Identifying Elder Abuse: Tools, Techniques and Guidelines for Screening and Assessment

Many representatives of health and social services, legal services, and law enforcement may unknowingly come in contact with elders who have been victimized. Identifying elders who have been victimized, or who are at risk for victimization, is integral to effective interventions. Screening and assessment tools and techniques exist to assist the practitioner in identifying the signs, symptoms and risk factors of elder mistreatment.

The following selected annotated bibliography was developed to provide practitioners and professionals working with elders and vulnerable adults with an overview of available resources, tools, techniques and guidelines for identifying elder abuse and neglect. Several articles offer summaries and evaluations of the tools currently in use (see "Progress in Elder Abuse Screening and Assessment Instrument," Fulmer et al. 2004, and Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America, Chapter 6: Screening and Case Identification in Clinical Settings, National Research Council, National Academy Press, 2003.)

Some of the articles, such as "Validation of the Indicators of Abuse (IOA) Screen," (Reis, M. & Nahmiash, D., 1998) detail specific instruments, while others, such as "Elder Abuse: Clinical Assessment and Obligation to Report," (Bergeron, L., 2004), are broader in scope.

Other publications referenced here, such as "Comparing the Alcohol-Related Problems Survey (ARPS) to Traditional Alcohol Screening Measures in Elderly Outpatients," (Fink et al., 2002) have been included to highlight the need to screen for risk factors associated with elder mistreatment. Several of the articles provide comparisons of various tools.

It is important to note that while dementia is a risk factor for elder mistreatment, the evaluation of cognitive impairment and the validity and reliability of tests of cognitive functioning are beyond the scope of this bibliography. (For more information on the relationship between cognitive impairment and elder mistreatment, see the CANE bibliographies, Dementia and Alzheimer, posted on the NCEA Web site.)

Most of these reference materials can be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by e-mailing cane-ud@udel.edu or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of books and articles representing a variety of perspectives on the subject. To access these and other annotated bibliographies, visit the CANE Bibliography Series on the NCEA Web site. For additional references on identification of elder abuse and neglect, including materials published prior to 1995, please visit the CANE online database at http://www.cane.udel.edu/

Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing cane-ud@udel.edu or telephoning (302-831-3525).

The National Center on Elder Abuse (NCEA) serves as a national resource for adult protective services, elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
        National Association of State Units on Aging (NASUA), Lead Partner
        American Bar Association (ABA) Commission on Law and Aging
        Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
        National Adult Protective Services Association (NAPSA)
        National Committee for the Prevention of Elder Abuse (NCPEA)<

This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services.
Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.

2005

1. P5922-20
Anetzberger, G.
Clinical Management of Elder Abuse: General Considerations
The Clinical Gerontologist; Vol. 28 (1/2), 27-41; 2005.
Journal article (scholarship)
(Note: co-published simultaneously as The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004.)
In this article, the author provides an overview of the considerations encountered throughout the clinical management of elder abuse. The process is divided into five steps: detection, assessment, planning, intervention, and follow-up. The detection phase occurs as the clinician tries to determine if elder abuse is suspected or known. Recommendations include interviewing both the suspected perpetrator as well as the victim, and seeing the victim in his or her home. Barriers to detection can include the personal values and beliefs that may affect the objectivity of the clinician (as well as the victim and perpetrator) in this process. When risk factors or signs of elder mistreatment are detected, further assessment is warranted. Specific guidelines are offered to enhance the assessment process (including the "5 P's" of interviewing: privacy, pacing, planning,
pitch and punctuality). The assessment phase should consider the individual's physical health, mental health, cognitive and functional status, environment, social support system, and recent family and life crises, in addition to evaluating the nature of the elder abuse. (Note: This issue, co-published simultaneously as a book, analyzes elder mistreatment through three case studies. Additional entries illuminate the roles of physicians, nurses, social workers and attorneys as they address clinical management from a multidisciplinary/interdisciplinary approach. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: http://www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

2. P5927-23
Dayton, C.
Elder Abuse: The Social Worker's Perspective
The Clinical Gerontologist; Vol. 28 (1/2),135-155; 2005.
Journal article (scholarship)
This article is part of an issue (co-published simultaneously as The Clinical Management of Elder Abuse) that focuses on three case studies to analyze elder mistreatment from the perspectives of various clinicians, physicians, nurses, social workers and attorneys as they address clinical management from a multidisciplinary/interdisciplinary approach. In this entry, taken from the perspective of the social worker, the assessment and interventions described are based upon the regulations and procedures of the Adult Protective Services (APS) in Cuyahoga County, Ohio. The following principles are examined in light of the case studies presented: freedom over safety; self-determination; participation in decision-making; and least restrictive alternatives. Other themes that complicate the intervention in these elder abuse scenarios that are considered include homosexuality, substance abuse, domestic violence and socio-economic status. (Note: The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: http://www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

3. P5924-23
McGreevey, J.
Elder Abuse: The Physician's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 83-103; 2005.
Journal article (scholarship)
This article is part of an issue (co-published simultaneously as The Clinical Management of Elder Abuse) that focuses on three case studies in order to analyze elder mistreatment from the perspectives of various practitioners as they address clinical management from a multidisciplinary/interdisciplinary approach. The physician's role is highlighted in this entry. The responsibilities to thoroughly and objectively document any observations related to suspected abuse or neglect, to assess whether or not the patient is in immediate danger, and to report suspected abuse to adult protective services (APS) are paramount. Barriers to assessment are also outlined, and include the difficulty of identification of elder abuse in the presence of chronic diseases. Issues addressed in the discussion of the case involving self neglect include the need to evaluate substance abuse, depression, functional and decisional capacity, and cognitive impairment. In the case study of the victim of domestic violence who is now the neglectful (and potentially abusive) caregiver of her terminally ill spouse, the doctor is cautioned to focus on his current needs rather than past actions, to directly communicate with the patient regarding his wishes (not through his caregiver) and to be aware of increased signs of caregiver burden. In the case study of the abusive and neglectful adult daughter of the Alzheimer's patient, the physician is urged to continue to attempt direct communication with the patient, to maintain an ongoing monitoring of the home situation, the patient's behavior and functioning, including her need for increased supervision, to monitor and treat underlying medical conditions that may contribute to problematic behaviors, and, if victimization is known, to refer to APS for investigation and intervention. Interventions are recommended in the context of Ohio state statutes. (Note: The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: http://www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

4. P5925-28
Miller, C.
Elder Abuse: The Nurse's Perspective
The Clinical Gerontologist; Vol. 28 (1/2), 105-133; 2005.
Journal article (scholarship)
This article is part of an issue (co-published simultaneously as The Clinical Management of Elder Abuse) that utilizes three case studies to analyze elder mistreatment from the perspectives of various clinicians as they address clinical management from a multidisciplinary/interdisciplinary approach. This entry describes the issues encountered by nurses in this process. The author describes how assessment of elder abuse and neglect differs from other forms of nursing assessment. For example, resistance by the patient to assessment and intervention is not uncommon. Specifically, it is recommended that the nursing assessment involve consideration of the patient's physical status (such as nutrition, hydration, bruises and injuries, etc.), degree of
frailty, caregiver's understanding of the patient's needs, living conditions (especially life threatening circumstances), history of violence on the part of the caregiver, and decisional capacity. (Note: The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at: http://www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)

2004

5. Bergeron, L.
Elder Abuse: Clinical Assessment and Obligation to Report
(Chapter 7, Health Consequences of Abuse in the Family, Kendall-Tackett, K., ed.; American Psychological Association, Washington, D.C.; 2004.)
Book chapter
Research suggests that elder abuse contributes to such psychological and psychiatric conditions as depression, post-traumatic stress, learned helplessness and alienation. According to the author, the purpose of this chapter is to address the role of the mental health professional in the clinical assessment, reporting and intervention of familial domestic elder abuse (noninstitutional). When reporting suspected abuse, counselors, psychologists and others are urged to inform the client of this, while emphasizing consideration for the client's safety. Professionals are also reminded that it is their legal and/or ethical obligation to report suspected abuse, not to verify the suspected mistreatment. Practical guidelines (including specific questions) for assessing the situation and reporting are outlined. Physical and psychological risk factors are summarized, along with theoretical models of elder abuse. Case examples illustrate various scenarios of suspected elder mistreatment. (Neither self-neglect nor mistreatment of individuals with developmental or other disabilities under age 60 is the subject of this chapter.)

6. P5850-9
Brown, K., Streubert, G. & Burgess, A.
Effectively Detect and Manage: Elder Abuse
The Nurse Practitioner; Vol. 29 (8), 22-31; August 2004.
Journal article (scholarship), online
This continuing education article is designed to assist nurse practitioners in identifying elder abuse and initiating appropriate interventions. Guidelines are offered for examination of bruises, abrasions, lacerations, the condition of skin and genitalia, as well as injuries to the head, neck, chest wall, abdomen, extremities, and genitals. The authors note that decreased pain perception and memory impairment can contribute to difficulty in assessment. (Note: This article, along with instructions for CE credits, can be accessed online at: http://www.findarticles.com/p/articles/mi_qa3958/is_200408/ai_n9454134 .)

7. P5940-13
Burgess, A. & Hanrahan, N.
Issues in Elder Sexual Abuse in Nursing Homes
Nursing and Health Policy Review; Vol. 3 (1), 5-17; 2004.
Journal article (scholarship)
This article presents cases studies of elder sexual abuse occurring in nursing homes in order to illustrate key elements of identification, assessment and treatment. Trauma masked as accidental bruising, communication deficits, recanting, physical and emotional indicators, inadequate evidentiary examination, sexually transmitted diseases, and resident to resident sexual abuse are among the issues analyzed.

8. P5510-9
Fulmer, T., Guadagno, L., Bitondo Dyer, C. & Connolly, M.
Progress in Elder Abuse Screening and Assessment Instruments
Journal of the American Geriatrics Society (JAGS); Vol. 52 (2), 297-304; 2004.
Journal article (literature survey)
The purpose of this article is to review and critique the elder abuse and neglect screening and assessment instruments currently available to health care professionals. Tools are categorized as checklists and guidelines, qualitative assessments, quantitative assessments, and combinations of the above. The following instruments are evaluated: AMA Diagnostic and Treatment Guidelines on Elder Abuse and Neglect, Subjective-Objective-Assessment Plan, Elder Abuse Diagnosis and Intervention Model, Rathbone-McCuan and Voyles format, H.A.L.F., Elder Assessment Instrument (EAI), Brief Abuse Screen for the Elderly (BASE), Indicators of Abuse Screen (IOA), Conflict Tactics Scale, Hwalek-Sengstock Elder Abuse Screening Test, Comprehensive Geriatric Assessment, and the Screening Tools and Referral Protocol: Stopping Abuse Against Older Ohioans: A Guide for Service Providers. The article includes a table listing the name of the instrument, author, year developed, method, whether there have documented psychometrics, and comments highlighting unique aspects of the tool.

9. P5824-00
Kentucky Medical Association's Subcommittee on Domestic Violence
KMA Model Health Care Protocol on Abuse, Neglect & Exploitation - Child, Spouse/Partner, Adult & Elder
Updated 2004
Protocol, online
As quoted from the purpose statement of this protocol: "...This model policy and protocol
information is provided: to facilitate, simplify, and standardize quality health care intervention for patients at risk of abuse, neglect or exploitation; to assist physicians to comply with standards, regulations and laws related to adult and child abuse, neglect and exploitation. These materials are to be used as guidelines to assist physicians to develop policies and procedures related to the needs of these patients. Every physician and facility administrator should have a mechanism established in which initial patient contact assesses for current and historical identification of abuse, neglect or exploitation..." The guidelines cover issues such as screening and assessment, examination and documentation, reporting, medical record keeping, insurance and legal issues (including consent), patient education, and referral. Interview and assessment forms are provided.

10. P5826-5
Kumamoto, K. & Arai, Y
Validation of 'Personal Strain' and 'Role Strain': Subscales of the Short Version of the Japanese Version of the Zarit Burden Interview (J-ZBI_8)
Psychiatry and Clinical Neurosciences; Vol. 58 (6), 606-610; 2004.
Journal article (research)
The Zarit Burden Interview is the assessment tool most widely used in North America and Europe to assess caregiver burden experienced by family members caring for impaired elders. This research was designed to confirm the construct validity of two subscales (personal strain and role strain) of the eight-item Japanese version of the Zarit Burden Interview (J-ZBI_8). Personal strain is described as the personally stressful component of the caregiving experience, while role strain is described as the stress related to role conflict or overload. The study sample consisted of 51 dyads of impaired elders (living in the community, and registered with a nursing clinic in Kyoto City) and their primary caregivers. Caregivers provided information regarding the extent and duration of their caregiving experience, the nature of the impaired elders' disabilities, and also completed the J-ZBI_8. Elders' ability to perform activities of daily living (ADLs) was assessed using the Barthel Index (BI); cognitive impairment was assessed using the Short-Memory Questionnaire (SMQ); and behavioral disturbances were assessed using the Troublesome Behavior Scale (TBS). Findings confirm the validity of both subscales. Behavioral disturbances were associated with personal strain, while ADL deficits were associated with role strain.

11. P5733-10
Lachs, M. & Pillemer, K.
Elder Abuse
The Lancet; Vol. 364 (9441), 1263-1272; October 2, 2004.
Journal article (scholarship)
In this overview, the authors present a summary of recent international research and clinical findings regarding elder abuse. It is intended to assist physicians and other health care professionals in the identification of elder mistreatment, and to offer guidance in intervention. Definitions, estimates of prevalence, and risk factors are reviewed. A comprehensive discussion is provided regarding the efficacy of formally screening asymptomatic patients for elder abuse. Authors also provide a table that describes a proposed medical assessment of elder abuse, linking specific recommendations with particular areas of concern. The importance of multidisciplinary interventions in treatment planning is discussed, along with the need to determine if patients
refusing interventions have the cognitive capacity to do so.

12. P5746-4
Meeks-Sjostrom, D.
A Comparison of Three Measures of Elder Abuse
Journal of Nursing Scholarship; Vol. 36 (3), 247-250; 2004.
Journal article (literature survey)
This paper presents a comparison of three elder abuse assessment tools: the Indicators of Abuse (IOA), the Elder Abuse and Neglect Assessment (EAI), and Elder Abuse Screening Test (EAST). The article provides a description of the three instruments (including format, scoring, strengths and weaknesses, and advantages and disadvantages in administration) and reviews the validity studies for each. Although no instrument has been fully researched for use in long-term care populations, the author indicates that the EAI has the best potential for use in institutional settings.

13. P5684-18
Nelson, H., Nygren, P., McInerney, Y. & Klein, J.
Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force (literature survey/scholarship)
Annals of Internal Medicine; Vol. 140 (5), 387-404; March 2,2004.
Journal article (literature survey), online
The purpose of this article is to review the evidence used in the U.S. Preventive Services Task Force (USPSTF) recommendation regarding the effectiveness of screening for family violence, including elder abuse. Drawing upon numerous health-related databases (such as CINAHL, MEDLINE, etc.), researchers selected English language studies that evaluated the performance of screening tools and interventions based in health care settings. Three studies were identified that evaluated the performance of screening instruments for elder abuse (Reis and Nahmiash, 1995; Neale et al., 1991; and Moody et al., 2000) that could be adapted to clinical settings. The Caregiver Abuse Screen (CASE) and the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) were the subjects of these studies, which received fair quality ratings from the reviewers. No studies based
within health care settings were identified that examined the effectiveness of elder abuse
interventions in health outcome measures, or provided assessment of adverse effects of screening or intervention. Appendices include a description of the literature search methods, the quality rating criteria, and several of the tools. (Note: This article is accessible online at: http://www.annals.org/cgi/reprint/140/5/387.pdf . For more information on the USPSTF recommendation on screening for family and intimate partner violence, see CANE file #P5683-5.)

14. P5683-5
U.S. Preventive Services Task Force (USPSTF)
Screening for Family and Intimate Partner Violence: Recommendation Statement
Annals of Internal Medicine; Vol. 140 (5), 382-386; March 2, 2004.
Journal article (scholarship), online
This article summarizes the statement of the U.S. Preventive Services Task Force (USPSTF) on screening for family and intimate partner violence, which updates the previous recommendation of 1996. The USPSTF "found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse." The task force found no studies that examined the effectiveness of interventions with older adults, therefore could not "determine the balance between the benefits and harms of screening" for domestic elder abuse. (Note: This summary is accessible online at http://www.annals.org/cgi/reprint/140/5/382.pdf .)


2003

15. P5651-10
Acierno, R. et al.
Assessing Elder Victimization - Demonstration of a Methodology
Social Psychiatry and Psychiatric Epidemiology; Vol. 38 (11), 644-653; November 2003.
Journal article (research)
The purpose of this preliminary study was to evaluate the feasibility of telephone interviewing as a methodology of data collection among elders. One-hundred and six individuals were interviewed by use of behaviorally specific questions regarding their experiences of abuse and assault. In addition, they were screened for psychopathology. Half of the sample was interviewed in person, and the other was interviewed via telephone. Results indicate that the interview technique was successfully adapted to telephone use, as rates for assessing abuse, assault and psychopathology were comparable among both sub-samples. Telephone-based interviewing appears a valid alternative to in-person identification of victimization.

16. P5313-43
Burman, J.
Lawyers and Domestic Violence: Raising the Standard of Practice
Michigan Journal of Gender & Law; Vol. 9 2003.
Journal article (scholarship)
This article presents a broad discussion of a lawyer's professional responsibilities when assisting clients who are either the victim or perpetrator of domestic violence. Not only are attorneys obligated to deal with the abuse if it is known, the author argues that given the pervasiveness of the problem, they must screen for intimate partner violence. Practical screening questions and indicators of abuse are also discussed. The balance between the duty to warn and the duty of confidentiality is considered.

17. P5250-7
Dyer, C. & Fisher, J.
The Hidden Health Menace of Elder Abuse. Physicians Can Help Patients Surmount Intimate Partner Violence.
Postgraduate Medicine; Vol. 113 (4), 21-24 and 30; April 2003.
Journal article (scholarship)
National estimates suggest that up to one half of all elder abuse cases involve domestic violence. This overview focuses on the role that physicians can play in the detection of intimate partner violence among elderly patients. Shame, fear, economic vulnerability, cultural differences, and an underestimation of the problem on the part of health care professionals contribute to the invisibility of the problem. Identifying the nature of the abuse (caregiver stress versus power and control issues) is a vital step that influences clinical direction. Assessment of competency and dangerousness, along with safety planning, should be continuously addressed in the management plan. Documentation and reporting are also discussed. A practical guideline for screening and intervention and a comparison of appropriate intervention/documentation and incomplete intervention/documentation is included.

18. P5194-2
Fulmer, T.
Elder Abuse and Neglect Assessment
Journal of Gerontological Nursing; Vol. 29 (1), 8-9; January 2003.
Journal article (scholarship)
This brief article presents pertinent information regarding the Elder Assessment Instrument (EAI), which has been used since the 1980's to identify potential elder abuse and neglect. A copy of the EAI, a screening tool containing 44 Likert-scale items, is included. The tool takes approximately 15 minutes to administer, and is recommended for use in clinical settings. (Note: This resource is available online at: http://consultgerirn.org/topics/elder_mistreatment_and_abuse/want_to_know_more .)

19. P5137-7
Kahan, F. & Paris, B.
Why Elder Abuse Continues to Elude the Health Care System
Mount Sinai Journal of Medicine; Vol. 70 (1), 62-68; 2003.
Journal article (research)
The Mount Sinai Hospital Elder Abuse Program was created in 1998 to identify elderly patients in the hospital who had experienced elder abuse or neglect, to assist them in attaining compensation, and to provide counseling, support, advocacy and referral. A case study is presented to illustrate the difficulties in providing services. Over a two-year period, 182 cases were identified and assessed, with approximately half of those referred patients having a diagnosis of memory impairment. This article presents information regarding the population served through this model program, and addresses the obstacles found in the health care setting. Interdisciplinary/multidisciplinary team work is pivotal, along with the continued education of health care professionals regarding the symptoms of elder mistreatment.

20. P5486-14
Kottwitz, D. & Bowling, S.
A Pilot Study of the Elder Abuse Questionnaire
Kansas Nurse; Vol. 78 (7), 4-6, and13; August 2003.
Journal article (research)
As quoted from the article, "The purpose of this study was to review the literature and develop a questionnaire with scales to determine how targeted participants perceived elder abuse." A 25-item instrument was developed that reflected Neuman's holistic system, addressing five domains of the elder's life (physical, psychological, developmental, socio-cultural and spiritual). The questionnaire was tested by 49 participants (nursing home staff members and family members named as agents under power of attorney documents). The alpha coefficient, .06687, is considered acceptable for a new instrument, but further study with various populations is indicated.

21. P5688-9
Levine, J.
Elder Neglect and Abuse: A Primer for Primary Care Physicians
Geriatrics; Vol. 58 (10), 37-44; October 2003.
Journal article (scholarship), online
This article provides an overview for primary care physicians on the topic of elder abuse and neglect. Case scenarios are presented to exemplify self-neglect, physical abuse and neglect, sexual abuse, and abuse in institutional settings. Tables include routine screening questions for practitioners to use during the clinical interview, along with warning signs of elder abuse. (Note: This article is available online at http://www.geri.com/geriatrics/data/articlestandard/geriatrics/412003/71640/article.pdf .)

22. N4883-552
National Research Council, Bonnie, R. & Wallace, R., editors
Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America,
Chapter 6: Screening and Identification in Clinical Settings
National Academy Press, Washington, D.C.; 2003.
Book (online)
As a result of the lack of systematic, empirical, peer-reviewed research on elder abuse, the National Institute on Aging commissioned the National Research Council to produce this study and to develop a research agenda on related issues. One chapter is dedicated to the topic of screening and case identification, and appendices include an annotated list of elder mistreatment measures. (This publication is currently accessible online at the National Academy Press site http://books.nap.edu/books/0309084342/html/index.html and may also be ordered in hardback by contacting 1 800-624-6242. Price: $57.95)

23. P5246-6
Richardson, B., Kitchen, G. & Livingston, G.
Developing the KAMA Instrument (Knowledge and Management of Abuse)
Age and Ageing; Vol. 32 (3), 286-291; May 2003.
Journal article (research)
This article discusses the development and testing of the vignette-based Knowledge and
Management of Abuse (KAMA) instrument, which was designed to assess the applied and practical knowledge of health and social services staff regarding abusive and potentially abusive situations involving older inpatients. Seventy-nine staff members working for a local trust in the U.K. participated in this study by completing two versions of the tool. Results indicate that both versions are valid tools that can identify gaps in knowledge among these professionals in order to develop effective training and education initiatives. A copy of each version of the KAMA is included in the appendices.

24. P5100-11
Schofield, M. & Mishra, G.
Validity of Self-Report Screening Scales for Elder Abuse: Women's Health Australia Study
The Gerontologist; Vol. 43. (1), 110-120; 2003.
Journal article (research)
This article reports on a study of the reliability and validity of the Vulnerability to Abuse Screening Scale (VASS). The factors of vulnerability, dependence, dejection and coercion are examined in this 12-item self-report. The baseline survey was completed in 1996 with follow-up in 1999. While determining the predictive validity of the VASS would require further research, the findings indicate that the tool demonstrates construct validity. A review of existing elder abuse screening tools is included.

25. P5217-8
Shugarman, L., Fries, B., Wolf, R. & Morris, J.
Identifying Older People at Risk of Abuse During Routine Screening Practices
Journal of the American Geriatrics Society (JAGS); Vol. 51, 24-31; 2003.
Journal article (research)
This study explored the links between various characteristics of older, community-dwelling individuals and the potential for elder abuse. Research was based upon data from 701 application interviews from the Michigan Home and Community Based Services (HCBS) waiver program and the Care Management program (November 1996 - October 1997). Five measures of elder abuse and neglect were used to identify those potentially victimized, and characteristics were analyzed to determine if an association was suggested. Thirty-three of the 701 demonstrated at least one of the signs of potential abuse. Short-term memory, psychiatric illness, alcohol abuse, and four measures of poor social functioning and impaired support were associated with the potential for mistreatment. While this index had a high degree of sensitivity for identifying potential abuse, it did not appear to have a high degree of specificity. The researchers suggest health care professionals combine these indicators with key questions from the Minimum Data Set for Home Care (MDS-HC) for screening and care planning.

26. P5590-15
Watson, L. & Pignone, M.
Screening Accuracy for Late-Life Depression in Primary Care: A Systematic Review
Journal of Family Practice; Vol. 52 (12), 956-964; December 2003.
Journal article (literature survey)
The purpose of this literature survey is to review the accuracy of depression screening instruments for use with older adults in the primary care setting. Among the nine assessment tools surveyed, the Geriatric Depression Scale (GDS), the Center for Epidemiological Studies Depression Scale (CES-D), and the SelfCARE (D) are identified as both sensitive and specific and appropriate for use in this setting. The CES-D and Cornell Scale for Depression in Dementia (CSDD) appear accurate for identifying depression in dementia patients with an average Mini-Mental Status Exam (MMSE)
score of 19, although more research is needed in this area. Tables include summaries of studies reviewed.


2002


27. P5219-9
Blum, B. & Feledy, T.
Undue Influence Worksheets for Police, APS, and Probate Investigators
Bennett Blum, M.D. and Tom Feledy, M.B.A., Park Dietz & Associates, Newport Beach, CA; 2002.
The Undue Influence Worksheet is based upon the IDEAL Model for analyzing potential undue influence in financial cases. Evidence of undue influence requires a listing of all pertinent events occurring between the victim and perpetrator. This packet contains an overview of financial abuse or exploitation; an overview of the IDEAL Model (Isolation, Dependence upon the perpetrator, Emotional manipulation or exploitation of vulnerability, Acquiescence, and Loss); the Events List Form; the Events Detail Form; along with examples of the completed forms. (Note: The Worksheet is available online, at no cost, at http://www.bennettblummd.com/coercion_undue_influence.html . Online ordering instructions are also provided, or you may telephone 520-750-8868 in Arizona, or Park Dietz & Associates, Newport Beach, CA, 949-723-2211.)

28. N4744-7
Chen, A. & Koval, K.
Elder Abuse: The Role of the Orthopaedic Surgeon in Diagnosis and Management
Journal of the American Academy of Orthopaedic Surgeons; Vol. 10 (1), 25-31;    January/February 2002.
Journal article (scholarship)
This article provides orthopaedic surgeons with detailed guidelines to assist them in detecting elder abuse. Acknowledging that no fracture patterns are considered pathognomonic of elder abuse, the need to examine the nature and pattern of injuries within the context of the client's physical health and mental well-being is emphasized. Specific recommendations are made regarding interviewing techniques, physical examination, differential diagnosis, and ethical considerations in devising a long-term care plan. A clinical procedural list (adapted from Lachs and Pillemer, 1995) is included.

29. P5141-10
Cowen, H. & Cowen, P.
Elder Mistreatment: Dental Assessment and Intervention
Special Care in Dentistry: Official Publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry; Vol. 22 (1), 23-32; 2002.
Journal article (scholarship)
Since head and neck injuries are the most common symptoms of physical abuse among the elderly, dentists are in a position to observe signs of mistreatment during examinations. Evidence of sexual abuse, and symptoms of malnutrition (due to neglect or self-neglect) may be also be detected. Dentists should take note of excessive delays between the times of the injury or illness and the seeking of treatment, repeated emergency room visits, and should observe patient-caregiver interpersonal dynamics. A table of physical and behavioral indicators for each subtype of mistreatment is included.

30. P5266-4
Fabacher, D. et al.
Validation of a Brief Screening Tool to Detect Depression in Elderly ED Patients
American Journal of Emergency Medicine; Vol. 20 (2), 99-102; 2002.
Journal article (research)
Research indicates that although depression among elders leads to higher rates of functional decline (including self-neglect) and morbidity and mortality, it is often undiagnosed by physicians. The purpose of this article is to assess the validity of a brief screening tool, the ED-DSI (developed by the authors) by comparing it with the 30 question Geriatric Depression Scale (GDS). During a six-month period in 1999, 103 medically stable emergency room patients aged 65 and older participated in the study. (The sample did not include patients with dementia.) Forty-nine percent scored positively for depression on the three-item ED-DSI, and 32 percent screened positively on the GDS. Results emphasize the need for screening emergency department elderly patients for depression, and suggest that the ED-DSI is useful tool, easily administered.

31. N4595-24
Fink, A. et al.
Comparing the Alcohol-Related Problems Survey (ARPS) to Traditional Alcohol Screening Measures in Elderly Outpatients
Archives of Gerontology and Geriatrics; Vol. 34 (1), 55-78; 2002.
Journal article (research)
In this study, 574 elderly patients at the UCLA Medical Center and Sansum-Santa Barbara Medical Foundation Clinics participated in a comparison of the newly developed Alcohol-Related Problems Survey (including an embedded version of the AUDIT) with two other well validated screening tools, the SMAST and the CAGE. The ARPS, which assesses the respondents' medical conditions and medication usage as well as patterns of alcohol usage, identified the respondents who scored positively on the other scoring tools. It also identified "hazardous" and "harmful" drinkers, due to the interaction of lower levels of alcohol consumption with medical conditions and medications that were not identified by the other tests. The implication is that this tool could be effective n the health care setting as a means to identify elderly patients at risk for alcohol related problems who were previously unidentified. The ARPS survey is included.

32. N4913-5
Harrell, R. et al.
How Geriatricians Identify Elder Abuse and Neglect
The American Journal of Medical Sciences; Vol. 323 (1), 34-38; January 2002.
Journal article (research)
Despite the fact that physicians see elderly patients, on average, five times per year, relatively few referrals to Adult Protective Services are made by this group of professionals. In this study, ten geriatricians practicing in Houston, Texas (none involved in the Texas Elder Abuse and Mistreatment Institute at Baylor College), were interviewed regarding their experiences in assessing and reporting suspected elder abuse. The physical indicators noted by these physicians as suggestive of potential mistreatment were fairly consistent with those identified throughout the literature (bruising, skin tears, evidence of malnutrition and poor personal hygiene, etc.). Medical noncompliance was also identified by a number of physicians as a red flag.

33. P5456-32
National Center on Elder Abuse (NCEA)
Sentinels: Reaching Hidden Victims - Project Final Report
National Center on Elder Abuse (NCEA), Washington, D.C.; May 2002.
Agency report
The goal of the National Center on Elder Abuse (NCEA) Sentinel Project, which was initiated in1999, was to identify and assist elders who are isolated and at risk for mistreatment. In order to identify such individuals, 1280 sentinels from various national organizations such as Meals on Wheels, the Humane Society of the United States, and the National Association of Retired Senior Volunteer Program Directors, were trained to identify those individuals at risk and isolated in their homes. The initiative resulted in the development of over 20 outreach products designed to promote awareness of elder abuse and appropriate services. Over 6,000 people were provided with these materials. In addition to an increase in adult protective services (APS) referrals, issues were identified that hindered the process of service delivery to those in need. Those issues included a lack of cross training among various professionals and advocates, and inconsistent communications between those working with elders. (Note: This publication is available online at the NCEA Web site at: sentinel0205.pdf)

34. P5702-8
Schofield, M., et al.
Screening for Vulnerability to Abuse Among Older Women: Women's Health Australia Study
The Journal of Applied Gerontology; Vol. 21 (1), 24-39; March 2002.
Journal article (research)
The face and construct validity of a brief self-report screening instrument, a modification of the Hwalek-Sengstock Elder Abuse Screening Test, is examined in this study. The tool was used to identify older women at risk of elder abuse among a representative sample of more than 12,000 participants of the Australian Longitudinal Study on Women's Health (or Women's Health Australia). Factor analysis revealed that vulnerability and coercion are indicators of risk of abuse. The authors suggest that the six items that reflect these factors may provide the basis for a brief clinical screening tool.

35. P5066-5
Stiles, M., Koren, C. & Walsh, K.
Identifying Elder Abuse in the Primary Care Setting
Clinical Geriatrics; Vol. 10 (7), 33-41; July 2002.
Journal article (scholarship)
This article provides an overview for physicians in the primary care setting for addressing elder abuse and neglect. The importance of observing not only physical but emotional and behavioral "red flags" (including dynamics between patient and caregiver) is discussed, along with documentation procedures and reporting concerns.

36. P5937-2
Sullivan, M.
Cargiver Strain Index (CSI)
Try This: Best Practices in Nursing Care to Older Adults; Issue Number 14; February 2002.
Publication series (online)
This brief online publication, part of a series published by the Hartford Institute for Geriatric Nursing at New York University, highlights the topic of caregiver burden, and identifies the Caregiver Strain Index (CSI) as a valuable tool for identifying risks (such as caregiver depression and fatigue) that can lead to neglect of care recipients and premature institutionalization. A copy of the tool is included. (Note: This resource is available online at: http://consultgerirn.org/uploads/File/Caregiver%20Strain%20Index.pdf .)

37. P5605-6
Teitelman, J. & Copolillo, A.
Sexual Abuse among Persons with Alzheimer's Disease Guidelines for Recognition and Intervention
Alzheimer's Care Quarterly; Vol. 3 (3), 252-257; Summer 2002.
Journal article (scholarship)
Although no studies have been conducted specifically on the incidence and prevalence of elder sexual abuse of individuals with dementia, research suggests that a high percentage of those victimized are cognitively impaired. This article is intended to present an overview of sexual abuse among individuals with dementia related to Alzheimer's disease or other conditions. It offers guidelines for professionals (such as nurses, nursing home staff, in-home caregivers, and other health care personnel) for the identification of sexual abuse among this vulnerable population. Physical indicators include injury to the genitals, the presence of sexually transmitted diseases, or infections. Less obvious indicators would include pain or difficulty performing routine functions, such as walking, sitting, or urinating. Although emotional and psychological indicators are more difficult to detect in the presence of other symptoms that may be related to the dementing process, dramatic changes from the individual's baseline behavior and demeanor should be noted. Sexual
abuse is defined not only as nonconsensual sexual activity, but also as sexual activity occurring when an adult is incapacitated and therefore unable to provide consent. Therefore questions are included that address the individual's awareness of the relationship, his or her ability to avoid exploitation, and the awareness of potential risks. Interview and assessment techniques (such as the use of anatomically correct dolls) are provided. The article concludes with discussion of appropriate interventions, depending upon whether the sexual activity is determined to be consensual or exploitative.

2001

38. L4531-13
American Medical Association (AMA)
Caregiver Health - Self-Assessment Questionnaires - Resources for Physicians
American Medical Association (AMA); Chicago IL; 2001
This self-assessment (printed in English and Spanish) was designed to help identify high risk situations among caregivers in order to prevent stress related illness, psychological stress and family conflict. The packet also includes recommendations and referral sources for physicians who are dealing with caregivers within the outpatient setting. Materials may be downloaded from the AMA Web site at
http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/caregiver-health/caregiver-self-assessment.shtml

39. N4666-11
Anetzberger, G.
Elder Abuse Identification and Referral: The Importance of Screening Tools and Referral Protocols
Journal of Elder Abuse & Neglect; Vol. 13 (2), 3-22; 2001.
Journal article (scholarship)
This article explores the origins of the "Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers" (STRP) as a means to address the gaps in detecting elder abuse and domestic violence in later life and providing appropriate services. The project is an outgrowth of recommendations of the Ohio Family Violence/Elder Abuse/Domestic Violence Roundtable which was established in 1996. The STRP, developed by The Benjamin Rose Institute, was designed to acquaint service providers with elder abuse and domestic violence in later life within various settings; to offer service providers with screening tools for detection; and to offer service providers a referral protocol. The eighteen month implementation of the STRP involved various stages of development, evaluation and dissemination, which are further discussed in this volume of JEAN.

40. N4667-9
Bass, D., Anetzberger, G., Ejaz, F. & Nagpaul, K.
Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers
Journal of Elder Abuse & Neglect; Vol. 13 (2), 23-38; 2001.
Journal article (scholarship)
This article details the components of the Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans (STRP). The project, developed by the Benjamin Rose Institute, is designed to assist service providers in the detection of elder mistreatment and domestic violence in later life and to offer guidance for appropriate referral. The introduction offers a brief overview of elder abuse and domestic violence and includes case examples followed by facilitative interview questions. It also includes a description of Ohio state elder abuse and domestic violence laws. The Referral Protocol is a decisional flow sheet that assists the service provider in determining if there is actual, suspected or potential abuse, while indicating referral resources appropriate to that type of circumstance. The Referral Protocol, the Actual Abuse Screening Tool, the Suspected Abuse Tool and the Risk of Abuse Tool are included in the article. (Note: This article is one of a series in this issue of JEAN that focuses on the development, implementation and evaluation of the Ohio Elder Abuse STRP.)

41. L4493-11
Bedard, M. et al.
The Zarit Burden Interview - A New Short Version and Screening Version        
The Gerontologist
Vol. 41 (5), 652-657; 2001.
Journal article (research)
The article discusses the process used to develop both a short and a screening version of the 22-item Zarit Burden Interview, the most consistently used measurement tool of dementia caregiver burden. Both a 12-item version (short) and a 4-item version (screening) were produced. The results were analyzed and compared to those of the longer version. The authors believe that the short version provides a more expeditious research instrument without sacrificing validity, but urges more research on the validity of this instrument's use in longitudinal studies.

42. L4489-11
Diwan, S., Ivy, C., Merino, D. & Brower, T.
Assessing Need for Intensive Case Management in Long-Term Care
The Gerontologist; Vol. 41 (5), 680-686; 2001.
Journal article (research)
The purpose of this research was to use available data to develop an "ecological" versus a "cookie-cutter" approach to the allocation of case management services and expertise to Home and Community Based Services (HCBS) clients. Believing that such an approach would enhance the client's chances for staying in the community, and observing that difficult clients require more intensive case management, the authors used content analysis of 70 HCBS cases and a case management time study to develop a screening tool to identify these high maintenance clients. The content area analyzed was divided into three categories (and later subcategories): clients with problematic personality/behavioral characteristics; informal caregivers with problematic personality/behavioral characteristics; clients with problems related to frailty and medical difficulties. Of the demanding cases, 34 percent were related to caregiver difficulties, 27 percent were related to client behavioral difficulties, 27 percent were related to a combination of both, and 11 percent were related to medical/frailty issues. The nine-item screening tool is included in the paper.

43. N4674-10
Ejaz, F., Bass, D., Anetzberger, G. & Nagpaul, K.
Evaluating the Ohio Elder Abuse and Domestic Violence in Late Life Screening Tools and Referral Protocol
Journal of Elder Abuse & Neglect; Vol. 13 (2), 39-57; 2001.
Journal article (research)
The article describes the process of refining the Ohio Elder Abuse Screening Tools and Referral Protocol (STRP) based upon qualitative and quantitative evaluations of the instruments and training materials. Feedback was initially provided through focus groups (comprised of representatives with various levels of expertise in the field, from both urban and rural service delivery settings) and by the Ohio Family Violence/Elder Abuse/Domestic Violence Roundtable. Initial recommendations to increase specificity within the interview and to clarify referrals were incorporated. The document was then distributed to 50 practitioners (for in-person training) and 110 practitioners (for self-training). Participants were selected from a range of human service agencies and representative Ohio counties. The document was edited, based upon participant responses, to simpler and less lengthy. The finding that the STRP was most helpful to practitioners least experienced with elder mistreatment led developers to target the materials towards those professionals. (Note: This article is one of a series in this issue of JEAN that focuses on the development, implementation and evaluation of the Ohio Elder Abuse STRP.)

44. P5540-13
Jogerst, G., Daly, J. & Ingram, J.
National Elder Abuse Questionnaire: Summary of Adult Protective Service Investigator Responses
Journal of Abuse and Neglect of the Elderly; Vol. 13 (4), 59-71; 2001.
Journal article (research)
Although Adult Protective Services professionals (APS) are the frontline responders to elder abuse victims, little research has been conducted on this population. The aim of this study was to examine the characteristics of APS investigators and APS programs throughout U.S. Surveys were completed by representatives from 1,409 of 1,860 offices, representing an 80 percent participation rate. Among the findings, 76 percent of the investigators were female, the mean age was 46.4 years old, and nearly half held a baccalaureate degree (most commonly a social work degree), and 99 percent were full-time employees with an average of nine years experience in their current positions. The APS investigative structure characteristics revealed that nearly half of the programs used elder abuse screening and/or risk factor instruments, while 93 percent used agency-developed or state mandated instruments. (Note: The individual state agency responses to the survey are accessible on the University of Iowa Department of Family Medicine Web site at: http://www.uihealthcare.com/depts/med/familymedicine/research/eldermistreatment/questionnaire.html . State surveys indicate which, if any, screening/assessment tools were used by individual departments.)

45. M34-23
Howell, A.E. & Macaluso, A.L.
Safe Outreach for Seniors (S.O.S.): A Collaborative Training Manual for Health Care and Law Enforcement
Kimball Medical Center; Lakewood, NJ; 2001.
Manual
This manual describes the Safe Outreach for Seniors Program (S.O.S.) that was formalized in 1998 between law enforcement and the Geriatric Evaluation Program Service (GEMS) at Kimball Medical Center. The program enlists police officers, often the first professionals to have contact with seniors who are at risk for self-injury or exploitation due to dementia, to make referrals for appropriate health care and social services. The manual provides an overview of dementia and guidelines for assessing risk indicators, such as impaired driving and unsafe residential environments. Actual referral reports are included to exemplify these situations. (Note: To order the manual, inquire about pricing, or inquire about the recommended "train the trainer session," contact GEMS, 1200 River Ave., Building 5, Lakewood, NJ 08701, or telephone 732/886-4797.)

46. N4625-8
Koziol-McLain, J., Coates, C. & Lowenstein, S.
Predictive Validity of a Screen for Partner Violence Against Women
American Journal of Preventive Medicine; Vol. 21 (2), 93-100; 2001.
Journal article (research)
This article summarizes a study that assesses the effectiveness of a brief screening tool for predicting partner violence. The sample was drawn from participants of the Colorado Behavioral Risk Factor Surveillance System (BRFSS) from November 1997 through June 1998. A three-question domestic violence screening was included in the larger survey, with any one "yes" response being scored as "positive." Follow-up telephone interviews were completed for 409 of the 695 participants of the BRFSS. The Conflict Tactics Scale (CST) and CST2 were used to assess verbal, physical and sexual aggression/violence and coercion in the three to six months following the initial survey. Women with a positive screen who were separated from their partners were at highest risk of abuse with a rate of 67 percent. Overall, women who screened positively were found to be 8.6 times more likely to be physically abused during the follow-up period than those who screened negatively. (Though not specific to elders, the original research sample included women ranging in age from 18 to 93.)

47. P5941-21
Lafata, M. & Helfrich, C.
The Occupational Therapy Elder Abuse Checklist
Occupational Therapy in Mental Health; Vol. 16 (3/4), 141-161; 2001.
Journal article (scholarship)
After providing an overview of the topic of elder abuse and existing screening and assessment tools used in health care settings to detect possible mistreatment, the authors present The Occupational Therapy Elder Abuse Checklist. Two versions of the tool were developed for use with elders who live alone as well as those who live with others. The checklist provides a guideline, which can be tailored to address the specific circumstances of an individual patient, to allow the health care professional to interview both the patient and caregiver regarding health, safety and financial issues, caregiver attitudes, and support systems (for both patient and caregiver). A case study (including completed checklist) is provided to illustrate the clinical application of this tool.

48. N4731-6
McFarlane, J. et al.
Abuse Assessment Screen-Disability (AAS-D): Measuring Frequency, Type, and Perpetrator of Abuse toward Women with Physical Disabilities
Journal of Women's Health & Gender-Based Medicine; Vol. 10 (9), 861-866; 2001.
Journal article (research)
This article reports on the evaluation of the effectiveness of the Abuse Assessment Screen-Disability (AAS-D). Five hundred and eleven women with physical disabilities, aged 18 to 64, were screened for abuse using two traditional screening questions. When two questions addressing abuse related to physical disabilities were included, the prevalence rate for this sample rose from 7.8 percent to 9.8 percent during the previous twelve months. Women with physical disabilities appeared most at risk to experience all types of abuse, and appeared more likely to be physically and sexually abused by health care providers and attendants. The four-question AAS-D is included.

49. P5935-4
Mosqueda, L., Heath, J. & Burnight, K.
Recognizing Physical Abuse and Neglect in the Skilled Nursing Facility: the Physician's Responsibilities
Journal of the American Medical Director's Association; Vol. 24 (4), 183-186; 2001.
Journal article (scholarship)
This article utilizes case scenarios to provide guidelines for physicians in the identification of elder abuse and neglect among patients in nursing homes and institutional care facilities. The authors emphasize that it is not the duty of the physician to substantiate the occurrence of mistreatment, but to recognize potential signs of abuse (such as unusual bruising patterns, etc.) and to refer appropriately for further evaluation. Lists of possible indicators of physical abuse and neglect are included. Medical directors are encouraged to take a proactive approach to the prevention of the mistreatment of vulnerable adults through policy development and training initiatives.

50. N4673-11
Nagpaul, K.
Application of Elder Abuse Screening Tools and Referral Protocol: Techniques and Clinical Considerations
Journal of Elder Abuse & Neglect; Vol. 13 (2), 59-78; 2001.
Journal article (scholarship)
The article explores the clinical implications of using the Ohio Elder Abuse Screening Tools and Referral Protocol (STRP). Through case study illustration, practical aspects of the interview, evaluation and referral process are discussed. Interviewing techniques, ethical dilemmas regarding self-determination and confidentiality, considering how to best intervene within complex family systems, and distinguishing elder abuse from domestic violence (or intimate partner violence) are among the clinical issues presented. (Note: This article is one of a series in this issue of JEAN that focuses on the development, implementation and evaluation of the Ohio Elder Abuse STRP.)

51. P5208-6
Osgood, N. & Manetta, A.
Abuse and Suicidal Issues in Older Women
Omega: Journal of Death and Dying; Vol. 42 (1), 71-81; 2001.
Journal article (research)
Abuse crisis hotlines do not typically screen for depression and suicidality, and suicide hotlines do not typically screen for histories of abuse. This study addresses the link between suicidal issues and histories of abuse. The hospital charts of ninety-two women, aged 55 and older, discharged from two psychiatric hospitals and one medical center (central Virginia, October 1994 through August 1996) were examined for information regarding suicidal ideation and behaviors and past or current abuse (childhood abuse, rape and battering.) There were a significantly higher number of women experiencing suicidal issues who had experienced past or ongoing abuse (54.8 percent), compared to women only 45.2 percent of the women with no reported histories of abuse. Social workers, counselors and other crisis intervention professionals are urged to assess abuse victims for depression and suicidality and to assess depressed clients for histories of abuse. A number of screening tools for both abuse and depression are identified.

2000

52. P5275-21
Choi, N. & Mayer, J.
Elder Abuse, Neglect, and Exploitation: Risk Factors and Prevention Strategies
Journal of Gerontological Social Work; Vol. 33 (2), 5-25; 2000.
Journal article (research)
Social workers, along with health practitioners, are in a position to recognize elder abuse, neglect and self-neglect. Researchers analyzed data from county adult protective services records to identify risk factors for different types of victimization. In particular, self-neglecting elders were compared with elders abused and/or neglected by others. Among cases of abuse and/or neglect by others, risk factors for physical and psychological abuse and neglect were compared with those of financial exploitation. Findings suggest that elders who abused substances were more likely to be self-neglecting. Cognitive deficits, inability to manage finances, and home ownership were identified as risk factors for financial abuse, which was more often perpetrated by strangers. Elders with greater physical health problems appeared more vulnerable to abuse and neglect by others.

53. P5938-5
Drayton-Hargrove, S.
Assessing Abuse of Disabled Older Adults: A Family System Approach
Rehabilitation Nursing; Vol. 25. (4), 136-140; July-August 2000.
Journal article (scholarship)
Using a case study, this article focuses on the role that rehabilitation nurses can play in the identification of elder abuse and neglect among older adults with disabilities. Guidelines are offered for assessing families at risk through a family systems approach. The framework of the systems approach is described, including environment inputs and limitations (material resources, education, support systems); family-altered core processes (such as high risk caregiver, role conflict, intergenerational violence, etc.); entropic family outputs (stress and overload, which can lead to elder abuse); and feedback design to identify risk and increase order (which is involves assessment of vulnerability, and interventions, including respite care, education and training, referral to adult protective services, etc.) (health care)

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