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Elder Mistreatment Assessment

Elder Mistreatment Assessment

By: Terry Fulmer, PhD, RN, FAAN, The John A. Harford Foundation

WHY: Elder Mistreatment 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), a 41-item assessment instrument, has been in the literature since 1984 (Fulmer, Street, & Carr, 1984; Fulmer, & Wetle, 1986; Fulmer, Paveza, Abraham, & Fairchild, 2000). This instrument is comprised of seven sections that reviews signs, symptoms and subjective complaints of elder abuse, neglect, exploitation, and abandonment. There is no actual score. A person should be referred to social services if the following exists:

1) if there is any evidence of mistreatment (abuse, neglect, exploitation, abandonment)
2) whenever there is a subjective complaint by the older adult of EM
3) whenever the clinician believes there is high risk for 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 AND 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<.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.
 
MORE ON THE TOPIC:
 
Best practice information on care of older adults: https://consultgeri.org
 
Aravanis, S.C., Adelman, R.D., Breckman, R., Fulmer, T., Holder, E., Lachs, M. S., O’Brien, J.G., & Sanders, A.B. (1993). Diagnostic and treatment guidelines on elder abuse and neglect. Archives of Family Medicine, 2(4), 371-88.
 
Evans, C., Hunold, K., Rosen, T., & Platts-Mills, T. (2017). Diagnosis of elder abuse in U.S. emergency departments. Journal of The American Geriatrics Society, 65(1), 91-97. doi:10.1111/jgs.14480
 
Fulmer, T., Paveza, G., Abraham, I., & Fairchild, S. (2000). Elder neglect assessment in the emergency department. Journal of Emergency Nursing, 26(5), 436-443.
 
Hoover, R., & Michol, P. (2014). Detecting elder abuse and neglect: Assessment and intervention. American Family Physician, 89(6), 453-460.
 
Lofaso, V. M., & Rosen, T. (2014). Medical and laboratory indicators of elder abuse and neglect. Clinics in Geriatric Medicine, 30(4), 713-728. doi:10.1016/j.cger.2014.08.003 
 
Wang, X. M., Brisbin, S., Loo, T., & Straus, S. (2015). Elder abuse: An approach to identification, assessment and intervention. Canadian Medical Association Journal, 187(8), 575-581. doi:10.1503/cmaj.141329