The Elder Abuse Suspicion Index © (EASI)
Under grant support from the Canadian Institute of Health Research (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. Mistreatment and neglect of older adults is a complex phenomenon with a multitude of suggested risk factors. As well, there are a number of theories as to its etiology, and a broad range of physical or psychological manifestations. Consequently, 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". The EASI 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 about possible mistreatment, or asks patient permission to refer her or him for specialized evaluation by social service workers, adult protection workers, or specially trained police.
The EASI was validated for face-to-face 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 observations of the patient. EASI completion commonly takes two to 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 eight diverse countries. (4)
The use of the EASI provides a means to ensure that men, sometimes missed as victims of elder abuse, are equally queried about mistreatment. Our interest in exploring gender differences in elder abuse were looked at by doing secondary analysis of data from our original CIHR study work and have been simultaneously described in a published journal article (6) and book chapter (7). Further secondary analysis of data from our EASI development and validation work has generated some understanding of the different approaches to elder abuse taken by various disciplines (social workers, nurses, physicians). Consideration of this may help in deciding whether other professions can use the EASI. (8)
The need to help physicians become more aware of tools that may assist them in elder abuse detection has been advocated. (9) In line with that goal our team has collaborated with 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 an EASI pocket-card which was distributed to family physicians across Canada. Aspects of this pocket-card were subsequently evaluated by a random sample of these family doctors as to appearance and readability. (10)
The Elder Abuse Suspicion Index - self administered © (EASI-sa)
In work supported by the New Horizons for Seniors Program of Human Resources and Social Development Canada the EASI has been shown feasible for seniors to self-administer in a modified format (EASI-sa), a process highly acceptable to them (5). The pros and cons of doctor-administered versus self-administered EASI have been explored with funding from the Public Agency of Canada and will likely vary from site to site.
The Elder Abuse Suspicion Index - long term care © (EASI-ltc)
The EASI has also been used as a platform on which to develop the EASI-ltc for use with residents in long term care facilities with Folstein mini mental scores of ≥ 24. (11) To reflect the nature of the long term care settings, the EASI has been expanded into a nine question tool, along with different instructions for administration. Utilization of the EASI-ltc assumes that long term care facilities have the ability to assess the mental status of individuals who score positively on the EASI-ltc. It also assumes that the facilities have a protocol in place to respond to possible abuse identified by the tool.
The Elder Abuse Suspicion Index - law enforcement officers © (EASI-leo)
An initiative on elder abuse conducted in the School of Public Health at Yale University explored the needs of police officers in the field and potential use by them of the EASI. Arising from positive feedback on the EASI the EASI was therefore incorporated by this team into an existing tool being used by those law enforcement officers. (12)
Related Elder Abuse Research
The focus of the EASI researchers has been on detection of elder mistreatment in various settings. However, once such abuse is identified it requires specialized follow-up. Janice Du Mont of Women’s College Hospital in Toronto leads a team that has examined this, and invited the collaboration of Mark Yaffe of the EASI group. To date her team has explored the potential for hospital-based interventions (13), what skills might be needed for such an intervention (14), and which professionals would be needed to carry this out (15).
Linguistic Versions of the EASI
As of October 1, 2018 we are aware of 15 linguistic versions of the EASI (see the drop-down boxes below). There are the English and French versions validated by our team, as well as 10 other linguistic versions created internationally by others. The latter have been reproduced on this webpage with the permission of their authors, who are identified with their versions. We are grateful to them for their collaboration and collegiality. We would welcome learning about any other versions of the EASI, and are open to including them on the website so that others might have increased access to them.
1. © The Elder Abuse Suspicion Index (EASI) was granted copyright by the Canadian Intellectual Property Office ( Industry Canada) February 21, 2006. (Registration No. 10364590)
2. © The Elder Abuse Suspicion Index – Long-Term Care (EASI- Ltc) was granted copyright by the Canadian Intellectual Property Office ( Industry Canada) November 9, 2017. (Registration No. 1144882.)
Questions about the EASI
May be directed to mark.yaffe [at] mcgill.ca.
Permission for use of the Elder Abuse Suspicion Index
Single copies of the EASI may be reproduced from this webpage for individual practice use.
Permission must be sought for EASI reproduction and use on a large scale, such as for electronic health records, institutional purposes, research activities, publications, and applications that have commercial implications. To enquire about obtaining this permission, kindly reproduce and complete the form in the drop-box that follows, and send it as an email attachment to mark.yaffe [at] mcgill.ca
Pocket cards for practical office use in English and French may be obtained from the National Initiative for Care of the Elderly (NICE) in Canada
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.
Ballard SA, Yaffe MJ, August L, Cetin-Sahin D, Wilchesky M. Adapting the Elder Abuse Suspicion Index © for use in long term care: A mixed methods approach. J. Applied Gerontology 2018. 733464817732443 doi 10:1177/0733464817732443.
KurKurina E, Lang BCL, Lama SD, Burk-Leaver E, Yaffe MJ, Monin JK, Humphries D. Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index © by law enforcement in the field. Journal of Elder Abuse and Neglect 2018. March-May; 30(2): 103-126.
Du Mont, J., Macdonald, S., *Kosa, D., *Elliot, S., Spencer, C., & Yaffe, M. Development of a comprehensive hospital-based elder abuse intervention: An initial systematic scoping review. PloS One. 2015. 10(5): e0125105. doi:10.1371/journal.pone.0125105
Du Mont J, Kosa D, Macdonald S, Elliot S, Spencer C, Yaffe M. Development of skills-based competencies for forensic nurse examiners providing elder abuse care. BMJ Open. 2016. doi: 10.1136/bmjopen-2015-009690.
Du Mont J, Kosa D, Macdonald S, Elliot S, Spencer C, Yaffe M. Determining professionals and respective roles and responsibilities for inclusion in a comprehensive hospital-based elder abuse intervention: A Delphi consensus survey. PLoS One. 2015. 10(12), e0140760. doi: 10.1371/journal.pone.0140760.