Elder Abuse and Neglect Assessment

Terry Fulmer, PhD, RN, GNP, FAAN

Dermatology Nursing. 2004;16(5) 

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).

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

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

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.

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.

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.

Dyer, C. B., & Goins, A. M. (2000). The role of the interdisciplinary geriatric assessment in addressing self-neglect of the elderly. Generations, 24(2),23-27.

Ferguson, D., & Beck, C. (1983). H.A.L.F. -- a tool to assess elder abuse within the family. Geriatric Nursing, 4(5), 301-4.

Hwalek, M., & Sengstock, M. (1986). Assessing the probability of abuse of the elderly: Toward development of a clinical screening instrument. Journal of Applied Gerontology, 5(2), 153-173.

Jones, J., Dougherty, J., Schelble, D., & Cunningham, W. (1988). Emergency department protocol for the diagnosis and evaluation of geriatric abuse. Annals of Emergency Medicine, 17(10), 1006-15.

Neale, A., Hwalek, M., Scott, R., Sengstock, M., & Stahl, C. (1991). Validation of the Hwalek-Sengstock elder abuse screening test. Journal of Applied Gerontology, 10(4), 406-418.

Phillips, L. R., & Rempusheski, V. F. (1985). A decision-making model for diagnosing and intervening in elder abuse and neglect. Nursing Research, 34(3), 134-9.

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          
8. Fractures          
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:
 
 
 
 
VII. Comments and Follow-up
 
 
 
 

Adapted from Fulmer, T. & Cahill, V.M. (1984). Assessing elder abuse: A study. Journal of Gerontological Nursing. 10(12): 16-20; Fulmer, T., Street, S., Carr, K. (1984). Abuse of the elderly: Screening and detection. Journal of Emergency Nursing. 10(3): 131-140.

Dermatology Nursing

is pleased to publish this regular feature, "Try This: Best Practices in Nursing Care to Older Adults," developed by the Hartford Institute for Geriatric Nursing.



This article was reprinted with permission from "Try This: Best Practices in Nursing Care to Older Adults" series from the John A. Hartford Foundation Institute for Geriatric Nursing. Mathy Mezey, EdD, RN, FAAN, is Director of the Institute and Terry Fulmer, PhD, RN, FAAN is Co-Director. Series Editor is Sheila Molony, MS, RN,C

Permission is hereby granted to reproduce this material for not-for-profit educational purposes only, provided The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University is cited as the source. Available on the internet at www.hartfordign.org. E-mail notification of usage to: hartford.ign@nyu.edu.

  1. Fulmer, T., Street, S., & Carr, K. (1984). Abuse of the elderly: screening and detection. Journal of Emergency Nursing, 10(3), 131-40.

  2. Fulmer, T., & Wetle, T. (1986). Elder abuse screening and intervention. Nurse Practitioner, 11(5), 33-8.

  3. Fulmer, T., Paveza, G., Abraham, I., & Fairchild, S. (2000). Elder neglect assessment in the emergency department. Journal of Emergency Nursing, 26(5), 436-443.

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