AMA Assessment Protocol for Physicians. This assessment protocol does not incorporate any type of screening procedure.

APS Protocols. Eighteen state APS programs have screening protocols for use by APS specialists, but only four agencies performed any tests of validity or reliability on their tool (Wolf, 2000).

Risk Factor Checklists. Such checklists have been developed in a variety of settings (Canadian Task Force on Periodic Health Examination, 1994). These questionnaires are mostly based on descriptive studies and not on empirical data. They often do not assess for neglect or address the difference between disease and abuse.

The Mount Sinai/Victim Services Agency Elder Abuse Project Questionnaire. This tool (1998) developed in New York, is made up of nine closed-ended direct questions. It is short and easy to administer. Responses, however, rely on the subjective evaluation of the possible victim, who may not be forthcoming with or have the cognitive capacity to provide the personal information it requests. Positive responses should trigger further evaluation of potential abuse or neglect. This type of tool may be the best for quick screening in busy emergency centers or clinics.

Elder Assessment Instrument (EAI). This instrument first was developed in 1981 and now includes a checklist assessing five domains, a summary, a disposition, and a narrative if the examiner is so inclined (Fulmer and Wetle, 1986). The EAI has a content validity index of 0.83 (Fulmer et al., 1984) and a reliability index of 0.83 (Fulmer and Wetle, 1986). This instrument is comprehensive and precise and can be used for serial assessments. Fulmer and colleagues (2000) demonstrated that the sensitivity and specificity were 71 percent and 93 percent, respectively, when compared with a panel of experts. The EIA has been used successfully by emergency department nurses and appears to be ideal for research. The time required to complete the form’s detailed inquiries make it less likely to be used by physicians in busy, acute medical settings (such as emergency departments) and more likely to be used in settings such as geriatric outpatient clinics.

Brief Abuse Screen for the Elderly (BASE). This tool contains five brief questions that take only a minute to complete (Reis and Nahmiash, 1998). It is coupled with training and designed to screen elders who are either caregivers or care receivers. Reis and Nahmiash (1998) report a 86 percent to 90 percent agreement by trained practitioners and a correlation between abusive and nonabusive caregivers. The BASE may be useful in busy clinical settings.



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