Annals of Long Term Care

Best Practices in Nursing Care to Older Adults
from The Hartford Institute for Geriatric Nursing
New York University, College of Nursing

Issue Number 15, Revised 2008

Series Editor: Marie Boltz, PhD, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

WHY: 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).

BEST TOOLS: The Elder Assessment Instrument (EAI), a 41-item Likert scale assessment instrument, has been in theliterature since 1984 (Fulmer, Street, & Carr, 1984; Fulmer, & Wetle, 1986; Fulmer, Paveza, Abraham, & Fairchild, 2000).
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

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

VALIDITY AND RELIABILITY: 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.

STRENGTHS AND LIMITATIONS: The major strengths of the EAI are its rapid assessment capacity (the instrument takesapproximately 12-15 minutes) and the way that it sensitizes the clinician to screening for elder mistreatment. Limitations include: no scoring system and weak specificity.

MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeriRN.org.
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.
Fulmer, T. (2003). Elder abuse and neglect assessment. Journal of Gerontological Nursing, 29(1), 8-9.
Fulmer, T. (2003). Elder abuse and neglect assessment. Journal of Gerontological Nursing, 29(6), 4-5.
Fulmer, T., & Cahill, V.M. (1984). Assessing elder abuse: A study. Journal of Gerontological Nursing, 10(12), 16-20.
Fulmer, T., Guadagno, L., Bitondo-Dyer, C., & Connolly, M. T. (2004). Progress in elder abuse screening and assessment
instruments. JAGS, 52(2), 297-304.
Fulmer, T., Paveza, G., Abraham, I., & Fairchild, S. (2000). Elder neglect assessment in the emergency department. Journal of Emergency Nursing, 26(5), 436-443.
Fulmer, T., Street, S., & Carr, K. (1984). Abuse of the elderly: Screening and detection. Journal of Emergency Nursing, 10(3), 131-140.
Fulmer, T., & Wetle, T. (1986). Elder abuse screening and intervention. Nurse Practitioner, 11(5), 33-8.
Neale, A., Hwalek, M., Scott, R., Sengstock, M., & Stahl, C. (1991). Validation of the Hwalek-Sengstock elder abuse
screening test.