Elder Abuse and Neglect Assessment

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Terry Fulmer, PhD, RN, GNP, FAAN
Dermatol Nurs 16(5):473, 2004. &#A9; 2004 Jannetti Publications, Inc. Posted 12/17/2004

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Elder abuse and neglect is a serious and prevalent problem that is estimated to affect 700,000 to 1.2 million older adults annually in this country. Only one in ten cases of elder abuse and neglect are reported and there is a serious underreporting by clinical professionals, likely due to the lack of appropriate screening instruments. Abuse, neglect, exploitation and abandonment are actions that can result in elder mistreatment (EM).

Best Tools
The Elder Assessment Instrument (EAI),[1,2,3] a 41-item Likert scale assessment instrument that has been in the literature since 1984. This instrument is comprised of seven sections that reviews signs, symptoms and subjective complaints of elder abuse, neglect, exploitation and abandonment. There is no “score”. A patient should be referred to social services if the following exists:

1. if there is any evidence of mistreatment without sufficient clinical explanation
2. whenever there is a subjective complaint by the elder of EM
3. whenever the clinician believes there is high risk or probable abuse, neglect, exploitation, abandonment

Target Population
The EAI is appropriate in all clinical settings and is completed by clinicians that are responsible for screening for elder mistreatment.

Validity/Reliability
The EAI has been used since the early 1980′s. The internal consistency reliability (Cronbach’s alpha) is reported at 0.84 in a sample of 501 older adults who presented in an emergency department setting. Test/retest reliability is reported at 0.83 [P less than 0.0001].

The instrument is reported to be highly sensitive and less specific. Strengths and Limitations The major strengths of the EAI are its rapid assessment capacity (the instrument takes approximately 12-15 minutes) and the way that it sensitizes the clinician to screening for elder mistreatment. Limitations include: no scoring system and weak specificity….

I. General Assessment
Very Good// Good// Poor// Very Poor// Unable to Assess
1. Clothing
2. Hygiene
3. Nutrition
4. Skin integrity
5. Additional Comments:

II. Possible Abuse Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
6. Bruising
7. Lacerations
9. Various stages of healing of any bruises or fractures
10. Evidence of sexual abuse
11. Statement by elder re: abuse
12. Additional Comments:

III. Possible Neglect Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
13. Contractures
14. Decubiti
15. Dehydration
16. Diarrhea
17. Depression
18. Impaction
19. Malnutrition
20. Urine burns
21. Poor hygiene
22. Failure to respond to warning of obvious disease
23. Inappropriate medications (under/ over)
24. Repetitive hospital admissions due to probable failure of health care surveillance
25. Statement by elder re: neglect
26. Additional Comments:

IV. Possible Exploitation Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
27. Misuse of money
28. Evidence of financial exploitation
29. Reports of demands for goods in exchange for services
30. Inability to account for money/ property
31. Statement by elder re: exploitation
32. Additional Comments:

V. Possible Abandonment Indicators
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
33. Evidence that a caretaker has withdrawn care precipitously without alternate arrangements
34. Evidence that elder is left alone in an unsafe environment for extended periods of time without adequate support
35. Statement by elder re: abandonment
36. Additional Comments:

VI. Summary
No Evidence Possible// Evidence Probable// Evidence Definite// Evidence Unable to Assess
37. Evidence of abuse
38. Evidence of neglect
39. Evidence of exploitation
40. Evidence of abandonment
41. Additional Comments:

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