Initiative to Help Physicians Identify and Report Elder Abuse

By: Carol Zernial, MA, Executive Director, WellMed Charitable Foundation
Friday, May 2, 2014

An elder abuse prevention and intervention initiative now underway in San Antonio will provide area physicians with a toolkit to help them and their clinical staffs identify potential elder abuse victims.

The U.S. Department of Health and Human Services awarded a $907,000 grant to the Texas Department of Family Protective Services, in partnership with the WellMed Charitable Foundation, the Benjamin Rose Institute on Aging and the Elder Justice Coalition. The grant is funding the initiative at WellMed clinics in five Texas locales. It is the largest elder abuse prevention and intervention initiative in the history of the Department of Family Protective Services’ Adult Protective Services (APS) division.

“As the elderly population continues to grow, it is vital that healthcare professionals are equipped with tools to identify elder abuse and develop strategies to prevent that abuse,” says George Rapier, MD, Chair and Founder of the WellMed Charitable Foundation. “We are working to increase awareness of elder abuse among physicians.

“Too often, most doctors assume that the patient will be removed from the situation and taken care of, but that may not be the case. We saw the need for the initiative when at the end of almost every one of our caregiver meetings, a participant expressed concern about a possible elder abuse situation.”

The three-year federal grant pays to embed two APS specialists within WellMed. They are training clinic staff — including more than 120 physicians, nurse practitioners and physician assistants — on risk factors for elder abuse. They also are helping develop screening and intervention protocols.

The grant also provides educational materials to senior patients at 60 WellMed primary care clinics in the Austin, Corpus Christi, El Paso, Lower Rio Grande Valley and San Antonio areas. WellMed serves more than 70,000 senior patients at its Texas clinics, making it the largest primary care provider for the aging population in the Lone Star State.

Through the grant, Texas APS and WellMed have implemented a short, six-item screening tool. The Elder Abuse Suspicion Index (EASI), developed by Canadian physician Mark J. Yaffe, MDCM, is administered by a clinician or trained staff. It has been validated in ambulatory clinical settings in Canada with cognitively intact seniors.

The EASI includes these questions:

  1. Have you relied on people for any of the following: bathing, dressing, shopping, banking or meals?
  2. Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids or medical care, or from being with people you wanted to be with?
  3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened?
  4. Has anyone tried to force you to sign papers or use your money against your will?
  5. Has anyone made you afraid, touched you in ways that you did not want or hurt you physically?
  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?

Acceptance of the tool by clinicians has been promising. Thirty percent of clinicians reported being familiar with EASI prior to training, though none had used it in the past. At post training, 92 percent agreed or strongly agreed it would be a useful tool to identify elder abuse.

Carol Zernial, MA

If you would like more information on the initiative or a presentation for your group, contact Debbie Billa, Grants Manager at the WellMed Charitable Foundation, at or 210-877-7752 or Rachel Wilson Duer, APS Community Engagement Program Specialist, at or 210-871-3036.