9
Moving Forward

Knowledge about elder mistreatment will advance only if its importance is recognized by policy makers and funding agencies, if useful theories and methods are successfully extrapolated from relevant disciplines and adjacent fields of research, and if adequate funding is available to support research careers in this field. The first of these conditions is likely to be satisfied as the population ages and mistreatment becomes more evident (a process that can be accelerated by conducting a sound study of national prevalence). The second is most likely to be satisfied if research on elder mistreatment is “located,” conceptually and operationally, in the mainstream of research funding. The third will require a concerted effort on the part of agencies that sponsor and regulate research.

FROM THE MARGINS TO THE MAINSTREAM

Recognizing that elder mistreatment crosses categorical boundaries in both health research and social science research, federal funding agencies (e.g., the National Institute on Aging, the Administration on Developmental Disabilities and Rehabilitation Research, and the National Institute of Justice) should work collaboratively to promote research on the abuse (physical and sexual) and financial exploitation of vulnerable adults, including older persons as well as younger adults with disabilities.

Another promising idea is to locate aspects of elder mistreatment research relating to caregiving in the domain of quality assurance in long-term care. According to the prevailing conceptualization of health care



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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America 9 Moving Forward Knowledge about elder mistreatment will advance only if its importance is recognized by policy makers and funding agencies, if useful theories and methods are successfully extrapolated from relevant disciplines and adjacent fields of research, and if adequate funding is available to support research careers in this field. The first of these conditions is likely to be satisfied as the population ages and mistreatment becomes more evident (a process that can be accelerated by conducting a sound study of national prevalence). The second is most likely to be satisfied if research on elder mistreatment is “located,” conceptually and operationally, in the mainstream of research funding. The third will require a concerted effort on the part of agencies that sponsor and regulate research. FROM THE MARGINS TO THE MAINSTREAM Recognizing that elder mistreatment crosses categorical boundaries in both health research and social science research, federal funding agencies (e.g., the National Institute on Aging, the Administration on Developmental Disabilities and Rehabilitation Research, and the National Institute of Justice) should work collaboratively to promote research on the abuse (physical and sexual) and financial exploitation of vulnerable adults, including older persons as well as younger adults with disabilities. Another promising idea is to locate aspects of elder mistreatment research relating to caregiving in the domain of quality assurance in long-term care. According to the prevailing conceptualization of health care

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America quality (easily extended to other human services), patient (or client) safety is one of the four components of quality in services (together with effectiveness, patient-centeredness, and timeliness) (Institute of Medicine, 2001). It is already understood that prevention of mistreatment is a core element of quality assurance in nursing home regulation. However, as noted earlier, 80 percent of vulnerable elderly persons live in community settings, not in nursing homes. Protecting elderly people in these settings, including their own homes, represents a parallel challenge for policy makers and an overlapping agenda for researchers aiming to understand the phenomenology, etiology, and consequences of mistreatment and the interventions that can reduce it. By viewing elder mistreatment through the prism of quality assurance (safety and security) in long-term care, it is possible to draw together the frameworks and methods of researchers studying the needs of, and services provided to, vulnerable elderly people in various long-term care settings, as well as those used by researchers studying power and conflict in human relationships (see Chapter 3). BUILDING THE INFRASTRUCTURE Researchers currently in the field indicate that the ability to attract new investigators is hampered by the lack of training funds. Both federal agencies and private foundations should make funds available for both predoctoral and postdoctoral training programs. Career advancement funding should be readily available to investigators who express an interest in pursuing careers in elder mistreatment research. Foundations supporting geriatric education in the professions should pay special attention to those seeking funding or support for careers in elder mistreatment research. An adequate long-term funding commitment to research on elder mistreatment must be made by relevant federal, state, and private agencies to support research careers and to develop the next generation of investigators in the field. To help develop the research infrastructure of the field, several steps are needed to remove barriers and create new opportunities: The Office for Human Research Protections needs to work with both experts in elder mistreatment and experts on human subjects protection to arrive at useful guidelines concerning research participation. Research funding is needed from agencies other than those already in the field. Most research on elder mistreatment has been supported by the National Institute on Aging, the Administration on Aging, and offices within the Department of Justice. Funding agencies with interests in aging or disabled or vulnerable populations, or in health care delivery (especially long-term care) and health/social policy research, should invest in research

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America in this important and understudied domain affecting older adults. For example, the Administration on Developmental Disabilities and Rehabilitation Research, the Centers for Medicare and Medicaid Services, or the Center for Mental Health Services might be interested in supporting research focusing on vulnerable adults who are often served by the adult protective services system. The Agency for Healthcare Research and Quality may be interested in research on reducing elder mistreatment as a measure of quality improvements, not only in nursing homes, but also in the entire range of long-term care settings. In addition, private foundations, such as the American Health Assistance Foundation and the Andrus Foundation, which support research on dementia and Alzheimer’s disease, should be encouraged to make elder mistreatment research one of their priority interests. Within the grant review system, particularly on the federal level, but within other funding sources as well, ways need to be found to incorporate experts in elder mistreatment into the review structure on a continuing basis. Most review groups include no experts in the field of elder abuse. New fields of interest or those in early stages of scientific development, such as elder mistreatment, are probably disadvantaged in the scientific review process in comparison to mature fields, especially when the review committees are not aware of the poorly developed state of knowledge. This problem can be ameliorated by ensuring that experts in the field participate in the review of relevant applications, either as special consultants or as members of the review groups. Persons currently doing research and practicing in the field of elder mistreatment need to disseminate the findings of their research and programmatic efforts in a more systematic and expeditious manner. CONCLUSION Systematic implementation of these recommendations will help establish a sound foundation for advancing knowledge on elder mistreatment. A genuine long-term commitment of resources to this important, though understudied, area will also help to recruit a new generation of scientists to the field. By the same token, however, it is clear that, in the absence of the kinds of investment recommended in this report, knowledge and understanding of elder mistreatment will remain thin, even as the population ages and the occurrence of mistreatment increases. A substantial commitment to research is needed to inform and guide a caring society as it aims to cope with the challenges ahead.