Good Practice Protocols Sirkka Perttu Draft Manual page 46-50

Screening/routine enquiry – incidental asking Screening in general Screening/routine enquiry – incidental asking asking based on suspicion may be felt by a person as insulting or discriminatory Universal screening is targeted to a whole population or a subgroup (e.g. to all patients visiting emergency) it is offered to all, without a risk status of the individual Selective screening is targeted to risk populations only based on risk factors

Elder abuse screening/routine enquiry Most of the screening tools are developed in US The need is for short and user-friendly tool which can be completed in busy practices Many instruments focus only on one perpetrator (e.g. care giver) Developed tools highlight suspicion of elder abuse rather than giving a definitive diagnosis of abuse; can lead to further investigation Tools are a method of assisting professionals to detect the risk of elder abuse The purpose of screening is the early identification of risk (not signs, symptoms)

Elder abuse screening/routine enquiry Older people need a specific screening tool because for example trauma in older people differs from other generations the abuser may influence on screening if he/she is a caregiver medications, illnesses and normal aging changes make difficult to recognise abuse Challenges arise in the context of their ability to respond competently: mental incapacity (dementia), frailty, anxiety, fear etc. Gender issues have not been in focus

Good sources for reading about screening of elder abuse Phelan, A., Treacy, M.P. (2011) A Review of Elder Abuse Screening Tools, NCPOP, School of Nursing, Midwifery and Health Systems, University College Dublin. http://www.ncpop.ie/userfiles/file/ncpop%20reports/538_NCPOP-proof7.pdf Silvia Perel-Levin 2008. Discussing Screening for Elder Abuse at Primary Health Care level. World Health Organization. http://apps.who.int/iris/bitstream/10665/43523/1/9789241594530_eng.pdf

Pre-conditions for using a screening instrument Professionals are trained to ask by a right way safe, respectful, sensitive, initiative taking, using nonthreatening language development of rapport between professional and a person interviewed non-judgemental, empathetic attitude Introduction: I would like to ask you a few questions about events that may happen in the lives of older people. Professionals are trained to use the instrument abuse of older women/elder abuse, dynamics, supporting, risk assessment, safety planning

Pre-conditions for using a screening instrument Professionals know the practical procedures there are written guidelines how to use the screening tool there are written guidelines what to do after possible disclosure agreed practice in own work place multiprofessional and multi-agency working model There are support and consultation possibilities for the professionals

ELDER ABUSE SUSPICION INDEX © (EASI) (Mark Yaffe 2008) Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals? Yes, No, Did not answer (Dependency; indicates whether a person is in dependent position and therefore at risk) Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with? Yes, No, Did not answer (Neglect) Have you been upset because someone talked to you in a way that made you feel shamed or threatened? Yes, No, Did not answer (Psychological/Emotional abuse)

ELDER ABUSE SUSPICION INDEX © (EASI) (Mark Yaffe 2008) 4) Has anyone tried to force you to sign papers or to use your money against your will? Yes, No, Did not answer (Financial abuse) 5) Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically? Yes, No, Did not answer (Physical/Sexual abuse) 6) Doctor: Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months? Yes, No, Not sure

Good reliability and validity in its three dimensions: Risk on Elder Abuse and Mistreatment – Instrument, REAMI (De Donder et al. 2017) Developed and validated in Belgium by Vrije Universiteit Brussel/Prof. Dr. Liesbeth de Donder & team Based on screening among 1920 older clients (55+) of home care in Belgium in 2012; most of the clients over 75 years Good reliability and validity in its three dimensions: risk factors of older person risk factors of the environment signal of abuse and mistreatment

Used by workers who know the older person Risk on Elder Abuse and Mistreatment – Instrument, REAMI (De Donder et al. 2017) Used by workers who know the older person Can be used by a single worker and/or professional teams Concentrates widely on risk factors: Three parts: 1: Risk factors of older person; Questions 1 – 6 2: Risk factors of social environment; Questions 7 – 16 3: Signals of Elder Abuse; Querstions 17 – 22

US 2016: Screening tool for emergency call staff (Paramedics) Eight domains of items identified as important for a screening tool and detection of elder abuse and neglect by emergency call staff: Condition of the outside home environment Condition of the inside home environment social support Medical history and medications Caregiving indicators Physical condition of the older adult Behaviour of the older adult Workers’ instinct

Medical examination and treatment protocol for assaulted patients in emergency (PAKE) Is a whole treatment package including Assault form details of the incident (place, date, who did, how did, what kind of violence, mental state, alcometer, further treatment) Principles for medical examination Body map Guidelines for photographing injuries Guidelines for documentation Guidelines for multi-agency work Good practices for paramedics, police, social work PAKE is used for patients who come to emergency because of assault