The Elder Abuse Suspicion Index © (EASI)
Under grant support from CIHR the EASI was developed and validated in English and French (1) to help family physicians detect those in their practices who are victims of elder abuse. Since mistreatment and neglect of older adults is a complex phenomenon with a multitude of suggested risk factors, a number of theories as to its etiology, and a broad range of physical or psychological manifestations, the EASI was not designed to be a screening tool in the traditional sense. Rather, the EASI respects doctors’ decision-making and diagnostic strategies that commonly involve indices of suspicion. It therefore aims to raise a doctor’s level of suspicion about elder abuse to a level at which the physician himself or herself makes in-depth exploration or asks permission of the patient to refer her or him for specialized evaluation by social service workers, adult protection workers, or specially trained police.
The EASI was validated for enquiry by family physicians of patients in their offices aged 65 and over, with a Folstein MMSE score of 24 or above. The EASI is comprised of only six questions and is rapid to administer. The first five are asked by the doctor and answered by the patient in a YES / NO format. The sixth question is answered by the doctor, based on his or her observaitons of the patient. In the majority of cases EASI completion takes about two minutes to do; maximum reported time is five minutes.
All six questions should be queried in the order in which they appear in the EASI. A response of YES on one or more of questions 2-6 should raise concern about mistreatment. Those who wish to explore a positive response further might be helped by referring to a practical review of elder abuse entitled “Understanding elder abuse in family practice” (2), or to a review created for the use of some specialists. (3)
The Elder Abuse Suspicion Index has been demonstrated to have content validity in seven diverse countries. (4) In work supported by the New Horizons for Seniors Program of Human Resources and Social Development Canada it has been shown feasible and acceptable by seniors for use in a self-administered format (EASI-sa) (5). The pros and cons of doctor-administered versus self-administered EASI have been explored with funding from the Public Agency of Canada and are pending publication. The use of the EASI to provide a context in which to explore gender differences in elder abuse have been looked at by doing secondary analysis of data from the CIHR study reported simultaneously in a published journal article (6) and book chapter (7). Further secondary analysis of the CIHR data has generated an understanding of different approaches to elder abuse taken by various disciplines which may help in deciding whether other professions can use the EASI. (8)
The need to make physicians more aware about tools that may assist them in elder abuse detection identification has been put forward (9), and with that goal in mind our team has collaborated with a project of the National Initiative for Care of the Elderly (NICE) and the Division of Aging and Seniors of the Public Health Agency of Canada to create and evaluate aspects of the appearance and readability of an EASI pocketcard that has been distributed to family physicians across Canada. (10)
As of January 2012 we are aware of 8 linguistic versions of the EASI. There are the English and French versions validated by our team, as well as 6 other linguistic versions created internationally by others. Those that we are aware of have been reproduced on this webpage with the permission of their authors. We are grateful to them for their collaboration and collegiality. We would welcome the addition of others.
© The Elder Abuse Suspicion Index (EASI) was granted copyright by the Canadian Intellectual Property Office ( Industry Canada) February 21, 2006. (Registration No. 10364590)
Questions about the EASI may be directed to mark [dot] yaffe [at] mcgill [dot] ca (Dr. Mark Yaffe)
|EASI- English version|
|EASI- French version|
|EASI- Spanish version|
|EASI- Hebrew version|
|EASI- Portuguese version|
|EASI- German version|
|EASI- Japanese version|
|EASI- Italian version|
- Copies of the EASI may be reproduced from this webpage.
- Pocket cards for practical office use may be obtained from the National Initiative for Care of the Elderly (NICE) in Canada
- Digital versions of the EASI
- Yaffe MJ, Wolfson C, Weiss D, Lithwick M. Development and validation of a tool to assist physicians’ identification of elder abuse: The Elder Abuse Suspicion Index (EASI ©). J Elder Abuse Negl.2008; 20 (3): 276-300.
- Yaffe MJ, Tazkarji B. Understanding elder abuse in family practice. Can Fam Physician 2012; 58:1336-40.
- Yaffe MJ. Elder Abuse. Chapter in Calhoun K, Eibling DE, Wax MK, Kost K. Geriatric Otolarygology. Taylor and Francis, New York, 2006. pp.635-645.
- Global Response to Elder Abuse and Neglect: Building Primary Care Capacity to Deal with the Problem Worldwide: Main Report. World Health Organization. Geneva. 2008 149 pages. ISBN 978 92 4 1563581. http://www.who.int/ageing/publications/ELDER_DocAugust08.pdf?ua=1 (Accessed July 29, 2011)
- Yaffe MJ, Weiss D, Lithwick M. Seniors’ Self-Administration of the Elder Abuse Suspicion Index (EASI): A Feasibility Study. J Elder Abuse Negl. 2012 ; 24(4) 277-292.
- Yaffe MJ, Weiss D, Wolfson C, Lithwick M. Detection and prevalence of abuse of older males: Perspectives from family practice. Journal of Elder Abuse and Neglect 2007; 19 (1/2): 47-60.
- Yaffe MJ, Weiss D, Wolfson C, Lithwick M. Detection and Prevalence of Abuse of Older Males: Perspectives from Family Practice. In Abuse of Older Men. (ed Kosberg, JI), Howarth Press, Binghamton, New York, 2007, pp. 47-60.
- Yaffe MJ, Wolfson C, Lithwick M. Professionals show different enquiry strategies for elder abuse detection: Implications for training and interprofessional care. Journal of Interprofessional Care 2009; 23(6), 646-54.
- Yaffe MJ. Detection and Reporting of Elder Abuse. Family Medicine 2010;42 (2): 83.
- Yaffe MJ, Leaney A. Technical report: An evaluation of the Elder Abuse Suspicion Index ( EASI) © pocketcard. Report prepared on behalf of the National Initiative for Care of the Elderly for the Division of Aging and Seniors of the Public Health Agency of Canada. March 2010.