Elder Mistreatment Detection and Screening Instruments

Several screening tools have been developed to aid providers in the detection of abuse. These instruments are typically comprised of questions intended to assess for potential or presenting mistreatment. In a preliminary screening, positive responses can be followed up with further screenings, examinations, or referrals to facilitate comprehensive assessment and appropriate intervention. These detection aids vary by profession and often require training prior to implementation.

While there are a number of screening instruments available to assist practitioners, currently there is no gold standard.¹ Tools vary in their format, length, and focus.

Although some have shown promise, they may not be sufficiently broad to offer comprehensive detection of multiple forms of abuse. Additional research is needed to assess mistreatment and validate tools in different contexts, over different cultures and risk groups, and across professional disciplines.²

General discussions and systematic reviews of elder abuse screening instruments are available.³ ⁴ ⁵

The following are among the tools identified for use in healthcare settings:

  • Brief Abuse Screen for the Elderly (BASE)⁶

  • Caregiver Abuse Screen (CASE)⁷

  • Detection of Elder abuse Through Emergency Care Technicians (DETECT)⁸

  • ED Senior Abuse Identification (ED Senior AID) tool⁹

  • Elder Abuse Suspicion Index (EASI) – also for LE¹⁰

  • Elder Assessment Instrument (EAI)¹¹

  • Elder Mistreatment Screening and Response Tool (EM-SART)¹²

  • Emergency Department Elder Mistreatment Assessment Tool for Social Workers (ED-EMATS)¹³

  • Expanded Indicators of Abuse (E-IOA)¹⁴

  • Geriatrics Mistreatment Scale (GMS)¹⁵

  • Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST)¹⁶

  • Indicators of Abuse (IOA)¹⁷

  • Lichtenberg Financial Decision Rating Scale (LFDRS-SF)¹⁸

  • Older Adult Financial Exploitation Measure (OAFEM)¹⁹

  • Responding to Elder Abuse in GERIatric care–Self-administered (REAGERA-S)²⁰

  • Vulnerability to Abuse Screening Scale (VASS)²¹

The following tools have been identified for use by Adult Protective Services and other caseworkers in the field of aging:

  • California Undue Influence Screening Tool (CUIST)²²

  • Elder Abuse Risk Assessment and Evaluation Tool (EARAE)²³

  • Elder Abuse Decision Support System (EADSS)²⁴

  • Weinberg Center Risk and Abuse Prevention Screen (WC-RAPS)²⁵

¹ McCarthy, C. (2017). Elder abuse screening tools: a systematic review. The Journal of Adult Protection, 19(6), 368–379.
² Gallione, C., Dal Molin, A., Cristina, F. V., Ferns, H., Mattioli, M., & Suardi, B. (2017). Screening tools for identification of elder abuse: a systematic review. Journal of Clinical Nursing, 26(15–16), 2154–2176.
³ Schofield, M. J. (2017). Screening for elder abuse: tools and effectiveness. In Elder Abuse (pp. 161–199). Springer, Cham.
⁴ McCarthy, L., Campbell, S., & Penhale, B. (2017). Elder abuse screening tools: a systematic review. The Journal of Adult Protection.
⁵ Gallione, C., Dal Molin, A., Cristina, F. V., Ferns, H., Mattioli, M., & Suardi, B. (2017). Screening tools for identification of elder abuse: a systematic review. Journal of Clinical Nursing, 26(15–16), 2154–2176.
⁶ Reis, M., & Nahmiash, D. (1995). Brief Abuse Screen for the Elderly (BASE).
⁷ Reis, M., & Nahmiash, D. (1995). Validation of the caregiver abuse screen (CASE). Canadian Journal on Aging / La Revue Canadienne du Vieillissement, 14(S2), 45–60.
⁸ Cannell, B., Weitlauf, J., Livingston, M. D., Burnett, J., Parayil, M., & Gonzalez, J. R. (2020). Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol. BMJ Open, 10(9), e037170.
⁹ Platts-Mills, H. (2020). Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse. Annals of Emergency Medicine, 76(3), 280–290.
¹⁰ Kurkurina, E., Lange, B. C., Lama, S. D., Burk-Leaver, E., Yaffe, M. J., Monin, J. K., & Humphries, D. (2018). Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index© by law enforcement in the field. Journal of Elder Abuse & Neglect, 30(2), 103–126.
¹¹ Fulmer, T. (2003). Elder abuse and neglect assessment. Journal of Gerontological Nursing, 29(6), 4–5.
¹² Platts-Mills, T., Sivers-Teixeira, T., Encarnacion, A., Tanksley, B., & Olsen, B. (2020). EM-SART: A scalable elder mistreatment screening and response tool for emergency departments. Generations, 44(1), 51–58.
¹³ Elman, A., Rosselli, S., Burnes, D., Clark, S., Stern, M. E., LoFaso, V. M., … & Rosen, T. (2020). Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique. Health & Social Work, 45(2), 110–121.
¹⁴ Cohen, M., Halevi-Levin, S., Gagin, R., & Friedman, G. (2006). Development of a screening tool for identifying elderly people at risk of abuse by their caregivers. Journal of Aging and Health, 18(5), 660–685.
¹⁵ Giraldo-Rodriguez, L., & Rosas-Carrasco, O. (2013). Development and psychometric properties of the Geriatric Mistreatment Scale. Geriatrics & Gerontology International, 13(2), 466–474.
¹⁶ Neale, A. V., Hwalek, M. A., Scott, R. O., Sengstock, M. C., & Stahl, C. (1991). Validation of the Hwalek-Sengstock elder abuse screening test. Journal of Applied Gerontology, 10(4), 406–418.
¹⁷ Reis, M., & Nahmiash, D. (1998). Validation of the indicators of abuse (IOA) screen. The Gerontologist, 38(4), 471–480.
¹⁸ Lichtenberg, P. A., Gross, E., & Campbell, R. (2020). A short form of the Lichtenberg financial decision rating scale. Clinical Gerontologist, 43(3), 256–265.
¹⁹ Phelan, A., Fealy, G., & Downes, C. (2017). Piloting the older adult financial exploitation measure in adult safeguarding services. Archives of Gerontology and Geriatrics, 70, 148–154.
²⁰ Simmons, J., Wiklund, N., Ludvigsson, M., Nägga, K., & Swahnberg, K. (2020). Validation of REAGERA-S: a new self-administered instrument to identify elder abuse and lifetime experiences of abuse in hospitalized older adults. Journal of Elder Abuse & Neglect, 32(2), 173–195.
²¹ Schofield, M. J., & Mishra, G. D. (1996). Vulnerability to Abuse Screening Scale (VASS).
²² Quinn, M. J., Nerenberg, L., Navarro, A. E., & Wilber, K. H. (2017). Developing an undue influence screening tool for Adult Protective Services. Journal of Elder Abuse & Neglect, 29(2–3), 157–185.
²³ Dauenhauer, J., Heffernan, K., Caccamise, P. L., Granata, A., Calamia, L., Siebert-Konopko, T., & Mason, A. (2019). Preliminary outcomes from a community-based elder abuse risk and evaluation tool. Journal of Applied Gerontology, 38(10), 1445–1471.
²⁴ Conrad, K. J., Iris, M., & Liu, P. J. (2017). Elder Abuse Decision Support System: Field test outcomes, abuse measure validation, and lessons learned. Journal of Elder Abuse & Neglect, 29(2–3), 134–156.
²⁵ Teresi, J. A., Ocepek-Welikson, K., Ramirez, M., Solomon, J., & Reingold, D. (2019). Methodological approaches to the analyses of elder abuse screening measures: Application of latent variable measurement modeling to the WC-RAPS. Journal of Elder Abuse & Neglect, 31(1), 1–24.