Hidden in the Shadows: Detecting and Addressing Elder Abuse

Table 1

Psychiatric Risk Factors for Abuse


Reason for Increased Risk
  • Impaired memory
  • Impaired judgment
  • Loss of personhood
Challenging behaviors
  • Resisting care
  • Difficult relationship with caregiver(s)
  • Aggression/agitation
  • Decreased motivation
  • Decreased self-esteem
Alcohol use
  • Aggressive behavior·
  • Disinhibition
  • Depression

Cooper C, Livingston G. Clin Geriatr Med. 2014;30(4):839-850.

Table 2

Domains to Assess When Screening for Elder Abuse


Reason for visit
  • Presence of psychological or physical disability
    Inability to participate in activities of daily living
  • Reluctance of caregiver to give information about elder’s condition
  • Delay in elder’s seeking/receiving professional assistance
  • Inappropriate caregiver reaction to clinician’s concern
Family history
  • History of abuse experienced by either the elder or the caregiver
Elder’s personal/social circumstances
  • Unrealistic expectations of the elder
  • Social isolation
  • Conflict in the family system
History of accidents
  • Pattern of accidents that do not make sense
Healthcare utilization
  • Healthcare “shopping” (ie, the elder does not have a regular physician)
  • Infrequent visits to physicians
Relationship between elder and caregiver
  • Duration and nature of the relationship
  • How much responsibility the caregiver has
  • Potential control/power dynamics
  • Financial resources
  • Power of attorney/how decisions are made

Flanagan AY. Sacramento, CA: NetCE, 2017.

Table 3

Screening Tools for Elder Abuse

Elder Abuse Screening Test (H-S/EAST)
Elder Abuse Suspicion Index (EASI)
Brief Abuse Screen for the Elderly (BASE)
Vulnerability to Abuse Screening Scale (VASS)

National Center on Elder Abuse (NCEA). Available at: http://eldermistreatment.usc.edu/wp-content/uploads/2016/10/Elder-Abuse-Screening-Tools-for-Healthcare-Professionals.pdf.

Table 4

Resources for Reporting Elder Abuse

US Department of Health and Human Services: https://www.hhs.gov/answers/programs-for-families-and-children/how-do-i-report-elder-abuse/index.html
Eldercare Locator: https://eldercare.acl.gov/Public/Index.aspx
National Adult Protective Services Association (NAPSA): http://www.napsa-now.org/get-help/help-in-your-area/
National Center on Elder Abuse (NCEA): https://ncea.acl.gov/suspectabuse/gethelp-reportingabuse.html
National Long Term Care Ombudsman Resource Center: http://www.ltcombudsman.org
National Academy of Elder Law Attorneys, Inc.: http://www.naela.org
National Clearinghouse on Abuse in Later Life: http://www.ncall.us

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This article originally appeared on Medical Bag