Approximately 15.7% of adults 60 years and older are at risk for abuse. Researchers developed the Decision Matrix for Elder Safety (DMES) tool to assess and determine abuse in older adults, according to a poster presented at the Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference held September 30 to October 2, 2021.

“Elder abuse is a societal problem that is frequently undetected, under-reported, and poorly defined,” stated study author Natalie R. Baker, DNP, CRNP, GNP-BC, ANP-BC, CNE, GS-C, FAANP. “The prevalence of elder abuse transcends all socioeconomic, ethnic, racial, and gender domains.”

Older adults with cognitive, psychological, and physical impairments are at an increased risk of elder abuse, with cognitive impairment being the greatest risk factor identified thus far. Different forms of elder abuse include physical, sexual, financial, psychological, and neglect, the study authors noted.


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The purpose for designing DMES was to “provide a classification tool that assesses elder abuse risk over a continuum as cognitive and functional decline occurs,” said study author Patricia M. Speck, DNSc, CRNP, FNP-BC, DF-IAFN, FAAFS, DF-AFN, FAAN.

With logarithmic documentation, advanced practice providers could use DMES to document and expose a pattern of decline and provide opportunities for prevention and intervention. Older patients with severe functional deterioration and full global cognitive decline are at high risk for abuse (see red squares in Figure).

Figure. Decision Matrix for Elder Safety (DMES) tool. Reprinted with permission from Speck and Baker.

When using the DMES tool, the degree of risk for elder abuse is calculated based on varying degrees of cognition and functional decline. Older adults with little or no cognitive and functional decline are still prone to abuse however, older patients with severe cognition and functional deterioration are at high risk for abuse.

Validated tools for functional assessment include the Katz Index of Independence in Activities assesses bathing, dressing, toileting, transferring, Dr Speck said. Lawton Instrumental Activities of Daily Living is used to assess domains including the ability to manage medications, finances, and transportation as well as the ability to use the phone and shop for oneself.

To evaluate cognition, the Mini-Mental State Evaluation (MMSE) is recommended, the researchers said. The MMSE consists of 30 items used to assess orientation, attention and working memory, short-term memory, language, and visual-spatial skills. The Mini-cog is another simple tool for assessing cognitive impairment.

The DMES is recommended when APRNs are evaluating older patients and offers a road map for elder abuse risk and identifies elder abuse by assessing cognitive and functional capacity, the researchers noted said.

If abuse is suspected, APRNs must safeguard the patient by contacting the appropriate authorities and document their findings in the medical records, the authors concluded. 

Visit Clinical Advisor’s meetings section for complete coverage of GAPNA 2021.

Reference

Speck PM, Baker NR. Assessing risk for elder abuse using decision matrix for elder safety tool. Poster presented at: Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference; September 30 October 2, 2021; San Diego, CA: P08