What Is the Elder Abuse Suspicion Index© (EASI)?

Growing awareness has led to greater efforts to protect the well-being of elderly people. Early elder abuse detections and interventions, as well as effective screening tools, help reduce elder abuse and neglect incidents. The Elder Abuse Suspicion Index© (EASI) is one such tool. Mark J. Yaffe, Maxine Lithwick, and Deborah Weiss at McGill University created the Senior's Self-Administration of the Elder Abuse Suspicion Index.

EASI is primarily administered by physicians working with geriatric patients and family medicine physicians in primary care settings to identify elder abuse. But the EASI tool is only appropriately used to examine cognitively intact seniors. The Mini Mental State Exam (MMSE) determines a senior's mental capacity. A score of 24 or higher on the MMSE means the senior is cognitively intact.

Elder abuse, also called older adult abuse, is a serious problem that will increase in the coming years as the older adult population increases. Elder abuse can occur at a nursing home, long-term care facility, or in one's own home. We will explore several forms of elder abuse in this article.

By 2030 more than 20% of the U.S. population will be over 65. As the Baby Boomer generation is retiring and living longer, the prevalence of elder abuse will likely grow.

But victims of elder abuse and their loved ones don't need to face these challenges alone.

How Does the EASI Work?

The EASI is a list of six questions intended to raise a primary care doctor or medical professional's suspicion of elder abuse. This simple abuse screening helps a doctor determine whether to report a case to authorities and justify referral to social services. Social workers or adult protective services (APS) will then investigate reports of elder abuse.

The six EASI questions are as follows:

1. Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals?
2. Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids, medical care, or being with people you wanted to be with?
3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened?
4. Has anyone tried to force you to sign papers or to use your money against your will?
5. Has anyone made you afraid, touched you in ways you did not want, or hurt you physically?
6. [For doctor]: Did you notice any of the following in the last 12 months: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues?

A "yes" response to these questions should raise concerns about elder abuse and lead to a follow-up inquiry.

The EASI is a quick assessment tool and is used to strengthen the reporting requirement. A study on the effectiveness of the EASI found that it took an average of two minutes to administer. About 97.2% of doctors found that its use would have either some or a large impact on their practice.

What Is Older Adult Abuse?

Abuse can happen to any older person despite their financial situation, culture, gender identity, physical health, mental health, or care setting. While these can be risk factors, abuse can happen to anyone. Signs of abuse are hard to see, and the situation may feel shameful to the victim.

Elder mistreatment and abuse can take many forms, including:

• Physical abuse
• Family violence
• Intimate partner violence
• Domestic violence
• Sexual abuse
• Emotional abuse
• Psychological abuse
• Abandonment
• Financial abuse and exploitation
• Neglect
• Self-neglect

While these are distinct categories of abuse, it's important to note that older adults can suffer from many types of elder abuse at once. This is commonly referred to as "polyvictimization." Abusers can range from nursing home staff members to loved ones and family members.

Older Adult Abuse and Memory Loss

It's important to note that elder abuse can occur when a senior suffers from dementia or other health problems affecting their mental capacity or judgment. But this is not always the case.

An older adult with intact mental capacity can still be vulnerable to abuse if they:

• Have increased dependence on others
• Have feelings of loneliness or fear
• Place a high degree of trust in others (such as caregivers or family members) with harmful intentions

Challenges in Identifying and Reporting Abuse

Elder abuse is a public health issue. One of the major challenges in combating elder abuse is the identification and reporting of such abuse. A New York State Elder Abuse Prevalence Study found that only 1 in 24 elder abuse cases were identified or reported through formal health and social services. Cases of neglect and financial exploitation are the majority of underreported cases. A tool like EASI may help these services identify elder abuse at a higher rate.

This is due to fear of reporting abuse or the inability to access law enforcement or other support resources.

Medical Professionals Reporting Suspected Abuse

With the challenges listed above, authorities have focused on healthcare professionals to identify abuse. Their regular contact with elderly patients places them in a unique position to identify and report suspected abuse.

Physicians and health care providers already report most older adult abuse cases. They are often under legal obligations to report under the laws of their state.

Problems arise in cases where elder abuse is not as easily identifiable. That is where EASI comes in. It was specifically designed to provide medical professionals with a standardized questionnaire to identify potential elder abuse cases. There are also versions of EASI in several languages, including English, Spanish, and French.

More Resources

For more information on reporting elder abuse, see FindLaw's Reporting Elder Abuse or the National Center on Elder Abuse resources.

See FindLaw's Elder Abuse Overview for more information on elder abuse generally.

If you suspect a case of elder abuse, consult an attorney specializing in legal issues for older adults. See FindLaw's attorney directory for an elder law attorney in your area.