Elder Abuse Suspicion Index
Also known as: EASI, Elder Abuse Suspicion Index screen, EASI elder mistreatment screen
The Elder Abuse Suspicion Index (EASI) is a brief, six-item tool designed to help physicians and other clinicians raise — and act on — a suspicion of elder mistreatment among cognitively intact, community-dwelling older adults. Developed by Mark Yaffe and colleagues at McGill University and validated in a 2008 study, it consists of five questions asked of the patient (covering neglect and physical, psychological, financial, and sexual abuse) plus a sixth item recording the clinician's own observations. It takes under two minutes to administer. The EASI does not diagnose abuse; rather, a 'yes' on any of questions 2 through 6 signals that mistreatment may be present and that referral to social services, adult protective services, or further evaluation is warranted. It is one of the most widely used elder-abuse case-finding instruments in primary care.
Key highlights
- Very brief (under two minutes) and easily integrated into a routine clinical encounter, prompting clinicians to raise a frequently overlooked issue.
- Covers the major abuse domains — neglect, psychological, financial, and physical/sexual — in plain, askable language.
- Combines patient self-report with clinician observation, capturing signs the patient may not report.
- Validated against a social-work reference standard and endorsed by clinicians as feasible and practice-relevant.
Intuition
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How it works
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When to use it
Use the EASI in primary care and ambulatory settings to prompt routine consideration of elder mistreatment in cognitively intact older adults, and to decide when to refer to social work or adult protective services. It is appropriate when a clinician is present to ask the questions and add observations, and when the goal is case-finding and lowering the threshold for suspicion rather than legal proof. It is not appropriate as a stand-alone diagnosis, in people with significant cognitive impairment (where self-report is unreliable and informant or observational tools are needed), or as a substitute for a comprehensive mistreatment assessment by trained professionals once suspicion is raised. Because of its moderate sensitivity, a negative EASI should not be taken to rule out abuse when other concerns exist.
Strengths & limitations
- Very brief (under two minutes) and easily integrated into a routine clinical encounter, prompting clinicians to raise a frequently overlooked issue.
- Covers the major abuse domains — neglect, psychological, financial, and physical/sexual — in plain, askable language.
- Combines patient self-report with clinician observation, capturing signs the patient may not report.
- Validated against a social-work reference standard and endorsed by clinicians as feasible and practice-relevant.
- Moderate sensitivity (~0.47) means it misses many true cases, so a negative screen does not rule out abuse.
- Validated only in cognitively intact community-dwelling older adults; it is not suitable for people with dementia.
- Self-report of abuse is affected by fear, shame, loyalty to the perpetrator, and dependence, biasing responses toward 'no.'
- It identifies suspicion only; confirmation, safety planning, and intervention require separate, resource-intensive evaluation.
Common pitfalls
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Applications
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Frequently asked
Does a positive EASI mean the patient is being abused?
No. The EASI raises suspicion; it does not diagnose abuse. A 'yes' on any of questions 2 through 6 indicates that mistreatment may be present and that the clinician should take further action — closer evaluation and, where appropriate, referral to social work or adult protective services. Confirming abuse, ensuring safety, and intervening require a fuller assessment by trained professionals. The instrument is a case-finding aid, not a definitive test.
Why is the EASI only for cognitively intact older adults?
Five of its six items rely on the patient's self-report, which requires that the respondent understand the questions and report accurately about the past year. In people with significant cognitive impairment such self-report is unreliable, so the EASI was developed and validated specifically in cognitively intact, community-dwelling older adults. For patients with dementia, informant-based or observational approaches to detecting mistreatment are more appropriate.
What do the sensitivity and specificity figures imply for use?
In validation the EASI had sensitivity around 0.47 and specificity around 0.75 against a social-work reference standard. The moderate sensitivity means roughly half of true cases may not screen positive, so a negative EASI should never be taken to rule out abuse when other concerns exist. The reasonable specificity and very short administration time make it a practical prompt for raising and acting on suspicion, with positives directed to fuller assessment.
Sources
- 1.Yaffe, M. J., Wolfson, C., Lithwick, M., & Weiss, D. (2008). Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI). Journal of Elder Abuse & Neglect, 20(3), 276-300.
- 2.Lachs, M. S., & Pillemer, K. A. (2015). Elder Abuse. New England Journal of Medicine, 373(20), 1947-1956.
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Cite this page
ScholarGate. (2026, June 23). Elder Abuse Suspicion Index. ScholarGate. https://scholargate.app/social-gerontology/easi-elder-abuse-screening