A number of screening measures have been developed and tested in different settings, including the emergency department, clinics, and at home.[41]National Center for Elder Abuse. Elder abuse screening tools for healthcare professionals. 2016 [internet publication].
https://pfs2.acl.gov/strapib/assets/Elder_Abuse_Screening_Tools_for_Healthcare_Professionals_d12f7089bd.pdf
There is no single globally accepted screening tool for abuse of older adults; however, there are several validated tools in use. If screening tests do not indicate abuse, then no immediate action is required.[37]Aravanis SC, Adelman RD, Breckman R, et al. Diagnostic and treatment guidelines on elder abuse and neglect. Arch Fam Med. 1993 Apr;2(4):371-88.
http://www.ncbi.nlm.nih.gov/pubmed/8130916?tool=bestpractice.com
[42]Rathbone-McCuan E, Voyles B. Case detection of abused elderly parents. Am J Psychiatry. 1982 Feb;139(2):189-92.
http://www.ncbi.nlm.nih.gov/pubmed/7055289?tool=bestpractice.com
[43]Fulmer T, Birkenhauer D. Elder mistreatment assessment as a part of everyday practice. J Gerontol Nurs. 1992 Mar;18(3):42-5.
http://www.ncbi.nlm.nih.gov/pubmed/1556397?tool=bestpractice.com
[44]Cooper C, Manela M, Katona C, et al. Screening for elder abuse in dementia in the LASER-AD study: prevalence, correlates and validation of instruments. Int J Geriatr Psychiatry. 2008 Mar;23(3):283-8.
http://www.ncbi.nlm.nih.gov/pubmed/17621366?tool=bestpractice.com
[45]Shugarman LR, Fries BE, Wolf RS, et al. Identifying older people at risk of abuse during routine screening practices. J Am Geriatr Soc. 2003 Jan;51(1):24-31.
http://www.ncbi.nlm.nih.gov/pubmed/12534841?tool=bestpractice.com
However, owing to the low sensitivity of some screening tests, continued monitoring is advised. Conversely, a positive screen does not necessarily mean abuse is happening, but guides the need for further evaluation.
At the Elder Mistreatment Symposium convened by the Centers for Medicare and Medicaid Services in 2013 in the US, three screening tools were identified for increased use in practice for the screening of abuse of older adults. These were the Elder Abuse Suspicion Index (EASI), the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale (VASS).[41]National Center for Elder Abuse. Elder abuse screening tools for healthcare professionals. 2016 [internet publication].
https://pfs2.acl.gov/strapib/assets/Elder_Abuse_Screening_Tools_for_Healthcare_Professionals_d12f7089bd.pdf
Elder Abuse Suspicion Index
The EASI is designed to be completed by a healthcare professional on cognitively intact older adults. It consists of 6 questions and takes less than 5 minutes to complete. If positive, the patient should be referred to adult protective services or an equivalent agency. The EASI has shown validity in eight countries, and has been validated for use in family practices and ambulatory clinic settings.[41]National Center for Elder Abuse. Elder abuse screening tools for healthcare professionals. 2016 [internet publication].
https://pfs2.acl.gov/strapib/assets/Elder_Abuse_Screening_Tools_for_Healthcare_Professionals_d12f7089bd.pdf
[48]McGill: Department of Family Medicine. Elder Abuse Suspicion Index © (EASI). Feb 2006 [internet publication].
https://www.mcgill.ca/familymed/research/resources/funding/elder
Hwalek-Sengstock Elder Abuse Screening Test
The H-S/EAST is completed by self-report or by a healthcare professional. It has good cross-cultural adaptation and can be used in the emergency or outpatient setting.[41]National Center for Elder Abuse. Elder abuse screening tools for healthcare professionals. 2016 [internet publication].
https://pfs2.acl.gov/strapib/assets/Elder_Abuse_Screening_Tools_for_Healthcare_Professionals_d12f7089bd.pdf
[49]Neale AV, Hwalek MA, Scott RO, et al. Validation of the Hwalek-Sengstock elder abuse screening test. J Appl Gerontol. 1991 Dec;10(4):406-18.
Vulnerability to Abuse Screening Scale
The VASS is used to identify older women at risk for abuse. It is a self-reported questionnaire of dependency, dejection, coercion, and vulnerability.[50]Schofield MJ, Mishra GD. Validity of self-report screening scale for elder abuse: Women's Health Australia study. Gerontologist. 2003 Feb;43(1):110-20.
http://www.ncbi.nlm.nih.gov/pubmed/12604752?tool=bestpractice.com