The Elder Abuse Risk Assessment Guide (EARA): An Introduction
Jennifer E. Storey, Stephen D. Hart & P. Randall Kropp
Simon Fraser University
Although ever present, elder abuse has not received the same amount of media,
government, and research attention as some other crimes. Thankfully, this trend is changing as
people begin to realize the prevalence and complexity of the problem. For instance, several
police jurisdictions have created specialized units to investigate and manage suspected elder
abuse due to the unique nature of this crime and the difficulties inherent in managing the risk
involved.
The few studies that have been conducted on the topic of elder abuse estimate the rate of
reported abuse to be between 4% and 6% in developed countries resulting in 10,000 incidents of
EA daily (World health Organization, 2002). The prevalence of elder abuse coupled with the
projected growth in the elder population (anticipated to more than double between 1995 and
2025 [WHO, 2002]) signals a need for resources to help prevent and manage the problem.
Of particular interest to us is the assessment and management of actual or suspected elder
abuse. As such, we are in the process of developing a risk assessment instrument for elder abuse
called the Elder Abuse Risk Assessment Guide or EARA. For the purposes of the EARA we define
elder abuse and neglect as the actual, attempted, or threatened physical harm of an elderly
person that is perpetrated by a younger person who is at least an acquaintance of the victim or
an individual of any age who owes a duty of care to the victim.
This definition excludes violence committed by strangers, and intimate partner violence
as these are already covered by other risk assessment instruments (e.g., HCR-20, B-SAFER,
SARA). The violence that will be considered in the EARA is perpetrated by individuals who have
a relationship with the elderly person, and in the case of spouses, those whose relationships also
include elements of dependence and care.
The identification, investigation, assessment, and management of elder abuse are tasks
that require the expertise and efforts of several types of professionals, including criminal justice,
health, care, and mental health professionals. As such, the EARA was developed to be applicable
and useful to a variety of professionals working with elder abuse victims and perpetrators. The
EARA was also designed to facilitate communication between these groups of professionals.
There are several different ways to conduct structured violence risk assessments. For the
EARA we will be using structured professional judgment (SPJ). In the SPJ method decisionmaking is directed by guidelines that have been developed to reflect the “state of the discipline”
with respect to scientific knowledge and professional practice (Borum, 1996). Essentially, the
guidelines assist the user by outlining what information and core risk factors should be
considered in a violence risk assessment and how to use that information to determine the risk
involved in the case and develop appropriate risk management strategies.
The SPJ method also underlies several widely used risk assessment instruments for other
forms of violence including domestic violence (the B-SAFER and the SARA), stalking (the SAM),
general violence (the HCR-20) and sexual violence (the SVR-20 and the RSVP).
Displayed below are the 28 risk factors and 4 domains of the EARA.
Nature of Abuse
Perpetrator Risk
Factors
Victim
Vulnerability
Factors
Community and
Institutional
Responsivity Factors
N1. Neglect
P1. Physical Health
R1. Availability
N2. Emotional Abuse
P2. Mental Health
N3. Financial Abuse
P3. Substance Use
N4. Intimidation/Threats
N5. Physical Abuse
P4. Dependency
P5. Stress and
Coping
P6. Attitudes
P7.Victimization
P8. Intimate
Relationships
P9. Non-Intimate
Relationships
V1.Physical
Health
V2. Mental
Health
V3. Substance
Use
V4. Dependency
V5. Stress and
Coping
V6. Attitudes
V7. Victimization
V8. Relationships
N6. Abuse is Diverse
N7. Abuse is Persistent
R2. Accessibility
R3. Affordability
R4. Acceptability
R5. Appropriateness
N8. Abuse is Severe
N9. Abuse is Escalating
N9. Abuse Involves
Supervision
Violations
We recently had individuals who are familiar with the fields of elder abuse and violence
risk assessment review the EARA manual and worksheet and provide feedback. We are currently
revising the EARA based on their comments. Our next step will be to conduct pilot testing using
elder abuse cases, again with individuals familiar with elder abuse and violence risk assessment.
These steps are common when creating SPJ risk assessment tools and help to increase the clarity
and utility of the final product. The pilot session is currently scheduled to take place in
Vancouver. If anyone is interested in assisting with this stage of the development process or has
comments about the information provided herein we encourage you to contact the lead author of
the instrument, Jennifer Storey at jstorey@sfu.ca and/or Alison Leaney of the Elder Abuse
Knowledge to Action Project of NICE at alison.leaney@nicenet.ca. The more feedback we
receive from knowledgeable people in the area the better the final product will be.
Following completion of the manual, training will be available for the EARA alone or in
conjunction with other SPJ risk assessment tools, such as the B-SAFER, the SARA and the SAM.