Screening and
Assessment of Elder
Mistreatment
Module 6
Nurse Responses to Elder Mistreatment
An IAFN Education Course
1
Screening and Assessment


Nurses need to know how to screen,
assess, document and report elder
mistreatment (EM)
Screening provides an opportunity
to detect or rule out EM
o
If there is a suspicion, screening can
trigger full assessment
2
Learning Objectives
By the end of this module, participants will be able to:




Discuss why, when, where, with whom and how
screening and assessing older adults for EM
should occur
Describe steps in interviewing
Discuss appropriate questions to ask
Describe techniques to communicate with
patients and their families and caregivers
during screening/assessment process
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Case: Mr. Rodriguez



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What do you see as presenting issues?
What additional information does the nurse
practitioner need in order to proceed and
respond effectively?
What screening questions could the nurse
practitioner ask in her initial conversation
with Mr. Rodriguez? With the son?
Do you foresee any screening or assessment
challenges with the patient and the son?
4
Screening and Assessment Process
1.
2.
3.
4.
5.
Why should nurses screen/assess?
Where should screening/assessment take
place?
Who should be screened/assessed?
When should screening/assessment take
place?
How should screening/assessment be
conducted?
5
Where?

Screening and assessment
for EM should occur in
community settings and
long-term care facilities
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Who?


Ideally, nurses should screen every
vulnerable older adult for EM
However, many practice settings
screen only when signs of
mistreatment are identified or when
there is cause to suspect
mistreatment
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When?


A few simple questions can routinely
be included in nurse interactions with
all older patients (as appropriate to
practice setting)
Additional questions can be asked if
concern/suspicion is raised
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How?

A specific plan for screening and
assessment for elder mistreatment
should be incorporated into a practice
setting’s written policies
9
Tools for Screening/Assessment


Screening and assessment for EM can
be facilitated through use of
assessment tools
These tools typically require discussion
with patient and others who accompany
patient
10
Questions to Ask?

What screening and assessment
questions would be useful to ask
older patients to screen/assess
for elder mistreatment?
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Interviewing Patients
1.
First ask general questions
2.
Then ask more questions as necessary
Probe for physical abuse, psychological abuse, sexual abuse,
neglect, abandonment and exploitation
o
3.
If you received an affirmative answer regarding a
possible incident of mistreatment, follow-up to
determine—
o
o
4.
How did it occur?
Where did it occur?
When did it occur?
Who was involved?
Document statements in medical record
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9 General Screening Questions
Based on AMA guidelines (1992)



Has anyone at home (or nursing home)
hurt you?
Has anyone at home (or nursing home)
ever touched you without your
consent?
Has anyone at home (or nursing home)
ever made you do things you did not
want to do?
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9 General Screening Questions (cont.)




Has anyone at home (or nursing home) ever
scolded or threatened you?
Are you afraid of anyone at home (or at
nursing home)?
Are you often left alone at home (or nursing
home)?
Has anyone at home (or nursing home) ever
failed to help you take care of yourself when
you needed help?
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9 General Screening Questions (cont.)
More specific questions may be asked of
residents in long-term care settings
 Since you have been here, has any employee,
resident, family member, volunteer or visitor
hurt you?
OR
 Since you have been here, has any employee,
resident, family member, volunteer or visitor
hit, slapped or otherwise hurt you?
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More Probing Questions

What are additional questions to ask
to probe for physical abuse,
psychological/emotional abuse, sexual
abuse, neglect, abandonment and
exploitation?
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Follow-Up Questions
If a patient answers YES, say
1.
2.
3.
I’m glad you told me about this.
When was the last time?
Can you give me an example?
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Normalize Task of Asking
Difficult Questions

It is hard for nurses to ask these
questions, but that’s what they
often have to do; ask difficult
questions so they know what the
patient is dealing with and then can
help the patient/make it safe for
them to disclose
T. Fuller, Try this: Elder mistreatment assessment, 2008
18
Consider…

What communication techniques and
methods during screening and
assessment might help raise the
comfort level of the patient and elicit
accurate and important information?
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Communications w/Patients


Seek informed
consent, explaining
scope and limits of
confidentiality
Ask about and plan for
patient safety
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Communications w/Patients


Questions first
directed at patient
Even if an older adult
has a cognitive
disability, it is
reasonable to ask
about mistreatment
S. Aravanis, R. Adelman, R. Breckman, T. Fulmer, E. Holder, M.
Lachs, J. O’Brien & A. Sanders, Diagnostic and treatment guideline
on elder abuse and neglect, Archive of Family Medicine, 1993
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Communications w/Patients

Question patients
initially in a private
setting, away from
caregivers, family or
others
Aravanis, Adelman, Breckman, Fulmer, Holder, Lachs, O’Brien &
Sanders
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Communications w/Patients

Keep questions
simple and direct
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Communications w/Patients



Find out the patient’s preferred method
of communication
Consider how circumstances of patient
might affect communications and
accommodate when possible
Use communication strategies that
encourage patients to talk openly and
honestly with you
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Communications w/Patients



Give patients a sense of hope and
help them open up
Use a warm, caring and empathic
manner
Anticipate and work to overcome
reluctance to disclose mistreatment
25
Screening/Assessment
Leaves Door Open…


Many patients will
deny mistreatment or
refuse to discuss it
However, screening
and assessment lets
them know someone
cares and help is
available
B. Brandl, Assessing abuse in later life , 2004
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Questioning Family and Caregivers



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How will you, as the nurse, approach this
situation given suspicions of mistreatment?
What challenges do you face with situations
like this?
What questions need to be asked of each
person involved? What additional information
would be useful to know?
Does the nephew have the authority to tell
you how to handle this case? What strategies
will you use to talk with Mr. Jones in private?
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Get Statements from Others

The likelihood of detecting or ruling
out elder mistreatment increases as
the net of observation and inquiry
made by clinicians is widened
G. Anetzberger (Ed.),
The clinical management of elder abuse, 2005.

Obtain statements from others after
talking alone with the patient (even
when you think the patient lacks
decision-making capacity)
28
Guardians/Holders of Power of Attorney

If a patient’s decision-making
capacity is questionable, you may
need to discuss matters with a legal
guardian or holder of power of
attorney, if one exists (unless that
person is the suspected perpetrator)
National Center on Elder Abuse, Guardianship and other legal protections of vulnerable adults , 2007
29
If Suspect Presents with Patient
Observe behavior
 Ask questions

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Sample Questions

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What does your _____ (e.g., father/mother) need help
with every day?
How do you and your ______ handle disagreements?
What expectations does your ______ have of you?
Is caring for your _____ different than you thought it
would be? How?
Sometimes providing care for a family member is
challenging. What do you do or who do you tell when
you are feeling stressed?
R. Chez, Elder Abuse: An Introduction for Clinicians (Slide presentation), 2009
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Separating Family Members and
Caregivers from Patients

Be creative in separating “hovering”
family members or caretakers
(including those who may be
suspects) from patients to create a
window of time to ask questions
32
Closing Assessment

What have you learned from this
module that you can apply to your
practice setting?
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Optional Activity
Role plays to practice asking questions and
using communications techniques



Round 1: A (Observer), B (Nurse), C
(Patient/Other)
Round 2: A (Nurse), B
(Patient/Other), C (Observer)
Round 3: A (Patient/Other), B
(Observer); C (Nurse)
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Debriefing Questions

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Ask Nurse: What did you do that worked in this
situation? What would you change? What did you do to
address challenges?
Ask the Observer: What behaviors did the nurse
demonstrate that were effective in communicating
w/patient and screening/assessing for mistreatment?
What else could the nurse could have done?
Ask Patient: What did the nurse do that you found
helpful? What would you like nurse to do to further help
you? OR
Ask Those who Accompany Patient: What did nurse do
to gain info? What else could she have done?
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