Elder abuse risk assessment instruments are specifically designed tools for gathering information about older adults and their circumstances in order to evaluate the possibility of abuse occurrence. They target the identification of risk factors, conditions empirically linked to the presumed causes of elder abuse. Risk assessment instruments offer a framework for deciding what strategies may be appropriate for problem intervention. There is broad recognition that accurate and efficient tools are needed. However, many existing risk assessment instruments have limited application or lack established validity or reliability.
The Importance Of Risk Assessment
Elder abuse risk assessment is important for three reasons. First, it improves the accuracy of problem identification by revealing characteristics of the victim, perpetrator, or environment key to determining the likelihood of elder abuse. Second, risk assessment provides information for planning service interventions. Interventions can be suitable or unsuitable depending on the nature and scope of risk factors present in the situation. Third, risk assessment helps avoid inappropriate use of resources. Services can be wasted or poorly timed if danger is miscalculated.
Risk assessment has specific qualities and purpose. Ideally it should be organized, timely, accurate, and thorough. In addition, it should focus on uncovering any risk factors for abuse occurrence, indicating their frequency, severity, longevity, and effects. For example, assessment may discover an adult son’s alcoholism and then explore how often he drinks, how much alcohol is consumed, whether or not he or others believe a drinking problem exists, and how he behaves under the influence of alcohol. Alcoholism on the part of the perpetrator is well documented through research as a risk factor for elder abuse.
Elder abuse risk assessment is not abuse screening. Assessment and screening are interrelated, but they differ in two ways: timing and depth. Screening comes before and is preliminary to assessment. For instance, detecting elder abuse through screening precedes evaluating the problem through assessment. Moreover, screening aims at determining the presence or absence of elder abuse based upon observed or reported examples or signs. Examples represent illustrations of the problem, and signs represent the consequences of abuse occurrence. For physical abuse, examples might include slapping or using a knife against an older adult, and signs might include resulting bruises or wounds. In contrast, risk assessment explores the dimensions of identified risk factors as described above.
The Function Of Risk Assessment Instruments
Elder abuse risk assessment instruments assist health care, social service, and law enforcement professionals to identify possible elder abuse situations and to understand the etiology of detected elder abuse. In most states these professionals have legally mandated elder abuse reporting responsibilities. Since older adults may not report their own harm or danger for reasons that include inability or fear, professionals in with this population assume a critical role in ensuring their safety. Unfortunately, reporting rates tend to be low in part because of the limited and inconsistent research delineating elder abuse risk factors. Without the identification of risk factors, there is no clear understanding of the antecedents to elder abuse or sound basis for developing risk assessment tools.
Risk assessment tools are useful at two levels. At the case level, they help ensure that elder abuse risk factors are identified. For this, they formalize the information gathering process of observation and interviewing. At the population level, they provide data for research. In turn, study findings establish the foundation for policy development and program planning around problem prevention and treatment.
Variation Among Elder Abuse Risk Assessment Instruments
There are five types of variation found among existing elder abuse risk assessment instruments. Three types concern targeted populations or settings, and two address format. Some tools target both the possible victim and perpetrator or caregiver, others only the victim. Some tools are applicable across professions; others are geared to only one, such as nursing or medicine. Some tools are tailored for in-home use and others for an organizational context, such as a hospital. Some tools represent simple checklists or indices; others are narrative guidelines, outlines, or questionnaires. Finally, some tools are quite lengthy, involving dozens of items; others are brief, referencing only a few risk factors.
Selecting the most appropriate risk assessment instrument should consider intended use. For example, shorter forms may be more appropriate to busy or fast paced settings, like hospital emergency departments. However, instrument selection can be difficult. There are many instruments available. Most have not been subjected to rigorous testing. Several include a confusing array of elder abuse examples and signs along with the risk factors. Some ambitiously attempt to cover assessment areas more indirectly related to elder abuse etiology, such as physical health or finances.
The variety of available tools is evident in the following list. Since there is no universally accepted elder abuse risk assessment instrument, those identified represent well-known and generally well-regarded tools.
- Anetzberger, G. J. (2001). Elder abuse identification and referral: The importance of screening tools and referral protocols. Journal of Elder Abuse & Neglect, 13(2), 3–22.
- Fulmer, T., Guadagno, L., Dyer, C. B., & Connolly, M. T. (2004). Progress in elder abuse screening and assessment instruments. Journal of the American Geriatrics Society, 52(2), 297–304.
- Meeks-Sjostrom, D. (2004). A comparison of three measures of elder abuse. Journal of Nursing Scholarship, 36(3), 247–250.
- National Research Council. (2003). Elder mistreatment: Abuse, neglect, and exploitation in the aging America. Washington, DC: National Academies Press.
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