with higher abuse rates except for resident-to-resident sexual abuse...Ombudsman staff and volunteer training sessions and number of trainees were significantly correlated with all categories of abuse except neglect and resident-to-resident sexual abuse...Total and state program expenditures and full time equivalent paid ombudsman program staff were significantly correlated with all types of abuse..." The article provides a discussion regarding the ombudsman reporting process, which requires the resident's approval, highlights variations in classification of complaints, and points out that nursing home abuse can be reported to the ombudsman, adult protective services, law enforcement, or state licensure agencies. These issues, along with individual program characteristics unique to specific states, coupled with state demographic differences, are some reasons why cross state comparisons are problematic, and why such annual reports alone "should not be construed to represent all abuse in nursing homes..."

41. S6275-63
Karp, N. of the AARP Public Policy Institute and Wood, E. of the American Bar Association Commission on Law and Aging
Guardianship Monitoring: A National Survey of Court Practices
AARP Public Policy Institute; Washington, D.C.; June 2006.
This report was designed to assess the current state of guardianship monitoring throughout the U.S., and to determine how the field has advanced since a 1991 ABA survey. The report provides an overview of the guardianship process and a history of monitoring reform efforts. The national project involved surveying experts in the guardianship system (387 judges, court mangers, guardians, elder law attorneys, and legal representatives of people with disabilities). There is an ongoing initiative to research guardianship monitoring through site visits and interviews in jurisdictions demonstrating exemplary practices. Key findings include the following: "Despite a dramatic strengthening of statutory safeguards, guardianship monitoring practices continue to show wide variation; practices regarding filing of reports by guardians have advanced over the past 15 years, with more courts requiring periodic personal status reports and forward-looking plans; verification of guardian reports and accounts is frequently lacking; over one-third of respondents said no one is designated to verify the information in these mandatory reports; over 40 percent reported that no one is assigned by the court to visit individuals under guardianship, and only one-fourth said that someone visits regularly; use of technology in monitoring is minimal, despite vast opportunities for web-based and email monitoring techniques and computerized data collection; funding for guardianship monitoring remains minimal." Appendices include the survey and a table of state statutory authorities for guardianship monitoring. (Both the "In Brief "and full report are accessible online at: http://www.aarp.org/research/legal/guardianships/2006_14_guardianship.html .)

42. S6357-7
Keith, P.
Nursing Home Administrators' Views of Their Own and Volunteer Resident Advocates' Enhancement of Long-Term Care
Journal of Elder Abuse & Neglect; Vol. 17 (1), 75-87; 2005.
The author of this article points out that the nursing home climate, which is significantly established by the nursing home administrators (NHAs), impacts the roles played by volunteer resident advocates associated with a Long-Term Care Ombudsman Program, and the effectiveness of their interventions. This study analyzed whether NHAs value the efforts of volunteer resident advocates (not certified ombudsmen) in enhancing long-term care. Such volunteers make regular but unannounced visits to long-term care facilities to advocate for residents and their families in order to resolve problems and to protect the vulnerable. One-hundred ninety-nine Iowan NHAs completed a survey regarding the impact they perceived that advocates had on residents' lives, how they protected residents' rights, informed staff of residents' needs, and resolved complaints made by or on behalf of residents. Eighty-nine percent of the participants believed most residents benefited to some degree from the volunteers' interventions, and 70 percent agreed that residents were usually pleased to meet with the volunteers. (Note: This article draws upon the same data set as that of CANE file #S63361-4.)

43. S6361-4
Keith, P.
Nursing Home Administrators' Views of Volunteers' Work in an Ombudsman Program
Journal of Aging Studies; Vol. 19 (4), 513-520; 2005.
Noting that research suggests that the presence of representatives from external state agencies within nursing home settings can be stressful to nursing home administrators (NHAs), this article analyzes NHAs' opinions of their interactions with volunteer resident advocates and the effectiveness of the volunteers' interventions on behalf of residents and their families. The author hypothesized that more frequent site visits and a greater amount of direct contact between the volunteer resident advocate (associated with a Long-Term Care Ombudsman Program, but not a certified ombudsman) and administrator would be associated with less satisfaction and perceptions of ineffectiveness; however, more frequent visits and a greater amount of contact between the advocate and administrator were associated with higher assessments of program effectiveness. Among the results, approximately one-third of those surveyed (n=196) found the program to be very effective, 45 percent believed it was somewhat effective, and 20 percent believed the program was somewhat or very ineffective. Eighty-one percent agreed or strongly agreed that they were satisfied with the work of the volunteers. Perceived benefits of volunteers' efforts were also reported, and included enhancements in the organizational environment of the nursing home, and improved relationships among the facility and other community entities. (Note: This article draws upon the same data set as that of CANE file #S6357-7.)

44. S6125-5*
Kemp, B. & Mosqueda, L.
Elder Financial Abuse: An Evaluation Framework and Supporting Evidence
Journal of the American Geriatrics Society/JAGS; Vol. 53 (7), 1123-1127; 2005.
This study was designed to develop a viable framework for evaluating cases of alleged elder financial abuse. Eight elements were incorporated into the framework: the older adult's vulnerability due to physical, psychological, pharmacological, or social problems; a trusted individual who exploits the vulnerability; the transference of assets during a period of vulnerability; isolation of the vulnerable adult; a lack of an appropriate assessment of the vulnerable elder's capacity to make such decisions; inadequate compensation for transfers; a lack of commonly accepted business protocols; a lack of recognition of the impact of the transaction by the perpetrator. A sample of 159 professionals (district attorneys, law enforcement, adult protective services professionals and social workers) were asked to rate how well the framework evaluated financial abuse cases, based upon their experiences in working directly with such cases. Out of 5 total points, the average rating was a 4.4, with 90 percent of the participants indicating that the framework mirrored their experiences very much or entirely. No significant differences were found among professional groups. The tool may be used by multidisciplinary teams, and by clinicians (particularly geriatric physicians) evaluating the victim's vulnerability and the dynamics between perpetrator and victim.

45. S6141-11*
Konig, J. & Leembruggen-Kallberg, E.
Perspectives on Elder Abuse in Germany
Educational Gerontology; Vol. 32 (1), 25-35; 2006.
This article describes the responses of 74 German participants (57 women and 17 men, aged 15 through 62) who provided examples of what they perceived as extremely, moderately, or mildly abusive behaviors of adult children towards elderly parents. The authors note the difficulty in finding a translation for the English word abuse; they used the term "missbrauch" which means "misuse" and can include "sexual abuse, substance abuse and taking unfair advantage of someone," and "misshandlung" which refers to physical violence. Among the findings, physical abuse was categorized most frequently as extremely abusive in nature, as were physical neglect and abandonment; psychological abuse was more often viewed as moderately abusive; economic abuse was viewed typically as moderate; and psychological neglect was viewed as primarily mild. A few gender and age differences were noted; for example, women offered more examples of psychological abuse as mild in degree, and men offered more examples of physical abuse as moderate in degree. (Germany)

46. S6294-16***
Lachs, M., Bachman, R., Williams, C., Kossack, A., Bove, C. & Leary, J.
Older Adults as Crime Victims, Perpetrators, Witnesses, and Complainants: A Population-Based Study of Police Interactions
Journal of Elder Abuse & Neglect; Vol. 16 (4), 25-40; 2004.
Drawing upon the New Haven EPESE study (Established Populations for Epidemiological Studies in the Elderly), the goal of this research was to examine the nature and extent of law enforcement contacts among older community members. Police records from the cohort's catchment area for 1985 through 1995 were analyzed to identify interactions between participants and law enforcement. The following details were abstracted from the records of the elders who had police involvement: their role (victim, perpetrator, complainant, or witness); type of crime; participant's relationship to perpetrator; whether or not a weapon was used; number of offenders; whether there was physical contact between the victim and offender; and if the victim required medical attention. These details were merged with the corresponding EPESE records to provide a police-health data set including demographic characteristics, psychological/social characteristics, medical indicators, and functional ability. Of the 2,321 cohort members, 684 (29.5 percent) had at least one police contact during this time frame, with a total of 1,651 incidents. Most commonly, participants were victims (57.5 percent), followed by complainants (7.5 percent), offenders (4.2 percent), and witnesses (3.4 percent). (Participants were also categorized as "other," and nearly 20 percent had multiple contacts involving various roles.) Of the incidents wherein participants were victims, 21 percent involved violence, including 42 episodes occurring in nursing homes, primarily involving resident-to-resident abuse. Larceny and burglary were the most common types of nonviolent crimes. Being male, African-American, and/or younger members of the cohort appeared associated with a statistically greater likelihood of police contact. An interesting finding was that cohort members who had police contact were less functionally impaired than those with no contact.

47. S6252-9
Lauder, W., Ludwick, R., Zeller, R. & Winchell, J.
Factors Influencing Nurses' Judgements about Self-Neglect Cases
Journal of Psychiatric and Mental Health Nursing; Vol. 13 (3), 279-287; 2006.
In this survey, researchers attempted to identify which patient characteristics had the greatest impact on nurses' judgments concerning decision-making capacity in cases of self-neglect, particularly involving patients with dementia or mental illness. Forty public health registered nurses from Ohio were surveyed regarding which interventions they would select (including Meals on Wheels, house cleaning, patient education, medication, community nursing referral, and referral to mental health service) in response to six vignettes depicting various cases of self-neglect. Results indicate nurses tended to broadly categorize patients as having no mental illness, minor mental illness and severe mental illness, and that the presence and degree of mental illness had the greatest impact upon interventions chosen. Problems with such immediate judgments are considered. (Note: The article includes a list of variables incorporated in the vignettes and the rationale for inclusion.)

48. S6398-8
Lee, M. & Kolomer, S.
Caregiver Burden, Dementia, and Elder Abuse in South Korea
Journal of Elder Abuse & Neglect; Vol. 17 (1), 61-75; 2005.
This study analyzes characteristics that may increase the likelihood of elder abuse among Korean elders with dementia who have family caregivers. Analysis was based upon interviews with a sample of 481 caregivers, and data from the Comprehensive Study for the Elderly Welfare Policy in Seoul. A number of predictors were evaluated, including demographic characteristics, caregiver and care recipient characteristics, the severity of cognitive impairment and functional ability, caregiver burden, and social support. Fifteen percent of the caregivers reported often ignoring care recipients questions; 15 percent acknowledged verbally abusing the care recipient frequently; 7.5 percent admitted to confining the care recipient in a room; and 3.3 percent admitted to physically abusing the care recipient. The degree of elder abuse appeared to be significantly associated with caregiver burden and with severe cognitive impairment. Caregivers who utilized formal support services were less likely to demonstrate abusive behaviors. (South Korea)

49. S6393-13
McCawley, A., Tilse, C., Wilson, J., Rosenman, L. & Setterlund, D.
Access to Assets: Older People with Impaired Capacity and Financial Abuse
Journal of Adult Protection; Vol. 8 (1), 20-32; May 2006.
This research involved a secondary data analysis of 234 cases of individuals aged 65 and over with impaired capacity who had been referred to the Guardianship and Administration Tribunal of Queensland, Australia. Data analysis focused on circumstances prior to referral to the Tribunal. Referrals were made to the Tribunal to determine the need for appointment of an administrator, either because of suspected financial abuse, or because the individual required assistance with asset management due to impaired capacity. Twenty-six percent of the referred cases were classified as suspected intentional and unintentional financial abuse. Findings suggest that in 60 percent of the cases of suspected financial abuse, perpetrators had been granted some level of authorization (for example, enduring power of attorney or EPA) to manage assets. While formal legal mechanisms may be necessary to ensure that individuals with impaired capacity are adequately protected, monitoring of such mechanisms is also necessary. In addition, greater education and preparation for those who provide substitute decision-making is also warranted. (Australia)

50. S6427-5
Mezey, M., Quinlan, E., Fairchild, S. & Vezina, M.
Geriatric Competencies for RNs in Hospitals
Journal for Nurses in Staff Development; Vol. 22 (1), 2-10; 2006.
This article reports on the development and testing of the "Geriatric Competencies for RNs in Hospitals," an instrument designed to measure core nursing skills necessary for appropriate care of older patients. Eight core competencies are identified: communication barriers; physiological and physical age related changes; pain assessment among cognitively impaired patients; skin integrity; functional status (including overall functioning, urinary incontinence or UI, nutrition/hydration, and falls and injuries); restraint use; elder abuse; and discharge planning. Efforts to validate the instrument began by testing geriatric registered nurses (RNs) and non-geriatric RNs on issues related to incontinence and falls. Results indicate that the tool is appropriate for use in the initial and ongoing monitoring of staff strengths and weaknesses.

51. S6344-9
Miller, L., Lewis, M., Williamson, G., Lance, C., Dooley, W., Schulz, R. & Weiner, M.
Caregiver Cognitive Status and Potentially Harmful Caregiver Behavior
Aging & Mental Health; Vol. 10 (2), 125-133; March 2006.
In this study, the association between caregiver cognitive status and potentially harmful caregiver behavior was assessed among 180 caregiver-care recipient dyads. At least mildly compromised cognitive status was detected among 39 percent of the informal caregivers. After controlling for factors such as amount of care provided, care recipient cognitive status, and caregiver depressed affect, care recipients of caregivers with compromised cognitive status reported experiencing more verbal abuse, including threatening behaviors. Also of note, spousal caregivers reported providing more care, were more likely to be depressed, and were more likely to be reported as abusive than non-spousal caregivers. (Note: This article is currently available online at: http://www.uga.edu/psychology/millerlab/publications/pubs_pdf/Miller_etal_Aging

52. S6451-10
Montminy, L.
Older Women's Experiences of Psychological Violence in Their Marital Relationships
Journal of Gerontological Social Work; Vol. 46 (2), 3-21; 2005.
This qualitative research analyzes the types of psychologically violent behaviors experienced by 15 women aged 60 to 81. Participants were recruited by practitioners who worked with older women who had experienced domestic violence (DV). Content analysis of the interviews suggests that psychologically violent behaviors could be categorized into the following broad groups: control; denigration; deprivation; intimidation; threats; abdication of responsibility; manipulation; blame; harassment; negation of reality; indifference; inducing guilt; sulking; and infantilization. Control behaviors appeared predominant, and increased during significant life transitions: upon retirement; when children left home; and when husbands experienced a decline in health status. Clinical implications underscore the need for early intervention and to talk with older women about gender roles. (Canada)

53. S6418-10
Moon, A., Lawson, K., Carpiac, M. & Spaziano, E.
Elder Abuse and Neglect Among Veterans in Greater Los Angeles: Prevalence, Types, and Intervention Outcomes
Journal of Gerontological Social Work; Vol. 46 (3/4), 187-204; 2006.
By analyzing the medical records of 575 veterans who had received services at the Veteran's Affairs Geriatric Outpatient Clinic in Los Angeles over a three year period, researchers studied the prevalence, types and intervention outcomes among this population. Elder abuse reports had been filed on behalf of 31 of the clients, representing 5.4 percent of the study population. Rates were higher among those aged 80 and older, and among Caucasian and African Americans. Financial abuse and self-neglect were reported most commonly, although eight veterans experienced multiple forms of mistreatment. While perpetrators were typically family members, three-fourths of the financial abuse was committed by non-family members. Nearly half of the victims suffered from dementia and over one-third experienced depression. The most common intervention was relocation of the victim to either a nursing home or board and care facility, followed by conservatorship arrangement. A breakdown of intervention outcomes by case type is included.

54. S6458-5
Morgan, E., Johnson, I. & Sigler, R.
Public Definitions and Endorsement of the Criminalization of Elder Abuse
Journal of Criminal Justice; Vol. 34 (3), 275-283; 2006.
This article reports upon the findings of a longitudinal cross-sectional study conducted to measure public definitions of elder abuse and the willingness to endorse criminal sanctions for perpetrators. Data was collected through random sample surveys conducted in the area of Tuscaloosa, Alabama, in 1986-1987 (n=117), again in 1991-1992 (n=134), and in 1996-1997 (n=159). Results suggest that the public perceptions of what constitutes physical elder abuse remained constant over time. Perceptions of neglect and psychological abuse also appeared relatively constant, with some exceptions. For example, not spending time with the elder was viewed as more neglectful in the earlier survey results compared to later findings. Perceptions of financial abuse appeared less consistent over time. Support for the criminalization of elder abuse increased throughout the course of the study, as participants endorsed the creation of misdemeanor and felony statutes, and prison sentences for punishment of perpetrators.

55. S6121-5
Mosqueda, L., Burnight, K. & Liao, S.
The Life Cycle of Bruises in Older Adults
Journal of the American Geriatrics Society/JAGS; Vol. 53 (8), 1339-1343; August 2005.
Although bruising may be a sign of elder mistreatment, little research on bruising has been conducted among geriatric patients. This study analyzed information on the occurrence, progression and resolution of accidental bruising in patients aged 65 and over. One-hundred and one seniors, living in both community-based independent settings and skilled nursing facilities participated, and were screened daily for evidence of new bruises. Seventy-three of the subjects developed at least one accidental bruise during the two week initial inspection period. Once identified, it was observed daily until resolution (up to six weeks). Participants (or their proxies) were asked to identify the source of the bruise. Ninety-six of the 108 identified bruises occurred on the extremities, while only 12 occurred on the trunk. None were found on the neck, ears, genitalia, buttocks, or soles of the feet. Participants were more likely to know the source of the bruise if it was on the trunk. Sixteen of the bruises were predominately yellow within the first 24 hours of the onset, which is contrary to the general perception that yellowing usually indicates an older bruise. People on medications affecting coagulation commonly had more than one bruise. Such data collection represents an initial step in providing a basis for comparison between accidental and suspicious bruising. (Note: An unpublished report of this research is available online at: http://www.ncjrs.gov/pdffiles1/nij/grants/214649.pdf#search=%22%22Bruising%20in%20the%20Geriatric%20Population%22%22 .)

56. S6445-13
Mouton, C., Larme, A., Alford, C., Talamantes, M., McCorkle, R. & Burge, S.
Multiethnic Perspectives on Elder Mistreatment
Journal of Elder Abuse & Neglect; Vol. 17 (2), 21-45; 2005.
In order to devise strategies to identify elder mistreatment (EM) across a variety of cultures, this study was conducted to gain insight into perspectives of EM from different cultural groups. Focus group interviews were conducted with three ethnically homogenous groups (African American, European American and Mexican American) of elders and a group of elder care professionals. Eighteen individuals participated in the ethnic groups and six participated in the professional group. Group discussion focused on the interpretation of various case scenarios. Discussion centered on social expectations (including gender role, filial obligations, marital fidelity and ageism); caregiver expectations (family caregivers were given greater leeway than professional caregivers); victim characteristics (vulnerabilities on the part of the victim influenced the interpretation of abuse); and characteristics of the interaction (such as resistance to care). Few cultural differences were observed in this study, which conflicts with previous findings. However, there were differences observed between the professional group and the ethnic groups, particularly relating to the issue of autonomy versus beneficence.

57. S6295-00*
NASD Investor Education Foundation, in cooperation with WISE Senior Services and AARP
Off the Hook Again: Understanding Why the Elderly Are Victimized by Economic Fraud Crimes
NASD Investor Education Foundation, with WISE Senior Services and AARP; Washington, D.C.; July 2006.
This study examines "why certain elderly investors are more susceptible to investment fraud than others, exposes the various tactics used by criminals to exploit seniors and offers strategies to help seniors avoid becoming victims... Researchers for the project analyzed undercover tapes of fraud pitches and surveyed victims and non-victims to determine how they differ. The researchers used their findings to develop practical messages to increase fraud awareness among seniors. Some of the key research findings include: investment fraud victims are more financially literate than non-victims; investment fraud criminals use a wide array of different influence tactics, from friendship to fear and intimidation tactics, to defraud the victim; fraud pitches are tailored to match the psychological needs of the victim; investment fraud victims are more likely to listen to sales pitches; investment fraud victims are more likely to rely on their own experience and knowledge when making investment decisions; fraud victims experience more difficulties from negative life events than non-victims; investment fraud victims are more optimistic about the future; investment fraud and lottery victims dramatically under-report fraud..." It is recommended that financial literacy and fraud prevention programs include education on persuasion tactics. (Note: To access the report and related materials, including a PowerPoint presentation and an audio file of real-life fraud pitches, visit http://www.nasdfoundation.org/research.asp .)

58. S6155-4
National Institute of Justice (NIJ), the Research, Development, and Evaluation of the U.S. Department of Justice
Victim Satisfaction with the Criminal Justice System
NIJ Journal; No. 253; January 2006.
This article was based upon the following three grant reports submitted to NIJ: "Victim Satisfaction with Criminal Justice Case Processing in a Model Court Setting;" "Forgoing Criminal Justice Assistance: The Non-Reporting of New Incidents of Abuse in a Court Sample of Domestic Violence Victims;" and "Effects on Victims of Victim Service Programs Funded by the STOP Formula Grants Program." In sum, this research suggests that victims of domestic violence (DV, also known as Intimate Partner Violence or IPV), may be so dissatisfied with the criminal justice system intervention that they are unlikely to contact the police the next time they need assistance. Among the women who chose not to report subsequent abuse were women who were least likely to have resisted the arrest of the offender during the previous incident, and those who were most likely to believe that the police action had negatively affected their safety. Among other findings, this research suggests that mandatory arrest policies have not resulted in more cases of DV being prosecuted. (Note: Not specific to elders.) (This article is accessible online at: http://www.ojp.usdoj.gov/nij/journals/253/victim.html .)

59. S6463-4
Nusbaum, N., Cheung, V., Cohen, J., Keca, M. & Mailey, B.
Role of First Responders in Detecting and Evaluating Elders at Risk
Archives of Gerontology and Geriatrics; March 2006.
Observing that first responders, such as police, fire fighters and emergency medical personnel, may have interaction with elders who live in relative isolation, this study was designed to evaluate their approach to vulnerable elders who may be victims of (or at risk for) elder abuse and neglect. One-hundred eighty-six first responders from northern Illinois completed a brief survey regarding their interactions with elders during the previous six months. More than half had encountered at least one elder that they believed may have been abused or neglected, and more than three-fourths estimated that they had met an elder who posed a danger to self or others, but very few (2 percent) had screened the elders for potential risk. Immediately following the survey, first responders participated in an educational intervention designed to promote awareness and routine screening. The results of the survey indicate that although first responders have potential to identify abused, neglected and at risk elders, a structured approach to screening for these conditions is warranted. (Note: This article is currently only available in pre-publication electronic format.)

60. S6468-12
Oh, J., Kim, H., Martins, D. & Kim, H.
A Study of Elder Abuse in Korea
International Journal of Nursing Studies; Vol. 43 (2), 203-214; February 2006.
This study examines the nature and extent of elder abuse in Songpa Gu, a district within Seoul, Korea. A total of 15,230 elders (representing 53 percent of the district's elderly population) were interviewed in their homes during 1999. Results indicate that 6.3 percent of the sample had experienced one form of mistreatment, with emotional abuse being most commonly reported, and physical abuse being least commonly reported. In more than three-fourths of the cases, sons and daughters-in-law were the perpetrators. All types of abuse were more common among elders who lived with their married children. (Korea)

61. S6118-25
Pattison, B., Fields, T., Whitley, B., Tharp, D., Walker, M., Khoury, S., Davis, T. & Tedesco, B., for the Office of Inspector General (OIG), Department of Health and Human Services (DHHS)
Nurse Aide Registries: Long Term Care Facility Compliance and Practices (OEI-07-04-00140)
Office of Inspector General (OIG), Department of Health and Human Services (DHHS);
July 2005.
This study examined the screening practices applied by nursing home administrators when hiring nurse aides and their compliance with federal regulations. Findings were based upon the responses to a random sample survey of 200 long-term care (LTC) administrators and on employment information from their facilities. All administrators reported consulting their state registry prior to offering employment, and 44 percent indicated that they periodically checked to determine if registries had been updated with adverse events concerning current staff members. Seventeen percent of the LTC facilities were not in compliance with federal regulations as they had either employed aides for a period longer than four months without completing required registrations or with registrations that expired. Additionally, 55 percent of the administrators only checked their own state registry. While 85 percent of participants reported that they had implemented additional screening procedures (such as criminal background checks and personal and employment reference checks), these efforts appeared limited in their usefulness for various reasons. Recommendations include the need to: review the registries of other states; employ unregistered aides for no more than four months, per federal regulations; and require periodic registry checks of all employed aides, in addition to conducting comprehensive criminal background checks prior to hiring. (Note: This report is accessible online at: http://oig.hhs.gov/oei/reports/oei-07-04-00140.pdf .)

62. S6219-12
Pavlou, M. & Lachs, M.
Could Self-Neglect in Older Adults Be a Geriatric Syndrome?
Journal of the American Geriatrics Society (JAGS); Vol. 54 (5), 831-842; 2006.
Researchers conducted an anlysis of the literature to consider the possibility that self-neglect is a geriatric syndrome. The authors define a geriatric syndrome as "...an accumulation of impairments in multiple systems that produces a phenotypic decline in function or independence..." In order to identify relevant literature, the MEDLINE and AGELINE databases were searched using keywords such as "self-neglect," "squalor syndrome," "Diogenes' syndrome," with related terms and known risk factors (such as dementia). In all, 54 articles were identified (24 case series, 13 theoretical articles, 11 observational studies and six reviews) of varying methodological quality. To assess whether self-neglect appears to be a geriatric syndrome, the material was evaluated along the following domains: multifactorial etiology; risk factors shared with other geriatric syndromes; association with functional decline; and association with mortality. Results suggest that self-neglect has multiple etiologies, that it shares risk factors with other geriatric syndromes, and that it is associated with increased mortality (only an association with functional decline was not identified). Therefore, the literature supports the concept of self-neglect as a geriatric symptom, which holds clinical implications for intervention. Recommendations are generated regarding identified gaps in self-neglect research.

63. S6411-9
Payne, B. & Gainey, R.
Differentiating Self-Neglect as a Type of Elder Mistreatment: How Do These Cases Compare to Traditional Types of Elder Mistreatment?
Journal of Elder Abuse & Neglect; Vol. 17 (1), 21-36; 2005.
This study compares features of self-neglect cases handled by adult protective services (APS) to other types of elder mistreatment. The needs and characteristics of self-neglecting clients are examined, along with the impact that stress has upon self-neglect. Seven hundred and fifty-one APS cases from three cities in Virginia were reviewed for information on demographic and family characteristics; reporter relationship to the client; services used; types of benefits received; functional, emotional and health status; problem areas; stressors; type of mistreatment; type of caregiver; information on caregiver burden; and case disposition. Results indicate that less education was associated with lower rates of self-neglect; clients who were unmarried were more likely to demonstrate self-neglect; and self-neglecting clients were more likely to refuse services. Of note, self-neglect clients were less likely than other clients to need assistance with toileting, with eating, and with using the telephone. They were more likely to have a psychiatric diagnosis and/or have problems with alcohol. No gender or age differences were observed. Differences in rates of self-neglecting clients were also found across city samples, which suggests the possibility that there is a relationship between self-neglect and community characteristics. These results are discussed within the context of prior research.

64. S6416-10
Powell, M. & Berman, J.
Effects of Dependency on Compliance Rates Among Elder Abuse Victims at the New York City Department for the Aging, Elderly Crime Victim's Unit
Journal of Social Gerontological Social Work; Vol. 46 (3/4), 229-247; 2006.
In this study, researchers considered the potential impact of dependency upon the rate of compliance for elder abuse victims serviced through New York's Elderly Crime Victim's Unit. Both dependency of the victim upon the abuser and dependency of the abuser upon the victim were analyzed in relationship to whether the victim followed through with referrals made for services through the Crime Victim's Unit or other community organizations. Ninety-five closed cases were analyzed. Dependency was assessed using a two-part instrument developed by the authors (the Dependency Scale), and the presence of cognitive impairment, substance abuse issues, and mental illness on the part of victims and abusers were also noted. The only significant association found was that victims of abusers with mental health and/or substance abuse issues were more likely to accept referrals for additional services. Further, abusers with substance abuse and/or mental health problems were found to be more dependent upon their victims.

65. S6179-14*
Rabi, K.
Israeli Perspectives on Elder Abuse
Educational Gerontology; Vol. 32 (1), 49-62; 2006.
Observing that a significant number of Israeli elders live within the community, have limited economic resources, rely heavily on family members for assistance and therefore may be a greater risk for elder mistreatment, this article considers the perceptions of elder abuse and neglect among two ethnic groups, the Ashkenazi (n=42) and the Sephardic (n=27). Participants, aged 18 to 80, provided examples of various types of mistreatment, and categorized the examples according to severity. Examples of physical abuse and neglect/abandonment were most commonly identified by both ethnic groups as extreme in nature. However, Ashkenazi were more likely to view physical and economic abuse as moderate in nature, and abandonment/neglect as mild in nature. Gender differences were also analyzed, and the one significant difference noted was that women were more likely to view disrespect as moderate abuse while men were more likely to view it as mild. (Israel)

66. S6534-12
Rabiner, D., O'Keefe, J. & Brown, D.
Financial Exploitation of Older Persons: Challenges and Opportunities to Identify, Prevent, and Address It in the United States
Journal of Aging & Social Policy; Vol. 18 (2), 47-68; 2006.
This study was designed to analyze the nature and scope of elder financial abuse and exploitation occurring in domestic settings. The following research methods were employed: a literature review on the topic to develop a conceptual framework; the identification of a network of nationally recognized experts; a meeting with a technical advisory group (TAG, comprised of 11 of the recognized experts) in order to discuss policy and research implications; and an examination of promising practices as well as barriers to services which were identified through site visits in four states (California, Colorado, Pennsylvania, and Illinois). Challenges to prevention, identification and intervention include the reluctance of the victim to report exploitation; mental and physical impairments of the victim; impediments to prosecution and civil litigation (including fear of the potential consequences); lack of senior support services and other resources (and a lack of awareness of existing resources); and the potential for misuse of legal protections (including powers of attorney and guardianships). National prevalence and incidence studies are recommended to measure the scope of elder financial exploitation, along with both small-scale and longitudinal studies to analyze various aspects of the problem (such as studies measuring the impact of exploitation upon the mental and physical health of victims; research on specific risk factors; assessments of program effectiveness; etc.). (Note: This article draws upon the same data set of CANE files R6024-22 and R6025-23.)

67. S6462-8
Repp, M. & Hughes, E.
The Rise in Reported Elder Abuse: A Review of State and National Data
Illinois Criminal Justice Information Authority; State of Illinois; August 2005.
This report discusses trends relating to reported elder abuse in Illinois from 1993 through 2003. During that time, reported cases rose from 4,142 in 1993 to 7,672 in 2003. Among the findings from 2003, financial exploitation (34 percent) was the most commonly reported, followed by emotional abuse, passive neglect, physical abuse, and deprivation. Of note, African Americans were disproportionately represented among reported victims. Living arrangements, relationships with abusers, and other characteristics are discussed. Twenty percent of the victims were cognitively impaired to some degree and more than one-fourth had multiple characteristics that put them at risk for mistreatment. Forty-nine percent of the abusers were not considered caregivers; 44 percent were categorized as informal caregivers, and 7 percent were paid caregivers. Data from state and national Ombudsman reports on institutional abuse is also reviewed. (Note: This report is available online at: http://www.icjia.state.il.us/public/pdf/Bulletins/Elderabuse2.pdf .)

68. S6423-21
Safarik, M. & Jarvis, J.
Examining Attributes of Homicide Toward Quantifying Qualitative Values of Injury Severity
Homicide Studies; Vol. 9 (3), 183-203; August 2005.
Although the qualitative study of injuries can reveal information about the dynamics between offender and victim, relatively little data is gathered on the nature of injuries incurred during homicides. This article reviews the modification and implementation of injury severity scales in the analysis of data from a sample of 128 elderly female homicide victims (aged 60 or older). In a previous study, these cases were comprehensively reviewed for information on the physical, sexual, behavioral, and psychological details of the homicides. Multivariate analysis was conducted to determine if there was a relationship among offender characteristics, the offender-victim relationship, and the offender's geographical proximity to the victim and the degree of injuries inflicted during the homicide. Of note, greater severity of injuries appeared associated with younger offenders and offenders who lived in closer proximity to their victims. Implications for criminal investigations are considered. (Note: This data set is also the subject of CANE file # N4885-13.)

69. S6477-6
Sauvageau, A. & Racette, S.
Fatal Neglect of the Elderly by a Spouse: A Case Report
Medicine, Science, and the Law; Vol. 46 (2), 173-176; 2006.
An atypical case study of a neglected 69 year old diabetic man is presented. After suffering a cerebral stroke, the man fell and was left on the floor by his spouse, who could not get him up and did not call for help. According to police records, the women reported that he was communicative after the fall and asked her not to call for emergency assistance. Although she fed him and tended to him on the floor, she did not administer his insulin. He died four days later due to hyperglycemia. The case was ruled a homicide by neglect. However, the spouse was not prosecuted. Authorities believed that she did not intentionally neglect her husband and that she had a history of psychological problems. (Canada)

70. S6397-4
Schonfeld, L., Larsen, R. & Stiles, P.
Behavioral Health Services Utilization Among Older Adults Identified Within a State Abuse Hotline Database
The Gerontologist; Vol. 46 (2), 193-199; 2006.
This study compared the behavioral health service usage of adults aged 65 and older identified through the Florida Abuse Hotline Information System (FAHIS) with other older service users. Identifying data from FAHIS was matched with Medicaid and Medicare data to determine frequency and costs of behavioral health service usage for both sub-populations for the calendar year 1999. Significantly higher rates of service usage and costs were associated with both Medicare and Medicaid enrollees identified through FAHIS, compared to other older adults. The authors acknowledge under reporting of elder mistreatment as a limitation of this study but recommend additional research in this area. They also emphasize the need for more detailed data collection by protective services, including screening for behavioral health problems.

71. S6399-8
Sink, K., Covinsky, K., Barnes, D., Newcomer, R. & Yaffe, K.
Caregiver Characteristics are Associated with Neuropsychiatric Symptoms of Dementia
Journal of the American Geriatrics Society/JAGS; Vol. 54 (5), 796-803; 2006.
In this cross-sectional study, based upon data from 5,788 patients and caregivers in the Medicare Alzheimer's Disease Demonstration and Evaluation project, researchers analyzed the association of caregiver characteristics with neuropsychiatric symptoms (NPS) of dementia patients. NPS include constant restlessness; constant talking; hallucinations; paranoia; episodes of unreasonable anger; combativeness, dangerousness to self; dangerousness to others; destructiveness; repetitive questioning; wandering; and waking the caregiver. After adjusting for severity of dementia and patient demographic characteristics, results indicate that NPS were positively associated with caregivers who were younger, less educated, more depressed, more burdened, or spent more time providing care. Health and social service professionals are urged to consider caregiver characteristics and the relationship dynamics between caregiver and care recipient when designing education and intervention plans.

72. S6400-4
Caregiver's Burden, Depression and Support as Predictors of Post-Stroke Depression: A Cross-Sectional Survey
Suh, M., Kim, K., Kim, I., Cho, N., Choi, H. & Noh, S.
International Journal of Nursing Studies; Vol. 42 (6), 611-618; 2005.
This study considers the impact of caregiver's burden, depression and support on post-stroke depression (PSD). Data was collected from 225 stroke survivors and their informal caregivers in Seoul, Korea. Multivariate analysis revealed that after adjusting for patient's clinical status, caregiver depression was significantly associated with an increase in PSD. Although increases in caregiver burden appeared related to increases in PSD the association was not statistically significant. Caregiver support was related to lower levels of PSD. The emotional distress of caregivers appears to have a negative impact on patients with clinical implications. Post-stroke care that addresses the needs of caregivers as well as patients may reduce the risk of PSD. (South Korea)

73. S6332-11
Tam, S. & Neysmith, S.
Disrespect and Isolation: Elder Abuse in Chinese Communities
Canadian Journal on Aging; Vol. 25 (2), 141-151; 2006.
This qualitative study of home care workers focuses on the social context of mistreatment among Chinese elders in Canada. Four focus groups were conducted with 40 participants, Chinese home care professionals and program coordinators who, while providing services, were exposed to suspected or actual cases of elder mistreatment. They described the prominence of disrespect, considered abusive because it violates traditional Chinese cultural values, exhibited as verbal abuse, ignoring the elder, scolding, nagging, name calling, threatening to institutionalize, and talking or joking about death. It was also manifested by isolating and restricting the elder, ignoring psychological and social needs, and limiting food choices. Dependency issues of the Chinese elderly immigrants were perceived, to a significant degree, to be related to social exclusion and the marginalization of this group in Canadian society. (Canada)

74. S6139-12*
Tauriac, J. & Scruggs, N.
Elder Abuse Among African Americans
Educational Gerontology; Vol. 32 (1), 37-48; 2006.
In this article, the authors review sociohistorical and other culturally specific elements that influence the perceptions of elder abuse among African-Americans. Financial strain is considered, along with the traditional characteristic of extended family, which often provides support and stability, but may also render the system vulnerable to conflict. In this convenience sample study, 25 female and 10 male African-American participants, aged 16 to 63, were asked to provide examples of extreme, moderate and mild elder abuse. Extreme abuse was predominantly characterized by examples physical aggression; verbal abuse was least frequently categorized as extreme; neglect/abandonment was classified as extreme in half of the examples provided. Although research suggests that it is a more common form of elder abuse among African-Americans (Dimah & Dimah, 2002; Griffin, 1994, 1999), only three examples of financial abuse or exploitation were given. Gender and age differences among responses are also discussed, along with implications for prevention and intervention. (U.S.)

75. S6396-2
Taylor, D., Bachuwa, G., Evans, J & Jackson-Johnson, V.
Assessing Barriers to the Identification of Elder Abuse and Neglect: A Communitywide Survey of Primary Care Physicians
Journal of the National Medical Association; Vol. 98 (3), 403-404; March 2006.
Five hundred primary care physicians from Genesee County, Michigan were sent a copy of either an attitude or knowledge survey regarding elder abuse issues. Ninety-five participants completed and returned the surveys. The attitude survey generated a greater response rate, and results suggest that a majority of the respondents acknowledged that physicians did not routinely screen for elder abuse. Those responding to the knowledge instrument revealed that they did not have an accurate understanding of the prevalence of elder abuse or of risk factors for abuse. A lack of understanding of reporting procedures was considered the greatest barrier to identification.

76. S6363-49*
U.S. Government Accountability Office (GAO)
Long-Term Care Facilities - Information on Residents who are Registered Sex Offenders or Are Paroled for Other Crimes (GAO-06-326)
U.S. Government Accountability Office (GAO); Washington, D.C.; March 2006.
This report was intended to determine the prevalence of sex offenders and paroled non-sex offenders residing in nursing homes and long-term care facilities; identify the legal requirements for notifying facilities and others when offenders are residents; and assess the extent to which long-term care facilities provide different supervision for these residents. Analysis of data from the FBI's National Sex Offender Registry (NSOR) revealed that approximately 700 registered sex offenders were living in nursing homes or intermediate care facilities for people with mental retardation (ICF-MR), comprising about 0.05 percent of the nation's 1.5 million long-term care population. Most offenders were male and under age 65. About 3 percent of all homes and .7 percent of ICF-MR receiving Medicare and Medicaid funds housed at least one sex offender during 2005, although this figure is considered an underestimate due to state data reporting limitations. Information was gathered from 8 reviewed states in which 204 residents were identified as paroled non-sex offenders. Because offender status is not tracked with abuse reporting, the overall risk posed by registered sex offenders and parolees could not be determined. Facility administrators voiced most concern for risk to cognitively impaired and mentally ill residents. The extent to which long-term care facilities are notified regarding the status of sex offenders varies significantly from state to state, as does the extent to which this information is shared by the administrators with staff and others. Specialized supervision of these residents is not typically based upon prior convictions but upon their demonstrated behaviors. As a result of this report, the GAO recommended that the Attorney General direct the FBI to conduct an assessment of the completeness of the NSOR, including state submission rates, and to consider ways in which this database could be more effective on a national level. (Note: This report is accessible online at: http://www.gao.gov/new.items/d06326.pdf#search=%22GAO-06-326%20Offenders%22 .)

77. S6457-12
Wang, J.
Psychological Abuse and Its Characteristic Correlates Among Elderly Taiwanese
Archives of Gerontology and Geriatrics; Vol. 42 (3), 307-318; May-June 2006.
Despite recently enacted protective services legislation in Taiwan, psychological elder abuse remains difficult to detect and to address. This cross-sectional study was designed to assess the prevalence of psychological abuse among elderly Taiwanese and to identify characteristics associated with this type of mistreatment. Data was drawn from a random sample of 195 institutionalized and community-based individuals, aged 60 and older, from several regions in southern Taiwan. Results indicate that 22 percent of the participants reported that they had experienced psychological abuse. Unmet needs for family contact, financial dependence, and being left alone involuntarily were the most common situations. There were no statistically significant differences in prevalence rates between the community-based and institutionalized groups. Psychological abuse appeared higher among participants with lower levels of cognitive and physical functioning. (Note: Items from the Psychological Elder Abuse Scale/PEAS, a tool developed by the author, are included.) (Taiwan)

78. S6336-10*
Wang, J.
Psychological Abuse Behavior Exhibited by Caregivers in the Care of the Elderly and Correlated Factors in Long-Term Care Facilities in Taiwan
Journal of Nursing Research; Vol. 13 (4), 271-280; December 2005.
This cross-sectional study analyzed characteristics associated with psychologically abusive behaviors perpetrated by long-term caregivers. The Caregiver Psychological Elder Abuse Behavior Scale (CPEAB) and the Caregiver Burden Scale were administered to 114 randomly selected participants (56 nurses and 58 care attendants) from nursing homes throughout southern Taiwan. Results suggest that caregivers with higher education, without special geriatric training, or who experienced higher work load burdens displayed more severe psychologically abusive behaviors. Younger participants demonstrated more psychologically abusive behaviors than did older participants; and nurses were more abusive than care attendants. Only one participant reported never displaying psychologically abusive behavior during the previous six months. Accusing the resident verbally, ignoring his or her requests, and insulting the resident were the most frequently reported behaviors. (Taiwan)

79. S6437-7
Werner, P., Eisikovits, Z. & Buchbinder, E.
Lay Persons' Emotional Reactions Toward an Abused Elderly Person
Journal of Elder Abuse & Neglect; Vol. 17 (2), 63-75; 2005.
One-hundred and sixty nine adults aged 45 and over were interviewed and presented with a case vignette depicting elder abuse. Two versions of the scenario were devised which varied on one aspect; in one version the victim had Alzheimer's disease, and in the other the victim had osteoporosis. Participants were randomly assigned to one of the two versions. Seventy-four percent of the participants indicated that, to at least some degree, the scenarios depicted abuse. The scenarios elicited predominantly positive emotional reactions, including compassion, concern and sympathy, although a very few respondents experienced neutral responses (including embarrassment, discouragement) or negative reactions (such as ridicule, irritation or rejection). Increased education appeared to be inversely associated with negative reactions, and feelings of sympathy appeared associated with increased exposure to abuse. The participants responding to the Alzheimer's version of the vignette reported higher levels of discomfort and concern for the victim. (Israel)

80. S3689-4*
Wigelsworth, A., Mosqueda, L., Burnight, K., Younglove, T. & Jeske, D.
Findings from an Elder Abuse Forensic Center
The Gerontologist; Vol. 46 (2), 277-283; 2006.
Employing a variety of research methods, including case study reviews and surveys of team members, the authors present the findings of an evaluation of the effectiveness and efficiency of the multidisciplinary Elder Abuse Forensic Center (EAFC). The EAFC, which was established in 2003 and addresses cases involving mistreatment of elders and vulnerable adults, is comprised of representatives from adult protective services (APS), social services, law enforcement, the district attorney's office, a medical response team, public guardian, ombudsmen, mental health services, victims services and domestic violence. Collaborators indicated that, overall, they believed the multidisciplinary format of case management and review was more time efficient than handling cases within a single agency or discipline; they also concurred that the interventions of the EAFC were more effective. They were more neutral on the question of whether the case outcomes would have been different if not addressed by the EAFC. Two cases are presented that highlight the collaborative process of the format, and the degree of complexity, in terms of forensic issues and family dynamics, of such cases.

81. S6446-13
Wilke, D. & Vinton, L.
The Nature and Impact of Domestic Violence Across Age Cohorts
AFFILIA; Vol. 20 (3), 316-328; Fall 2005.
This study, a secondary analysis of data from the National Violence Against Women Survey (NVAWS, 1995-1996), compared the nature and impact of domestic violence (DV) across different age cohorts. Three-hundred and ninety-eight women who reported being victimized were divided into three age cohorts (aged 18 to 29, n=157; aged 30 to 44, n=187; and aged 45 and older, n=54). Similar patterns regarding the severity, types of abuse experienced and perpetrators were observed across all age groups. Older women reported experiencing abuse for longer periods of time and were more likely to be currently involved with their abusers. Also, older women experienced higher rates of chronic mental health problems and greater use of tranquilizers and antidepressants. Three-fourths of the respondents across all age groups reported that they were unlikely to report abuse to the police.

82. S6424-9
Winterstein, T. & Eisikovits, Z.
The Experience of Loneliness of Battered Old Women
Journal of Women & Aging; Vol. 17 (4), 3-19. 2005.
This qualitative research was part of a larger study on the experiences of older battered women. In-depth interviews were conducted with 21 Jewish women from Northern Israel aged 60 to 85. Thirteen of the participants were living with abusive partners during the time of the study, and eight were separated but not divorced. This article focuses on content analysis regarding the theme of loneliness as an outcome of intimate partner violence. Loneliness was discussed as it permeated the intimate partnership, which in some cases began with an arranged marriage. For many women, it was reflected by estranged relationships with their children. It was also reflected by limited social contact and support. Therapists and others working with older survivors of domestic violence are encouraged to use a narrative approach to allow women to reframe their experiences in order to see their strengths while expanding their social support systems. (Israel)

83. S6454-5
Zink,T., Fisher, B., Regan, S. & Pabst, S.
The Prevalence and Incidence of Intimate Partner Violence in Older Women in Primary Care Practices
Journal of General Internal Medicine; Vol. 20 (10), 884-888; 2005.
This study was designed to analyze the incidence and prevalence of intimate partner violence (IPV) among women, aged 55 and older, who were seen at least one time in a primary care practice during the previous year. Nine-hundred and ninety-five women who had been seen in health care settings affiliated with an academic institution completed telephone interviews that assessed health status and the experience of psychological, physical and sexual abuse occurring since age 55. The prevalence rate of physical abuse (since age 55) among those surveyed was 1.52 percent, and the incidence rate for the preceding year was 0.41 percent. Prevalence and incidence rates for sexual abuse were 2.14 percent and 1.12 percent respectively. Victims of IPV reported a greater number of health conditions (3.84) than those not victimized (3.21), and victims were more likely to experience chronic pain, anxiety and depression.

84. S6439-9
Zink, T., Jacobson, C., Pabst, S., Regan, S. & Fisher, B.
A Lifetime of Intimate Partner Violence: Coping Strategies for Older Women
Journal of Interpersonal Violence; Vol. 21 (5), 634-651; May 2006.
This study analyzed the coping strategies used by 38 women, aged 55 and older, to survive long term abusive intimate partner relationships. Through grounded theory analysis of interview transcripts, three coping strategies were identified. Women reappraised their situations in a manner that allowed them to create boundaries within the relationships. They also focused on different domestic roles. Finally, they sought emotional support from other sources, including friends, extended family, and through work or volunteer experiences. Participants indicated that maintaining the appearance of conjugal unity was of great importance.

III. Scholarship

85. S6434-3
Alford, D.
Legal Issues in Gerontological Nursing - Part I: Abuse and Neglect of Older Adults
Journal of Gerontological Nursing; p10-p12; January 2006.
In this article, an expert nursing panel highlights legal aspects of the nurse's response to elder abuse. Being alert to the possibility of abuse and neglect and understanding reporting obligations are paramount. (Panel participants included Deborah Karas, of the Nursing Services Group, Barrington, IL; Annette Lueckenotte, of Barnes-Jewish West County Hospital, Creve Coeur, MO; Karen Devereaux Melillo, Department of Nursing, University of Massachusetts, Lowell, MA; Jane Nunnelee, of the Louise Herrington School of Nursing, Baylor University, Dallas, TX; Susan Scanland of GeriScan Geriatric Consulting, Clarks Summit, PA; Karl E. Steinberg, geriatrician and a nursing home and hospice medical director, Oceanside, CA; Ronald Walent, of Laguna Honda Hospital and Rehabilitation Center, San Francisco, CA; and Lin Zahn, Professor of Nursing, University of Massachusetts, Lowell, MA.)

86. S6151-13
American Bar Association Commission on Law and Aging
State Adult Guardianship Legislation: Directions of Reform - 2005
American Bar Association Commission on Law and Aging; January 2006.
This paper summarizes the highlights of legislation related to adult guardianship enacted in 2005 throughout the U.S. As quoted from the introduction: "...at least 14 states passed a total of 24 adult guardianship bills -- as compared with 19 bills in 14 states passed in 2004...New Jersey enacted the first major reform of the state's guardianship laws in more than 30 years. Six states made changes in their public guardianship programs, including legislation in Texas providing for extensive reform and reorganization of adult protective services (APS) and guardianship; as well as the creation of a public guardianship program in Georgia. Two states (Texas and New Jersey) initiated guardian certification/registration programs, and one state (Idaho) included certification in a pilot program. In addition, a number of states strengthened the monitoring and accountability of guardians, while others made procedural changes or addressed the powers and authorities of guardians..." Additional legislation is highlighted from the following states: North Dakota, Nevada, Virginia, New Hampshire, Colorado, Arkansas, New York, Minnesota, Washington, and Connecticut. (Note: This paper is available online only at: http://www.abanet.org/aging/docs/guardian1.pdf.)

87. S6177-23
American Bar Association Commission on Law and Aging, and the Maryland Office of the Attorney General
Making Medical Decisions for Someone Else: A Maryland Handbook
American Bar Association Commission on Law and Aging; April 2006.
This handbook provides detailed and practical guidelines for surrogate decision-makers of incapacitated individuals in the state of Maryland. The handbook addresses the scope of responsibilities of the health care proxy (such as obtaining medical information, consenting to or refusing tests and treatment, authorizing the transfer of the patient, etc.) Surrogates are advised to communicate with the individual for whom they may need to make decisions regarding their beliefs, values, and wishes prior to incapacitation, if possible. (Note: This handbook is accessible online at: http://www.abanet.org/aging/publications/docs/proxy_guide_long_final_2.pdf . The brochure, "Making Medical Decisions for Someone Else: A Guide for Marylanders," is available at: http://www.oag.state.md.us/Healthpol/Proxy_guide_brochure.pdf .)

88. S6156-125*
The Anti-Ageism Taskforce at the International Longevity Center (ILC) - USA, sponsored by the Open Society Institute
Ageism in America
International Longevity Center - US, LTD.; New York; 2006
This publication begins with a "report card" of seven major areas where ageism is evident within the United States (elder abuse, discrimination in health care, nursing homes, emergency services, the workplace, the media, and in marketing). It is also considered within the context of the family and culture. A history of ageism in America is presented, and topics covered include the creation and perpetuation of ageism, personal and institutional ageism, and the costs of ageism. The effectiveness of existing policies designed to combat age discrimination are reviewed, along with recommended initiatives. (Note: This publication is available online at: http://www.ilcusa.org/news/story_aging.htm . To request a hard copy of this report please contact the ILC-USA Communications Department at [email protected] or 212-606-3380.)

89. S6385-7*
Baker, M. & Heitkemper, M.
The Roles of Nurses on Interprofessional Teams to Combat Elder Mistreatment
Nursing Outlook; Vol. 53 (5), 253-259; September/October 2005.
This article describes the contributions that nurses can make to interdisciplinary teams addressing elder mistreatment, such as the King County Elder Abuse Project (EAP) of Seattle, Washington. Established in 2001 by the King County Prosecuting Attorney's office, the EAP was designed to facilitate the prosecution of cases of mistreatment among elders and individuals with disabilities; foster collaboration with law enforcement; and provide training on elder mistreatment to first responders in the community. Specifically, nurses can assist in chart reviews, provide education to other team members, and provide education to the public. Participation in the EAP by faculty from the University of Washington School of Nursing has led to the institution's development of a Master's degree program, the Advanced Practice Forensic Nurse Specialists.

90. S6464-12
Bergeron, L.
Self-Determination and Elder Abuse: Do We Know Enough?
Journal of Gerontological Social Work; Vol. 46 (3/4), 81-102; 2006.
In this discussion, the author suggests that the notion of competency and the principles of self-determination are oversimplified in elder abuse literature, and that adult protection laws provide inadequate guidelines for social workers and others who encounter competent elders who refuse services and opt to remain in potentially life-threatening situations. APS professionals are encouraged to base decisions balancing autonomy and protection not only on the client's immediate stated wishes, but after considering the client's life history (including decision-making practices), an in-depth understanding of the client's competency, awareness of cultural influences, knowledge of relevant legal statutes, and the ability to think critically about ethical complexities. The impacts of intergenerational issues and family dynamics upon decision-making capacity are also considered. Case scenarios from the media as well as from the author's experiences are used to illustrate various aspects of the question, "At what point is a depressed, or sick, or abused person unable to choose?" Offering the choice of "negotiated consent" by assisting the client in minimizing the abuse or developing a safety plan is an alternative intervention. A multidisciplinary, collaborative response is considered vital.

91. S6470-11
Bomba, P.
Use of Single Page Elder Abuse Assessment and Management Tool: A Practical Clinician's Approach to Identifying Elder Mistreatment
Journal of Gerontological Social Work; Vol. 46 (3/4), 103-122; 2006.
By framing elder abuse as a geriatric syndrome, it is hoped that physicians and other health care professionals will be more willing to and capable of screening for elder mistreatment. This paper describes the purpose and development of a one-page tool that provides practical guidelines for screening and assessment of elder abuse, neglect and exploitation. The Principles of Assessment and Management of Elder Abuse Tool (included) has been distributed in primary care, long-term care, and emergency settings. It has also been used by social service professionals, law enforcement and bank employees. The article provides a general discussion of indicators of abuse and screening questions included in the tool.

92. S6460-9
Boxerbaum, E. & Donaldson, P.
Respecting and Protecting Elders
Journal of Healthcare Protection Management; Vol. 21 (2), 67-75; 2005.
This article provides an overview of security in elder care settings, such as long-term care facilities, as a means of preventing victimization. A needs assessment should be performed to determine a facility's strengths and weaknesses, and should cover perimeter and access controls, internal security, the means to protect residents who are not capable of protecting themselves, and measures to protect caregivers and visitors. Recommendations should be implemented in ways that are consistent to the organization's mission and values. A number of technologies are discussed, such as the use of video security and wearable GPS-based devices.

93. S6474-31
Bruce, P.
The Ascendancy of Assisted Living: The Case for Federal Regulation
Elder Law Journal; Vol. 14; 2006.
In light of the increase in assisted living residents, the author argues that the industry requires uniform, and therefore federal, regulation to protect vulnerable adults from inadequate care. A history of long-term care in the U.S. is provided along with the sociodemographic factors contributing to the development and growth in assisted living. Although states have attempted to regulate the industry, the definitions of assisted living and resultant regulations have varied significantly. State regulation schemes and their shortcomings are examined. Notable discrepancies exist in many areas: regulation of disclosure; regulation of care level expectations and ambiguity regarding scope of care; staffing requirements; physical and facility regulations; and medication management. Most states lack sufficient resources to adequately monitor assisted living facilities. The author argues that federal regulation of assisted living is permitted under the Commerce Clause of the U.S. Constitution since multi-state providers generate interstate commerce.

94. S6293-21***
Caccamise, P. & Mason, A.
Policy Paper: New York State Summit Targets Elder Abuse, "The Time to Act is Now"
Journal of Elder Abuse & Neglect; Vol. 16 (4), 41-61; 2004.
In May, 2004, 96 leaders in aging services met to create the New York State Action Agenda to advance the state's response to elder abuse. This article describes the purpose and process of the event from its inception through recommendations generated. Lifespan of Rochester convened the summit which was modeled after the 2001 National Policy Summit on Elder Abuse, held in Washington D.C., sponsored by the National Center on Elder Abuse (NCEA). Representatives from aging services, adult protective services (APS), criminal justice, domestic violence agencies, financial institutions, faith communities, and education participated. Work group topics included intervention models, financial exploitation, public awareness and education, self-neglect, prosecution and law enforcement, and public health. Areas of discussion included policy and legislation, funding and resources, research and data, program development and prevention. The following needs were among the highest priorities identified: legislative reform to enhance prevention, intervention, and prosecution; statewide research on the scope of elder abuse and the development of methodology for ongoing data collection; and statewide evidence-based training for first responders and community partners.

95. S6408-5
Cohen, C.
Consumer Fraud and the Elderly: A Review of Canadian Challenges and Initiatives
Journal of Gerontological Social Work; Vol. 46 (3/4), 137-144; 2006.
This article reviews the available data on consumer fraud affecting elders in Canada. Findings from various studies suggest that financial exploitation is the most common form of elder abuse perpetrated in Canada, and recent studies suggest that between 50 and 90 percent of telemarketing fraud victims are over age 60. Risk factors are considered, including social isolation. Promising practices, model programs and legislative initiatives are highlighted, including PhoneBusters (a national deceptive telemarketing call center based in Ontario) and the Competition Bureau of Canada (which collaborated with other agencies to form the Deceptive Telemarketing Prevention Forum). (Canada)

96. S6387-9*
Curtis, L.
Partnering with Faith Communities to Provide Elder Fraud Prevention, Intervention, and Victim Services
OVC Bulletin; April 2006.
This article provides an overview of an elder fraud prevention program, an initiative of the Denver District Attorney's Office, combining education and intervention through faith communities. The components of the Clergy Against Senior Exploitation (CASE) Partnership, an eighteen month demonstration project of the Office of Victims of Crime, U.S. Department of Justice, are described and include efforts to form alliances between the District Attorney's office and various faith communities, train clergy regarding elder fraud, provide education and outreach to seniors, distribute monthly fraud alerts and provide assistance to seniors through crime reporting, victim support, and fraud prevention services. Follow-up surveys of both clergy and senior participants suggest that the project was effective in raising awareness and developing prevention strategies. Measurable goals, flexibility in customizing programs to meet the needs of individual faith denominations, sharing "best practices," and employing adult learning techniques were identified as key in the successful implementation of the project. Due the success of this program, it has been successfully replicated in three other Colorado sites, and is scheduled to be replicated throughout the country. (Note: This publication is accessible online at: http://www.ojp.usdoj.gov/ovc/publications/bulletins/elderfraud_case/pfv.html .)
See also CANE file # S6533-5.)

97. S6212-19*
Dessin, C.
Elder Law: Should Attorneys Have a Duty to Report Financial Abuse of the Elderly?
Akron Law Review; Vol. 38; 2005.
This article considers whether attorneys can and should report suspected elder financial abuse under mandatory reporting statutes. Conflicts arising from the mandate to report suspected abuse, and the Model Rules of Professionals Conduct which describes the attorney's duty to maintain client confidences, are discussed. Distinctions between the Pre-Ethics 2000 version of the Model Rules and the Ethics 2000 revision are highlighted; under the latter, in some cases an attorney would be able to reveal information in order to "prevent reasonably certain death or substantial bodily harm..." in states only where the reporting is mandatory. The author summarizes the three basic approaches adopted by states to deal with the need to protect client confidentiality while complying with any mandatory reporting requirements. She argues that difficulties in assessing the potentially exploitative nature of financial transactions notwithstanding, attorneys remain responsible for being alert to potential abuse in order to protect the best interests of the client and to fulfill the obligation to provide competent representation. In conclusion, under the principles of providing competent representation, the author argues that the attorney should report suspected financial abuse when the client is perceived as incapable of consenting to the allegedly abusive behavior. In addition, the attorney should report suspected abuse when learning of it through the perpetrator.

98. S6120-20***
Doron, I., Alon, S. & Offir, N.
Time for Policy: Legislative Response to Elder Abuse and Neglect in Israel
Journal of Elder Abuse & Neglect; Vol. 16 (4), 63-82; 2004.
This article provides an overview of the history of the policy response to elder abuse and neglect in Israel. The initial legislative response was characterized by the authors as paternalistic. The following phase appeared more punitive and required mandatory reporting. The third phase emphasized protection and intervention. It appears that the current phase is evolving to emphasize education and empowerment. The authors advocate for a policy response that is multidisciplinary, involves the "unheard voice" of the older population, and allocates necessary resources to develop and implement training and education initiatives.

99. S6386-11*
Dubble, C.        
A Policy Perspective on Elder Justice Through APS and Law Enforcement Collaboration
Journal of Gerontological Social Work; Vol. 46 (3/4), 35-55; 2006.
In this overview, the historic, economic, political, ideological, and societal aspects of policies that promote collaboration between adult protective services (APS) and law enforcement in response to elder mistreatment are examined. The impact of the right to self-determination upon legal interventions (such as reporting issues, prosecution) is among the topics considered. Efforts of the AARP and the National Center on Elder Abuse (NCEA) to promote awareness of elder mistreatment are highlighted. In conclusion, the need for and the costs associated with policies that reflect elder justice are discussed.

100. S6129-2
Epplin, J.
Identifying Elder Abuse in the Home Care Setting
Annals of Long-Term Care; Vol. 14 (1), 15-16; January 2006.
Through a question and answer format, this column provides an overview on identifying elder abuse, neglect and self-neglect among home care patients. Potential physical and psychological indicators and risk factors, including dementia, are discussed, along with the need to report suspected mistreatment to the appropriate authorities. (Note: This article is accessible online at: http://www.hmpcommunications.com/altc/displayArticle.cfm?articleID=article5137 .)

101. S6417-15
Geroff, A. & Olshaker, J.
Elder Abuse
Emergency Medicine Clinics of North America; Vol. 24 (2), 491-505; May 2006.
In this overview, the role of the emergency physician in detecting and addressing elder abuse is described. The history of the recognition of and response to elder mistreatment, definitions of abuse, indicators of abuse, and victim and perpetrator characteristics are highlighted. The importance of taking an accurate patient history and suggested screenings questions are also discussed. Ethical and legal issues encountered when addressing suspected mistreatment are reviewed.

102. S6257-7
Gibbons, S.
Self-Neglect: A Proposed New NANDA Diagnosis
International Journal of Nursing Terminologies and Classifications; Jan-March 2006.
This article proposes a new North American Nursing Diagnosis Association (NANDA) diagnosis for self-neglect and provides the basis for standardized terminology. The author believes that this will not only facilitate multidisciplinary/interdisciplinary communications often necessary in addressing such cases, but will facilitate the international and national study of the phenomenon. The importance of assessing the severity and intentionality of self-neglecting behaviors are considered. Brief case studies are presented to illustrate defining characteristics. (NANDA International is an organization which promotes the development of nursing diagnostic terminology.)(Note: Currently, this article is available online at: http://www.findarticles.com/p/articles/mi_qa4065/is_200601/ai_n16118485 .)

103. S6438-20
Gibson, M. & Hayunga, M. for the AARP Public Policy Institute
We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters
AARP Public Policy Institute; Washington, D.C.; May 2006.
As quoted from the AARP Public Policy Institute Web site: "In an effort to identify lessons learned in the aftermath of hurricanes Katrina and Rita and to share promising practices, AARP convened a diverse group of more than 100 government officials at federal, state and local levels; emergency preparedness and response experts; relief organizations, and aging and disability advocates in Washington, DC, on December 1st, 2005. All of the panelists were 'people who had been there'. The goal of the conference was to bring the right stakeholders together to explore workable strategies for the future to better protect older persons in both the community and in nursing homes..."(Note: Both the full report and summary are accessible online from: http://www.aarp.org/research/assistance/lowincome/better.html . To obtain hard copies, free of charge, contact Tish Williams, [email protected] .)

104. S6441-9
Griffith, R.
Making Decisions for Incapable Adults 3: Protection, Guardians and Advocates
British Journal of Community Nursing; Vol. 11 (5), 214-221; 2006.
In this article, a district nurse and general practitioner discuss a case of suspected elder abuse involving a community dwelling elder. Health care professionals believe that her needs would be more adequately addressed in a care home, but her son, the suspected abuser, refuses to consider the placement. When the police conclude that there is insufficient evidence to prosecute the son, the multidisciplinary care team considers the Mental Capacity Act of 2005 as a potential means to protect the patient. (U.K.)

105. S6530-14
Hockley, C.
Staff Violence against Those in Their Care (from Workplace Violence: Issues, Trends, Strategies; Bowie, V., Fisher, B. & Cooper, C., eds.)
Willan Publishing; Devon, UK; Chapter 5, 77-96; 2005.
This chapter presents an overview on violence perpetrated by staff members against those in their care, such as residents of nursing homes or aged care facilities, or of other health and residential care settings. Abusive health care professionals, including caregivers, are categorized into three groups: sadistic abusers, who repeatedly and systematically abuse residents and patients without remorse; reactive abusers, who behave violently out of impulse; and those who are negligent. Management may also perpetrate abuse and neglect indirectly through the organizational culture. Means to address the problems are discussed, including legislation from the U.S. and the U.K., and education and training. Levels of intervention include conciliation, civil disciplinary action, and criminal legal action. (U.K., U.S.)

106. S6335-10*
Jayawardena, K. & Liao, S.
Elder Abuse at End of Life
Journal of Palliative Medicine; Vol. 9 (1), 127-136; February 2006.
This article provides palliative care professionals, including the hospice team, with an overview of elder abuse and neglect issues that may be encountered during end of life care. The authors point out that caregiver stress should be of special consideration when assisting terminally ill patients. All health care professionals should be aware of family dynamics and cultural issues relevant to patients' circumstances. The multidisciplinary nature of hospice care is also effective in addressing elder abuse and neglect. Providing education regarding the dying process, assistance in delegating responsibilities and providing referrals when necessary are not only elements of good care provision, but are also strategies that reduce stress and may prevent abuse and neglect. If the need to report mistreatment to protective services arises, members of the palliative care team are in a position to collaborate with APS in various ways: by providing information regarding mistreatment, as well as patient and family needs; by assisting in engaging the victimized patient in protective services; by participating in the evaluation of the patient's capacity to make decisions; and in communicating ongoing concerns.

107. S6413-5
Kenney, J.
Domestic Violence: A Complex Health Care Issue for Dentistry Today
Forensic Science International; Vol. 159 (Supplement 1), S121-S125; 2006.
This article discusses the role of the dentist in the detection and intervention of domestic violence, including child abuse, intimate partner violence, abuse of the disabled, and elder abuse. As the head and neck are visible during dental exams, clinicians are in a position to observe many injuries that may result from mistreatment. The author recommends using the RADAR protocol: routinely screen; ask direct questions; document findings; assess patient's safety; and review options and refer victim for appropriate services. In addition, dentists may further assist victims by providing reduced price or free dental care.

108. S6148-3*
Kruse, C.
"Think of Me as the Daughter You Never Had"
NAELA News; 9-11; August-September 2005.
In this commentary, the author describes scenarios of undue influence that may be encountered in elder law practice. The first phase of the exploitation is accomplished when the elder has entered a state of dependency upon the predatory caregiver, a state in which he or she is isolated from other friends, relatives, and acquaintances. He argues that not only may the attorney intervene when he or she suspects that an elder is being financially exploited, but that he or she should intervene to protect, by seeking the appointment of a guardian or through other means, as allowed for in the Model Rules of Professional Conduct 1.14 (b).

109. S6378-4
Liao, S. & Mosqueda, L.
Physical Abuse of the Elderly: The Medical Director's Response
Journal of the American Medical Director's Association (JAMDA); Vol. 7 (4), 242-245; May 2006.
This article provides an overview of the role of the medical director in home health care settings in detecting and addressing elder physical abuse. In particular, he or she should ensure that the potential for elder abuse is openly discussed at multidisciplinary team meetings. Reporting issues, physical indicators, and risk factors are discussed using a case study as a focal point.

110. S6401-42
Luu, A. & Liang, B.
Clinical Case Management: A Strategy to Coordinate Detection, Reporting, and Prosecution of Elder Abuse
Cornell Journal of Law and Public Policy; Vol. 15; Fall 2005.
Despite legal mandates to report elder abuse, cases of elder mistreatment remain significantly under-reported. In this article, the authors emphasize the need for coordination between the health care and legal systems in order to provide support and protection to older victims, and to increase the likelihood of bringing the perpetrator to justice. In particular, nursing case managers could perform this function in a variety of health care settings. Part I of the article is an overview of the nature of elder abuse and the settings in which it may occur. Part II outlines the state of California's statutes addressing elder abuse. Part III identifies problems and gaps in the current response to elder abuse. In Part IV, the role of the nursing case manager in detecting and reporting mistreatment, and in providing care, support and referral for the victim, is described.

111. S6138-11*
Malley-Morrison, K., Nolido, N. & Chawla, S.
International Perspectives on Elder Abuse: Five Case Studies
Educational Gerontology; Vol. 32 (1), 1-11; 2006.
This article serves as an introduction to an issue of Educational Gerontology dedicated to international and cultural perspectives related to elder abuse. The authors review the existing literature to highlight cultural differences in how elders and others throughout the U.S. perceive various forms of mistreatment, and provide a brief comment regarding the World Health Organization's Missing Voices research series which addressed elder mistreatment throughout eight countries (including five developing countries as well as western, industrialized nations). Researchers describe the cognitive-ecological approach that their international working group has adopted. The perspective focuses on "individual, neighborhood, and sociocultural contributors to abuse -- and conceptions of abuse." Universal themes of human rights and the impact of traditional roles within culturally specific settings are also examined. The "Cross-Cultural Definitions of Family Violence and Abuse Survey," is also described. The instrument was developed by the research group, translated into 20 languages, and posted online in order to generate cross-cultural data, which is the source of information for the studies included in this special issue. The themes of collectivism and individualism are among those highlighted by the articles selected for this issue. (Note: The survey is accessible online at: http://people.bu.edu/jdgmnts/survey.html . To view descriptions of other articles included in this issue, see CANE file #s S6180-11, S6141-11, S6179-14, S6139-12, and S6403-10) (International)

112. S6533-5
Morrissey, M. & Curtis, L.
Partnering with Faith Communities to Prevent Elder Fraud and Exploitation
The Prosecutor; Vol. 39 (6), p10, 12, 14, 15, & 47; November/December 2005.
This article describes the Communities Against Senior Exploitation (CASE) Partnership of the Denver District Attorney's Office, which was selected by the Bureau of Justice Assistance, Office of Justice Programs, as a "national model for replication, training, and technical assistance." The project is designed to combat elder fraud through a coalition of faith-based communities, prosecutors and other law enforcement entities. Basic components of the program include partner recruitment, clergy/leader training, monthly fraud alerts, power against fraud seminars, and victim and fraud prevention assistance. Through the initial project, 210 faith community partners were recruited; 340 clergy and other leaders participated in training; 4,500 older adults, their family members and caregivers participated in Power Against Fraud seminars; and over 200 older individuals and their families were assisted through victim and prevention services. (For more information visit: http://case.denverda.org/case/default.htm . See also CANE file # S6387-9.)

113. S6474-3
Multhaup, K.
A Multicomponent Approach to Teaching Sensitive Topics: Elder Abuse as an Example
Teaching of Psychology; Vol. 32 (4), 261-263; 2005.
This brief article describes one instructor's method of teaching sensitive topics, such as elder abuse, in psychology curricula. The multicomponent approach, which includes an attitude and perception survey, video presentation, class discussion, and written exercises, is designed to raise awareness of the topic, relevant cultural issues, and research implications.

114. S6430-5
Neno, R. & Neno, M.
Identifying Abuse in Older People
Nursing Standard; Vol. 20 (3), 43-47; September 28, 2005.
Intended for nurses, this overview covers the following issues related to elder abuse and neglect: definitional problems; limited data on prevalence and incidence; risk factors; assessment strategies (including multidisciplinary approaches); and interventions. Tables included list potential indicators for neglect and physical, psychological, financial, and sexual abuse. Note: This article is available online at: http://www.nursing-standard.co.uk/archives/ns/vol20-03/pdfs/v20n03p4347.pdf#search=%22%22Identifying%20Abuse%20in%20Older%20People%22%20Nursing%20Standard%22 .)

115. S6405-15
Nerenberg, L.
Communities Respond to Elder Abuse
Journal of Gerontological Social Work; Vol. 46 (3/4), 5-33; 2006.
This article presents an overview of the community response to elder abuse throughout the past 20 years. Types of mistreatment are defined and theories of abuse are summarized. The evolution of abuse reporting laws, adult protective services (APS), and other agencies that investigate and address abuse (such as the Long-Term Care Ombudsman Program) are also discussed. Victims' service needs are identified and include shelters, legal assistance, mental health assessments and counseling. The role of multidisciplinary teams is highlighted. Funding issues and other barriers to service access are considered. The article concludes with examples of practices and programs designed for prevention and intervention.

116. S6433-3
O'Doherty, M.
Lessons Learned: A Case Study
Home Health Care Management; Vol. 18 (2), 103-105; February 2006.
In this case study presentation, family members describe how an in-home caregiver financially exploited their elderly parents. They also chronicle the difficulties they encountered in attempting to intervene, due in part to the father's resistance. A lawsuit is pending on the issue of whether the agency hiring the caregiver acted negligently by not conducting a criminal background check.

117. S6403-10
Patterson, M. & Malley-Morrison, K.
A Cognitive-Ecological Approach to Elder Abuse in Five Cultures: Human Rights and Education
Educational Gerontology; Vol. 32 (1), 73-82; January 2006.
This paper, the concluding article in an issue dedicated to the topic of culture and elder abuse, synthesizes the themes identified in preceding studies. The recognition that elder abuse is underestimated in all cultures studied (the U.S., Israel, Germany, Japan and Brazil) and variance of rates within and across cultures reinforces the need for prevalence studies. Research on the context in which abuse occurs is also needed in order to better identify risk factors. While physical and psychological aggression and economic abuse were identified in all studies, specific examples of each type of abuse varied across cultures. Cultural differences in family structures may be relevant to perspectives on elder mistreatment, and societal elements contribute to various aspects of abuse and neglect. (Note: To view descriptions of other articles included in this issue, see CANE file #s S6180-11, S6141-11, S6179-14, S6139-12, and S6138-11.)

118. S6154-7
Pearsall, C.
Forensic Biomarkers of Elder Abuse: What Clinicians Need to Know
Journal of Forensic Nursing; Vol. 1 (4), 182-186; December 2005.
This overview describes biomarkers that could signal elder abuse and neglect to physicians, nurses and other health care practitioners. Bruises, lacerations, abrasions, and fractures are among the potential indicators of physical abuse, and although they may be the result of accident or complications of the aging process, such biomarkers should trigger further discussion and assessment on the part of the clinician. Dehydration, decubiti, malnutrition, and burns may be indicators of intentional or unintentional abuse, neglect, and self-neglect. Dementia and mental health issues contribute to the risk for mistreatment. Guidelines for nursing assessments for all types of abuse, including inadequate levels of care, and sexual abuse, are outlined.

119. S6467-12
Podnieks, E.
Social Inclusion: An Interplay of the Determinants of Health - New Insights into Elder Abuse
Journal of Gerontological Social Work; Vol. 46 (3/4), 57-79; 2006.
This essay emphasizes the need to promote the principles of social inclusion across health and social sectors in order to enhance the protection of older Canadians. Research reveals a number of complex interactions among socioeconomic, personal, and behavioral factors that create risk for elder abuse and neglect and that are also associated with health status. Income, income distribution, social status, social support networks, employment and working conditions, physical and social environments, personal health practices, individual capacity, coping skills, genetic endowment, and health services are considered in this light. Shookner's "The Inclusion Lens" is summarized and presented as a tool for analysis of legislation, policy, and practices, and as a strategy for intervention to decrease the marginalization of elders. (Canada)

120. S6419-7
Reingold, D.*
An Elder Abuse Shelter Program: Build It and They Will Come, A Long Term Care Based Program to Address Elder Abuse in the Community
Journal of Gerontological Social Work; Vol. 46 (3/4), 123-135; 2006.
This article describes the establishment of the Weinberg Center, part of The Hebrew Home for the Aged at Riverdale. The goals of the Center are to promote public education and awareness regarding elder abuse in the community; to implement strategies for identifying and engaging victims; and to provide a long term care based shelter. The Center initiatives employ a multidisciplinary approach in collaboration with the Bronx District Attorney, the Manhattan District Attorney, New York City Adult Protective Services, New York Weill Cornell Medical Center, Pace Women's Justice Center, Westchester Adult Protective Services, Westchester District Attorney, and Westchester County Department of Senior Programs and Services. The Center provides both short term emergency shelter as well as long term care planning, which includes the client's safe return home with community supports, or transition to one of the Hebrew Home's housing arrangements.

121. S6449-18
Schall, V.
The New Extreme Makeover: The Medical Malpractice Crisis, Noneconomic Damages, the Elderly, and the Courts
Appalachian Journal of Law; Vol. 5 (1); Spring 2006.
Tort reform and damage caps are emerging as solutions for the U.S. "medical malpractice crisis" but appear to disadvantage elder residents of nursing homes who are victims of abuse and neglect. This legal commentary provides background on sociodemographic trends and the increasing need to provide protection for institutionalized elders. The author reviews the conflict among the courts addressing the constitutionality of statutory noneconomic (pain and suffering, for example) damage caps. Arguments that suggest these measures are necessary to protect medical insurance rates are challenged. In conclusion, the author argues that nursing home abuse should be either treated as a distinct form of custodial neglect, or should not be subjected to caps on noneconomic damages.

122. S6440-27*
Schuyler, D. & Liang, B.
Reconceptualizing Elder Abuse: Treating the Disease of Senior Community Exclusion
Annals of Health Law; Vol. 15; Summer 2006.
This paper outlines a multidisciplinary approach to assessing the needs of the elderly within the community and addressing existing abuse and neglect. An overview of elder abuse is presented, including a history of the federal and state (notably California) initiatives. In particular, the function of multidisciplinary teams (MDTs) is highlighted along with a number of model programs: the Elder Abuse Forensic Center in Santa Ana, California; the Family Justice Center of San Diego, California; and the Elder Justice Centers of Tampa and Palm Beach, Florida. The components of a proactive, community systems approach include local needs assessment sensitive to the cultural needs of an area; the identification of service providers; and facilitating access between service providers and seniors.

123. S6432-5
Shyrock, S., Hunsaker, D., Corey, T. & Weakley-Jones, B.
Forensic Evaluation of the Elderly
The Journal of the Kentucky Medical Association; Vol. 103 (9), 451-455; 2005.
Clinical forensic medicine (CFM, a branch of medicine that evaluates the victim of trauma and or neglect) may assist in detecting elder abuse. An overview of the risk factors for maltreatment and the clinician's responsibilities are presented. Specific screening questions are included that address the patient's general circumstances, health and well-being, functional abilities, financial status, emotional and psychological status, and specifics regarding the presenting injury. Physical indicators that require further investigation are outlined.

124. S6459-39
Stafford, B.
Expeditious Efforts for the Elderly: Covenant Care, Inc. v. Superior Court
U.C. Davis Law Review; Vol. 39; February 2006.
This legal note examines the California Supreme Court ruling on Covenant Care, Inc. v. Superior Court and its potential impact upon cases involving resident abuse and neglect. Case law is cited that illustrates the overlap of the Elder Abuse and Dependent Adult Civil Protections Act ( referred to by the author as the "Elder Abuse Act", which enhances remedies for "reckless, fraudulent, oppressive, and malicious acts of abuse and neglect by individuals and entities"), the Medical Injury Compensation Reform Act (MICRA, which provides defendant protections for nursing homes and other health care providers), and the California Code of Civil Procedure Section 425.13 (which "seeks to prevent unsubstantiated punitive damages claims from being included in claims against healthcare providers"). The details, rationale, and rulings of the Covenant Care v. Superior Court case are described. The case involved a family seeking punitive damages against a nursing home facility for abuse of a resident and claimed the "intentional, egregious elder abuse went beyond the scope of professional negligence." The court determined that section 425.13 did not apply to this or other claims alleged under the Elder Abuse Act. The author indicates that this decision will provide incentives for attorneys to take on elder abuse claims by expanding the boundaries for punitive damages and by eliminating procedural hurdles.

125. S6461-10
Straka, S. & Montminy, L.
Responding to the Needs of Older Women Experiencing Domestic Violence
Violence Against Women; Vol. 12 (3), 251-267; March 2006.
This overview describes the response and limitations of both the domestic violence (DV) and the elder abuse fields in addressing the needs of older women experiencing victimization. The feminist theory of DV and the women's shelter network is described as it meets, or fails to meet, the needs of older women. Although there is growing interest in this area, and more programs exist now for this population than did fifteen years ago, there are still relatively few specialized resources available. Issues that restrict the accessibility of traditional shelters for older women (such as time limits on occupancy, physical barriers, etc.) are described. The response to elder abuse, originally based on the child protection model and viewed as primarily relating to caregiver issues, is incongruent with the power and control theory of DV. Due to the caregiver burden conceptualization of elder abuse, cases of DV may be missed; moreover, responses may be based upon sympathy for abusers. The authors briefly describe current research initiatives designed to foster dialogue across the two networks in order to develop integrated services. (Canada)

126. S6431-11
Thompson, H. & Priest, R.
Elder Abuse and Neglect: Considerations for Mental Health Practitioners
Adultspan Journal; Vol. 4 (2), 116-128; Fall 2005.
This article is intended to raise awareness of elder abuse among mental health professionals, including counselors, psychologists, psychiatrists, and other therapists. Risk factors, abuser characteristics, and victim characteristics that are observable within the therapeutic process are described. The importance of cultural sensitivity in understanding intergenerational issues and attitudes is emphasized, and findings related to specific ethnic groups are presented. Clinical interventions may include individual, family, and relationship counseling; treating the victim's symptoms which may include depression, shame, sadness, etc., through emotional, cognitive, and behavioral approaches; empowerment for caregivers; and positive reminiscence to enhance the caregiver-care recipient relationship. When victimized elders choose to remain in the home with an abuser, the interventions must address both victim and perpetrator and should emphasize accountability on the part of the abuser. Legal and ethical issues are also discussed.

127. S6190-12
Twomey, M., Quinn, M. & Dakin, E.
From Behind Closed Doors: Shedding Light on Elder Abuse and Domestic Violence in Later Life
Journal of the Center for Families, Children & the Courts; Vol. 6; 2005.
This article, intended for members of all judicial systems, provides an overview of elder abuse and domestic violence in later life with a particular emphasis on legislation and projects from the state of California. Definitions, causal theories and risk factors are presented, along with barriers that older individuals may experience when attempting to seek assistance. The complex nature of elder abuse cases that reach the courts are highlighted. (Note: This article is available online at: http://www.courtinfo.ca.gov/programs/cfcc/pdffiles/4_Twomey.pdf .)

128. S6254-21
Uekert, B., Dancy, D., Peters, T. & Herman, M., for the National Center for State Courts
Policy Paper: Report from the First National Meeting of the Elder Abuse and the Courts Working Group Meeting
National Center for State Courts; Williamsburg, VA; June 2006.
Policy paper (online)        
The multidisciplinary Elder Abuse and the Courts Working Group was "established by the NCSC in 2005 to increase judicial awareness, build court capacity, and develop tools that courts can use to improve the identification of and response to the growing problem of elder abuse." The first meeting of the Working Group was convened in April 2006. Recommendations were made in the following areas: to encourage judicial leadership; to increase judicial and court awareness of elder abuse; to foster the training of judges and court staff; to improve court documentation of elder abuse; and to encourage funding agencies to provide adequate resources to allow for an improved court response. (Note: This paper is accessible online at: http://www.ncsconline.org/famviol/elderabuse/pdf/MeetingReportFINAL.pdf .)

129. S6428-3
Underwood, R.
Good Reasons to Take Elder Abuse Seriously
Nursing Homes; Vol. 54 (9), 106-108; September 2005.
This brief article provides guidelines for nursing home administrators to assess their facilities' potential risk for elder abuse and neglect. Two key issues are highlighted: the need to provide consumer education on elder abuse and neglect; and the need to have in place a clear and comprehensive protocol for addressing mistreatment. Specific recommendations for achieving these goals are outlined.

130. S6435-3
Walling, A.
Intervention and Treatment Strategies for Elder Abuse
American Family Physician; Vol. 72 (5), 896; September 2005.
This brief overview discusses the importance of assessing residential arrangements, dementia, social isolation, mental illness, and substance abuse in order to improve the identification of elder abuse and neglect victims in primary care settings.

131. S6472-28
Watts, L. & Sandhu, L.
The 51st State - The "State of Denial": A Comparative Exploration of Penal Statutory Responses to "Criminal" Elder Abuse in Canada and the United States
Elder Law Journal; Vol. 14; 2006.
In this article, the authors describe and compare the criminal justice response to elder abuse in the U.S. and Canada. While the U.S. "has experienced a vibrant and substantive discussion of the issues related to the criminality of elder abuse...," Canada has not. The current status of the law of both countries is discussed, as well as factors that may contribute to the differences. The authors argue that although the Canadian penal response may be ultimately different from that of the U.S., a national debate is long overdue. (Canada)

132. S6388-7
West, S.
Joining Up Adult Protection and the Disciplinary Process
Journal of Adult Protection; Vol. 8 (1), 4-10; May 2006.
"No Secrets," a report published in the U.K. by the Department of Health and the Home Office in 2000, emphasized the need for multi-agency policies in response to adult protection issues. The author is reporting on the implementation of this approach in Peterborough and Cambridgeshire, England. While the implementation has been generally successful with collaboration among health care and mental health professionals, housing officers, social services and law enforcement, certain agencies have remained unintegrated in terms of reporting suspected mistreatment and continue to act independently. The benefits of the multi-agency, multidisciplinary approach are described in an effort to encourage further coordination of services. (U.K.)

133. S6166-6
Wislowski, A. & Cuellar, N.
Voting Rights for Older Americans with Dementia: Implications for Health Care Providers
Nursing Outlook; Vol.54 (2), 68-73; March-April 2006.
In light of the aging U.S. population, the fact that seniors are the most likely citizens to exercise the right to vote, and the likelihood of the increase in the prevalence of dementia among voting aged citizens, this article examines possible implications for health care providers. Very little research exists on the voting patterns of individuals diagnosed with dementia, but one small study (n=75) of dementia caregivers revealed that nearly two-thirds of the sample with dementia did vote, and it was not uncommon for caregivers to assist in the voting process. Although some research suggests that certain characteristic features of certain types and degrees of dementia affect cognitive abilities operant in the voting process, other research suggests that in and of itself, a diagnosis of dementia "does not presuppose inability to vote." The lack of a uniform policy regarding voting for long-term care residents and homebound elders, access to voter registration, and voting technology are among the topics considered in the article. Physicians and other health care professionals not only play a role in the functional assessment of patients with dementia, but may also participate in the development, testing, implementation, and monitoring of screening tests for voter eligibility in order to preserve the civil liberties of voters with dementia.

IV. Books, Manuals and Training Resources

134. S6264-00*
Banker's Academy of the Edcomm Group
Focus on Elder Financial Abuse
Banker's Academy, Edcomm Group; 2006.
By integrating text, graphics, sound, video, and interactive scenarios, this online modular learning package is designed to educate employees of banks and financial institutions regarding elder financial abuse and exploitation, and their responsibilities to address the problem. The program presents an overview of various types of elder financial abuse, and includes information on recognizing the signs of exploitation, protecting customers, and appropriately reporting suspected abuse. The program can be tailored to the specific needs of the institution. For more information on the program, including fees, visit the Banker's Academy at: http://bankersacademy.com or http://bankersacademy.com/index.php?fromU%20of%20Del . )

135. S6284-28*
BITS Fraud Protection Toolkit: Protecting the Elderly and Vulnerable from Financial Fraud and Exploitation
Washington, D.C.; February 2006.
This toolkit was developed to assist employees of banks and financial institutions in addressing elder and vulnerable adult financial exploitation. Descriptions are provided for numerous types of frauds, scams and exploitation schemes, perpetrated by professional predators as well as caregivers, family members, friends and acquaintances of the victim. Guidelines for implementing employee training and protection plans are outlined, as are guidelines for addressing suspected fraud. The roles of loss prevention and legal departments are discussed, along with recommendations for collaborating with external community, state and federal agencies, adult protective services (APS) and law enforcement. The toolkit also includes a list of consumer protection tips, and a resource list for additional information, education and training on elder financial abuse and related issues. (Note: BITS is a nonprofit consortium comprised of executives from 100 of the largest financial institutions in the US. The consortium fosters collaborative approaches to emerging issues in the financial services field. The toolkit is accessible online only at: http://www.bitsinfo.org/downloads/Publications%20Page/bitstoolfeb06.pdf . The BITS Fraud Protection Guide: Protecting the Elderly and Vulnerable from Financial Fraud and Exploitation, is also available online at: http://www.bitsinfo.org/downloads/Publications%20Page/bitselderly.pdf .For additional resources, including a PowerPoint presentation on this material, visit the BITS homepage at: http://www.bitsinfo.org/index.html .)

136. S6115-104
Brandl, B., for the National Clearinghouse on Abuse in Later Life (NCALL)
Mandatory Reporting of Elder Abuse: Implications for Domestic Violence Advocates
National Clearinghouse on Abuse in Later Life (NCALL)/Wisconsin Coalition Against Domestic Violence (WCADV); 2005.
As quoted from the WCADV web site: "Americans are growing older and increasingly domestic violence programs are working with older victims. In many states, domestic violence staff members are mandated reporters of elder abuse. This issue paper is designed to assist domestic violence advocates in finding the necessary information to engage in critical analysis of how to provide safety and women-defined or victim-centered advocacy in an environment of mandatory reporting of elder abuse. Several key issues must be examined and analyzed when considering best practice and development of policies, protocols, and procedures. This project, in response to requests for information and technical assistance by domestic violence advocates, was funded by the Office on Violence Against Women, with legal research provided by the American Bar Association Commission on Law and Aging..." (Note: This publication is available online at: http://www.ncall.us/docs%5CMandatory_Reporting_EA.pdf , by emailing [email protected] or by telephoning (608) 255-0539.)

137. S6255-00
GeroNurse Online
Elder Mistreatment and Abuse
GeroNurse Online; 2006
This online geriatric nursing education resource provides a succinct overview of elder mistreatment, including definitions and examples, background and epidemiology, risk factors, assessment and screening tools, physical assessment, interventions and care strategies, and expected outcomes. Decision trees and additional tools are included. (Note: This tool is available online only at: http://www.geronurseonline.org/index.cfm?section_id=50&geriatric_topic_id=29&sub_section_id=216&page_id=476&tab=2 .)

138. S6350-225*
Harris, D. & Benson, M.
Maltreatment of Patients in Nursing Homes There Is No Safe Place
Haworth Press, Inc.; Binghamton, NY: 2006.
This book presents an overview of issues of abuse, neglect and exploitation involving nursing home residents and presents a framework for developing practical methods of addressing these problems. In addition, it presents the results of a nationwide study on thefts of residents' possessions and assets. Employees, administrators, and family members of residents from 47 nursing homes throughout the U.S. were surveyed on a wide range of topics, including the factors that contribute to maltreatment, characteristics of residents and employees, the bureaucracy of nursing homes, victimization rates, workforce issues, and federal regulations for nursing homes. Recommendations for enhancing the nursing home environment and reducing all forms of abuse are generated, and include theft-prevention training programs, criminal background checks and improved screening of potential employees, education and advocacy for staff members, and the reform of federal regulations. (Note: This book is not available through CANE. To purchase, contact the publisher online at: http://www.haworthpress.com/store/product.asp?sku=5461 . Price: hard cover: $34.95 or soft cover: $16.95. Telephone: 1-800-429-6784 in the U.S./Canada or 607-722-5857 outside the U.S./Canada.)

139. S6114-00*
National Consumers League (NCL)
Telemarketing Fraud Educators Toolbox
National Consumers League (NCL); 2005.
As quoted from Justice Information, a newsletter of the U.S. Department of Justice: "...The Telemarketing Fraud Educators Toolbox provides tips, presentations, scripts for radio PSAs and speeches, and much more. Materials are available in both English and Spanish..." The toolbox is intended for "representatives from government agencies, unions, social service agencies, schools, and nonprofit organizations... The Toolbox is not intended for use by businesses, trade associations, or the media. If you are not sure whether you qualify to use the Toolbox, please contact NCL at [email protected]." (Not specific to elders.) (Note: This resource is available online only at: http://www.fraud.org/toolbox/members.htm .)

140. S6334-00
New York Protective Services for Adults
Facing the Challenges of Dementia: Tools to Support and Protect Persons with Dementia
New York Protective Services for Adults; 2006.
This online training course, designed specifically for New York's adult protective services caseworkers, covers the following topics: Signs and Symptoms of Dementia; Understanding the Disease; Communication Strategies; Living Alone: Special Challenges; the Home Environment; Day-to-Day Care; and Supporting Caregivers. (Note: This training material is accessible online at: www.ocfs.state.ny.us/main/psa/cbt/dementia/dementia.htm .)

141. S6140-55*
Patronek, G., Loar, L. & Nathanson, J.
Animal Hoarding: Structuring Interdisciplinary Responses to Help People, Animals, and Communities at Risk
The Hoarding of Animals Research Consortium/HARC; Tufts University, MA; 2006
While the majority of self-neglect cases do not involve animal hoarding, animal hoarding cases often accompany cases of human self-neglect. This manual contains the findings from a forum held in April, 2004, among representative stakeholders (human health and welfare, municipal government, and animal welfare) regarding the process of effective intervention in animal hoarding cases. The goal of the forum was to generate an understanding of the role each discipline plays in resolving cases and minimizing recidivism. The manual presents an overview of various stakeholders, and a plan to maximize the resources each brings; discusses the means to foster cooperation among collaborating agencies; identifies different types of hoarders; describes how to establish integrated interventions based upon the characteristics of the agencies involved, the hoarder and the specific case; and discusses the means to reduce recidivism and to effect long-term change. Appendices include models of documents needed to establish an interdisciplinary team, including sample ordinances, statutory models, and memoranda of understanding. (Note: This publication is available online at http://www.tufts.edu/vet/cfa/hoarding/pubs/AngellReport.pdf . Hard copies are available. Price (including s/h): $15 each for orders of 1-5 copies $10 each for orders of 6-15 copies. For orders of >15 copies, please contact us for volume discounts. Make check payable to MSPCA and mail to: MSPCA, Attn: Jan Holmquist 350 South Huntington Avenue Boston, MA 02130.)

142. S6333-00
Williams, M.E.
The Ethical Challenges of Elder Abuse (CME Course)
Medscape CME Center; May 26, 2006.
This online CME course for physicians and other health professionals summarizes a presentation delivered at the American Geriatrics Society 2006 Annual Scientific Meeting, entitled "Ethical Dilemmas in Elder Abuse: Successful Resolutions of Challenging Cases." It is intended to enable health professionals to demonstrate an understanding of ethical principles in their treatment of the older patient, recognize community resources needed to assist in resolving difficult cases, identify barriers and limitations in the social service and legal system; and identify the threshold and appropriate approaches for reporting elder abuse and the liabilities for failing to report. (Note: This course is accessible online at: www.medscape.com/medscapetoday/cme . To find the session, type the search term "Ethical Challenges of Elder Abuse".)

V. Selected Federal Hearings

143. S6482-00
U.S. Senate Special Committee on Aging
Caring for Seniors in a National Emergency: Can We Do Better?
Washington, D.C.; May 18, 2006.
This hearing examines the needs of the vulnerable elderly during national and local emergencies (such as the Gulf Coast hurricanes of 2005) with a focus on how to better prepare for such disasters. Testimony was heard from the following witnesses: Maurice Frisella, a senior who survived Hurricane Katrina, from New Orleans, LA; Jean Cefalu, a former nurse and volunteer from Slidell, LA; Dan Sutherland, Officer, Office for Civil Rights and Civil Liberties, Chair, Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities, Department of Homeland Security, Washington, DC; Cindy Bascetta, Director, Health Care, U.S. Government Accountability Office, Washington, DC; Amy B. Aiken, Assistant Director, Miami-Dade Office of Emergency Management, Miami, FL; Carmel Bitondo Dyer, M.D., Associate Professor of Medicine, Director, Baylor College of Medicine Geriatrics Program at The Harris County Hospital District, Houston, TX. (Note: The testimony from this hearing can be accessed online from: http://aging.senate.gov/public/index.cfm?Fuseaction=Hearings.Detail&HearingID=170 .)

144. S6215-00
U.S. Senate Special Committee on Aging
Not Born Yesterday: How Seniors Can Stop Investment Fraud
Washington, D.C.; March 29, 2006.
According to the U.S. Federal Trade Commission's data, investment fraud is responsible for significant losses among Americans aged 50 and over, ranking fourth among all complaints lodged by this age group. This hearing addresses the need for enhanced financial literacy among older individuals, and emphasizes the need for prevention and intervention programs, which would be funded through the proposed Elder Justice Act. Testimony was provided by the following speakers: Ruth Mitchell, Victim of Investment Fraud, Columbiana, OH; Barry Minkow, former scam artist, San Diego, CA; Patricia Struck, President, North American Securities Administration Association (NASAA), Washington, DC; Elisse Walter, Executive Vice President, Policy & Oversight, National Association of Securities Dealers (NASD), Washington, DC; and Susan Ferris Wyderko, Acting Director, Division of Investment Management, U.S. Securities and Exchange Commission (SEC), Washington, DC. (Note: The transcript and web cast of this hearing are available online at: http://aging.senate.gov/public/index.cfm?Fuseaction=Hearings.Detail&HearingID=166 .)

145. S6478-00
U.S. Senate Special Committee on Aging
Preparing Early, Acting Quickly: Meeting the Needs of Older Americans During a Disaster
Washington, D.C.; October 5, 2005.
In the wake of Hurricane Katrina, inadequacies in national, state, and local emergency response systems were exposed. This hearing focuses on how vulnerable adults and the elderly could be better served during such disasters. Testimony was provided by the following witnesses: Keith Bea, Specialist, American National Government, Government and Finance Division, Congressional Research Service, Washington, DC; Maria Greene, Director, Division of Aging Services, Georgia Department of Human Resources, Atlanta, GA; Jeffrey Goldhagen, Director, Duval County Health Department, Jacksonville, FL; Leigh Wade, Executive Director, Area Agency on Aging of Southwest Florida, Inc., Fort Myers, FL; Carolyn S. Wilken, P.hD., MPH. , Associate Professor, FYCS, Extension Special, Gerontology, Gainesville, FL; Susan Waltman, Senior Vice President and General Counsel, Greater New York Hospital Association, New York, NY. (Note: Testimony from this can be accessed online from: http://aging.senate.gov/public/index.cfm?Fuseaction=Hearings.Detail&HearingID=100 .)

146. S6216-00
U.S. Senate Special Committee on Aging
Old Scams - New Victims: Breaking the Cycle of Victimization
Washington, D.C.; July 27, 2005.
This hearing focuses on scams, frauds, and identity theft, and their impact upon older Americans. The following witnesses testified on various types of financial exploitation, interventions, and prevention initiatives: Lois C. Greisman, Associate Director, Federal Trade Commission; Zane M. Hill, Acting Assistant Chief Inspector, United States Postal Inspection Service; Anthony Pratkanis, Professor of Psychology, University of California at Santa Cruz; Denise C. Park, Director, National Institute on Aging Roybal Center for Healthy Minds, University of Illinois; Helen Marks Dicks, Director, Elder Law Center, Coalition of Wisconsin Aging Groups; and Vicki Hersen, Director of Operations, Elders in Action, Portland, OR. Testimony also highlighted scientific research that provides insight into the social, psychological and physiological factors that contribute to the vulnerability of older victims. (Note: The transcript and web cast of this hearing are available online at: http://aging.senate.gov/public/index.cfm?Fuseaction=Hearings.Detail&HearingID=71 .)

Other Hearings Sponsored by the U.S. Senate Special Committee on Aging from July 2005 through June 2006:

06-27-2006 10:00 AM The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?

06-21-2006 10:00 AM Managing Retirement Assets: Ensuring Seniors Don't Outlive Their Savings

05-25-2006 10:00 AM Preparing For Pandemic Flu

05-03-2006 10:00 AM Innovation in the Aging Network: The Future of Social Services for Older Americans

04-06-2006 10:00 AM Employment and Community Service for Low Income Seniors: Are We Getting The Job Done?

03-15-2006 10:00 AM Bridging the Gender Gap: Eliminating Retirement Income Disparity for Women

03-09-2006 10:00 AM Long-Term Care Financing: Are Americans Prepared?

02-02-2006 10:00 AM Meeting The Challenges of Medicare Drug Benefit Implementation

10-05-2005 10:30 AM Preparing Early, Acting Quickly: Meeting the Needs of Older Americans During a Disaster

09-29-2005 10:00 AM The Impact of Direct-to-Consumer Drug Advertising on Seniors' Health and Health Care Costs

07-20-2005 02:30 PM Sound Policy, Smart Solutions: Saving Money In Medicaid

*This article has been highlighted in a previously posted annotated bibliography. To search the CANE Bibliography Series, go to www.elderabusecenter.org/default.cfm?p=cane.cfm .

*** Although some publication dates may be earlier, these publications first appeared in print during this time frame.

To search for earlier references on topics related to elder abuse, please visit the CANE Web site at: http://db.rdms.udel.edu:8080/CANE .

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