1. Good Practice Protocols
Sirkka Perttu
Draft Manual page 46-50

2. Screening/routine enquiry – incidental asking
Screening in general
Screening/routine enquiry – incidental asking
asking based on suspicion may be felt by a person as insulting or discriminatory
Universal screening is targeted to a whole population or a subgroup (e.g. to all patients visiting emergency)
it is offered to all, without a risk status of the individual
Selective screening is targeted to risk populations only
based on risk factors

3. Elder abuse screening/routine enquiry
Most of the screening tools are developed in US
The need is for short and user-friendly tool which can be completed in busy practices
Many instruments focus only on one perpetrator (e.g. care giver)
Developed tools highlight suspicion of elder abuse rather than giving a definitive diagnosis of abuse; can lead to further investigation
Tools are a method of assisting professionals to detect the risk of elder abuse
The purpose of screening is the early identification of risk (not signs, symptoms)

4. Elder abuse screening/routine enquiry
Older people need a specific screening tool because for example
trauma in older people differs from other generations
the abuser may influence on screening if he/she is a caregiver
medications, illnesses and normal aging changes make difficult to recognise abuse
Challenges arise in the context of their ability to respond competently: mental incapacity (dementia), frailty, anxiety, fear etc.
Gender issues have not been in focus

5. Good sources for reading about screening of elder abuse
Phelan, A., Treacy, M.P. (2011) A Review of Elder Abuse Screening Tools, NCPOP, School of Nursing, Midwifery and Health Systems, University College Dublin.
Silvia Perel-Levin Discussing Screening for Elder Abuse at Primary Health Care level. World Health Organization.

6. Pre-conditions for using a screening instrument
Professionals are trained to ask by a right way
safe, respectful, sensitive, initiative taking, using nonthreatening language
development of rapport between professional and a person interviewed
non-judgemental, empathetic attitude
Introduction: I would like to ask you a few questions about events that may happen in the lives of older people.
Professionals are trained to
use the instrument
abuse of older women/elder abuse, dynamics, supporting, risk assessment, safety planning

7. Pre-conditions for using a screening instrument
Professionals know the practical procedures
there are written guidelines how to use the screening tool
there are written guidelines what to do after possible disclosure
agreed practice in own work place
multiprofessional and multi-agency working model
There are support and consultation possibilities for the professionals

8. ELDER ABUSE SUSPICION INDEX © (EASI) (Mark Yaffe 2008)
Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals? Yes, No, Did not answer (Dependency; indicates whether a person is in dependent position and therefore at risk)
Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with? Yes, No, Did not answer (Neglect)
Have you been upset because someone talked to you in a way that made you feel shamed or threatened? Yes, No, Did not answer (Psychological/Emotional abuse)

9. ELDER ABUSE SUSPICION INDEX © (EASI) (Mark Yaffe 2008)
4) Has anyone tried to force you to sign papers or to use your money against your will? Yes, No, Did not answer (Financial abuse) 5) Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically? Yes, No, Did not answer (Physical/Sexual abuse) 6) Doctor: Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months? Yes, No, Not sure

10. Good reliability and validity in its three dimensions:
Risk on Elder Abuse and Mistreatment – Instrument, REAMI (De Donder et al. 2017)
Developed and validated in Belgium by Vrije Universiteit Brussel/Prof. Dr. Liesbeth de Donder & team
Based on screening among 1920 older clients (55+) of home care in Belgium in 2012; most of the clients over 75 years
Good reliability and validity in its three dimensions:
risk factors of older person
risk factors of the environment
signal of abuse and mistreatment

11. Used by workers who know the older person
Risk on Elder Abuse and Mistreatment – Instrument, REAMI (De Donder et al. 2017)
Used by workers who know the older person
Can be used by a single worker and/or professional teams
Concentrates widely on risk factors: Three parts:
1: Risk factors of older person; Questions 1 – 6
2: Risk factors of social environment; Questions 7 – 16
3: Signals of Elder Abuse; Querstions 17 – 22

12. US 2016: Screening tool for emergency call staff (Paramedics)
Eight domains of items identified as important for a screening tool and detection of elder abuse and neglect by emergency call staff:
Condition of the outside home environment
Condition of the inside home environment
social support
Medical history and medications
Caregiving indicators
Physical condition of the older adult
Behaviour of the older adult
Workers’ instinct

13. Medical examination and treatment protocol for assaulted patients in emergency (PAKE)
Is a whole treatment package including
Assault form
details of the incident (place, date, who did, how did, what kind of violence, mental state, alcometer, further treatment)
Principles for medical examination
Body map
Guidelines for photographing injuries
Guidelines for documentation
Guidelines for multi-agency work
Good practices for paramedics, police, social work
PAKE is used for patients who come to emergency because of assault