conducted the National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998). In this study, modeled after recent incidence studies of child abuse, the researchers identified a nationally representative sample of 20 counties in 15 states; for each county sampled, they collected data from the local APS agency as well as approximately 1100 professional “sentinels” having frequent contact with the elderly. In 1996, according to the projections based on this study, about 450,000 persons age 60 or older experienced abuse or neglect in family settings, about 16 percent of whom were in the APS report files. It is generally acknowledged that these findings detect only the most overt cases and thus significantly underestimate the incidence of elder mistreatment.

Studies of professionals and agency records are justified in those situations in which investigators specifically want to know how professionals view elder mistreatment. But researchers have too often used these professional surveys to estimate the incidence or prevalence of elder mistreatment, or to establish its causes. They are not appropriate for these purposes. Future research in this area should go beyond archival data and should rely to a much greater extent on elder persons’ accounts of their experiences and on their perceptions regarding their own security.

Lack of Population-Based Data

Data on the extent of elder mistreatment in the general population are sparse. Representative sample surveys of community populations are urgently needed. Over the past two decades, knowledge about violence in families and the victimization of children and other vulnerable people has improved significantly. A major advance has been the fielding of major population-based victimization surveys that have helped to establish reliable prevalence estimates of select problems, such as intimate partner violence and child physical and sexual abuse. Similar progress has not occurred in the field of elder mistreatment.

In the earliest research about two decades ago, studies were generally conducted on small, nonrandom samples, with little generalizabilty to the population. Furthermore, research in the field was conducted independently by investigators from different disciplines, using different methods and without recognizing the problems faced by other investigators. For example, the medical community focused on clinical signs and symptoms that could not be explained by disease markers, and this was a daunting task. Very often, older adults who had multiple chronic diseases or conditions might have symptoms that could mask or mimic mistreatment. Using a patient-based approach to study elder mistreatment is also fraught with potential for sample bias, in that if an older adult does not have a doctor or



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