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This thesis, full of valuable insights and information, contrasts definitions of elder abuse in the Lumbee community (Robeson County, North Carolina) with those in nearby New Hanover County, North Carolina (also in southeastern North Carolina, not as impoverished as Robeson County, but home to an increasing elderly population). Locklear uses Ferdinand Tonnies's theory (1957) of Gemeinschaft and Gesellschaft to describe the difference in service delivery in the two counties: informal approach (Gemeinschaft) in Robeson County, vs. formal approach (Gesellschaft) in New Hanover County. See Table 1, "Bi-cultural approaches to social issues", page 56 for a comparison of characteristics of the two systems.Locklear's introductory section discusses differing definitions of abuse and neglect; theories of elder abuse; how elder abuse is measured; and (especially useful) cultural values of Lumbee people, especially Lumbee elders, that must be understood in order to diagnose and treat elder abuse:Placidity and silence (hiding feelings of discomfort so as not to embarrass the self or others; retreating if pressed too much in conversation;Modesty (preferring not to call attention to oneself, therefore not wanting to ask for help; reluctance to bring a family problem to the attention of others in the community);Family first (minimizing one's own needs, even to the point of self-neglect, so that others in the family will have what they need);Generosity and the land (family members live on family-owned property, often adjoining, or move in with family members if help is needed; people borrow things from each other and repay at a later date);Avoid bringing shame to the family (because gossip is prevalent in the Lumbee community, family issues, including abuse, are not discussed; and the abused elder is also likely to remain silent to avoid embarrassing the family);Women as caregivers (practically all caregiving activities that take place in the home are done by Lumbee women, often by daughters or granddaughters who work full time and have their own children);Reluctance to admit disability, or fear of being labelled as disabled; Distrust;Belief that there is a welfare stigma attached to receiving government assistance Locklear's literature review on elder abuse in Native American communities revealed the following, which seems relevant to Robeson County: "There is a general consensus that poverty and the breakdown of community economic life in Native American communities fosters dependency, which affects risk in two ways: elders who rely on family members for care and food are at risk, and elders upon whom others depend are also at risk" (p. 46). He goes on to offer the following observations about the informal system of elder care in Robeson County:> Informal caregivers may be performing services they are not qualified to perform. This situation may have been necessitated by lack of income or resources.> Lumbee people become disabled at an earlier than average age, and they may have several disabilities at once.>Neglect and exploitation are the most frequently occurring forms of mistreatment of Lumbee elders. The elder may be forced to do without medications, companionship, food, medical assistance, or help with the tasks of daily living. Exploitation is often financial and often takes place in families with drug or alcohol abuse problems. Elders do without in order to loan money, which they're unlikely to be repaid, to family members. Elders may also be financially exploited by home health workers or con artists. Both family members and home health care workers have exploited elders by pawning their possessions, prescriptions, food, or food stamps.>Generous Lumbee elders, often on a fixed income, may be abused by caregivers who live off the elder, providing no assistance in return and, in some cases, using the elder's home as a drug house or prostitution house.>Verbal or psychological abuse may occur when the elder wants to be self-sufficient and disagrees with family members; or when the elder is suffering from dementia, depression, or substance abuse.> An abused Lumbee elder may silently wait out the abuse, rather than complain, and may require lengthy explanations of services before accepting any help.>Locklear's informal interviews revealed that Lumbee elders view drug and alcohol problems as "prevalent causes" of elder abuse and neglect (p. 52).>Service providers in Robeson County report that "the most vulnerable victims were men, those with the most disabilities, those living in rural areas, and those living with drug or alcohol abusers" (p. 53).>Locklear observes that respect for elders among the Lumbee is slowly diminishing. He believes that "assimilation, acculturation, and loss of traditional values all pose a significant threat in the diminishing respect of Lumbee elders" (p. 54). Locklear then makes a number of comparisons between New Hanover County and Robeson County in terms of awareness of and provision of services for the elderly. He concludes with helpful recommendations on how service providers can improve their recognition of abuse among Lumbee elders, communication with those elders, and provision of services. Particularly useful is his "list of [thirteen] questions that can be asked to probe an understanding" (p. 69) of cultural factors that are involved in the help-seeking and decision-making of abused elders and their families.