Elder Abuse Assessment Questions: Types, Interview, and Reporting

Elder abuse assessment questions are structured, direct prompts that ask an older adult about physical harm, neglect, self-neglect, financial exploitation, emotional mistreatment, and sexual abuse, paired with observation of the person, the caregiver, and the home. About one in ten older adults living at home experience some form of abuse, neglect, or exploitation, and the true figure is higher because most cases go unreported.¹ The questions below are the ones a comprehensive evaluation actually uses, organized by the type of harm they are designed to uncover, along with what to do with the answers.

Screening Questions Are Not a Comprehensive Assessment

A brief screening flags suspicion; a comprehensive assessment gathers evidence. The Elder Abuse Suspicion Index uses six questions in time-limited settings like a primary care visit, and it is not designed to confirm abuse. Its job is to raise suspicion enough to trigger a referral.² A positive screen means look deeper, not abuse confirmed.

A comprehensive assessment follows a positive screen, a direct report, or a referral. Validated instruments like the Elder Assessment Instrument cover 41 items across signs, symptoms, and subjective complaints related to abuse, neglect, exploitation, and abandonment. The tool produces no numerical score. A clinician refers the older adult to social services whenever any evidence of mistreatment exists, whenever the older adult voices a subjective complaint, or whenever the clinician judges the risk to be high.³ The judgment component is what makes it comprehensive.

Check Decision-Making Capacity First

Before asking about any specific type of abuse, evaluate whether the older adult can understand your questions and communicate answers. This shapes every interview that follows. A clinical capacity assessment is a functional determination by a clinician about whether someone can adequately make a specific decision. Legal capacity is a separate court determination that can change the person’s legal status.⁴

The clinical framework looks at four abilities: understanding information, appreciating how it applies to the person’s own situation, reasoning through options, and communicating a choice.⁴ Standardized cognitive screens like the Mini-Mental State Examination can help quantify impairment, but they do not adequately capture executive functions such as planning and decision-making, and scores can be affected by age, education, culture, and testing conditions. A screen alone is not enough to conclude someone lacks capacity.

Capacity is decision-specific and can shift throughout the day. An older adult who cannot manage complex finances may still reliably report that someone hit them. And an older adult who seems intact during a brief conversation may have intermittent confusion an abuser exploits. Time interviews for when the person is most alert, and revisit key questions if you have any doubt.

Physical Abuse Questions

Physical abuse means the knowing infliction of bodily harm, including hitting, pushing, slapping, or improperly restraining an older adult.⁵ The questions aim to connect visible injuries with explanations that make medical sense, and to learn whether the person fears the people responsible for their care.

Have you been hit, slapped, kicked, or pushed by anyone? Ask plainly. Many older adults will not volunteer this without a direct question.
Are you afraid of anyone who is supposed to be caring for you? Fear of a caregiver is one of the strongest indicators even when no injury is visible.
How did you get this bruise, burn, or cut? Unexplained injuries, especially in areas normally covered by clothing, warrant follow-up. Bruises in different stages of healing suggest repeated incidents.
Has anyone ever restrained you, locked you in a room, or tied you to a bed or chair? Improper restraint counts as physical abuse even when a caregiver frames it as safety.

Observation matters as much as the answers. Document the location, size, shape, and color of any injuries, noting whether they match the explanation given. Injuries shaped like hands, fingers, or objects are particularly concerning. Falls are common, but a pattern of repeated emergency visits for falls with inconsistent explanations is a red flag.

Neglect Questions

Neglect is the failure to provide the food, shelter, medical care, or personal safety an older adult needs, whether the caregiver acts deliberately or simply fails to follow through.⁵ It is harder to detect than physical abuse because the signs build gradually.

Are you getting your medications on time and in the right amounts? Missed refills and inconsistent dosing are among the most common signs and can have serious health consequences.
Have you been eating regularly, or have you lost weight recently without trying? Weight loss and dehydration point to inadequate nutrition.
Do you have access to your eyeglasses, hearing aids, dentures, or walker? Withholding aids isolates the person and creates dependency.
How often are you left alone, and for how long? Extended periods without help for someone who needs assistance can itself constitute neglect.

Environmental observation fills in what the questions miss. Check for unkempt hair, soiled clothing, strong body odor, untreated bedsores, and whether the living space has adequate food, heat, and functioning utilities. An empty refrigerator tells you more than a careful answer about meals.

Self-Neglect Questions

Self-neglect is different from caregiver neglect. It happens when an older adult’s own physical or cognitive limits prevent them from performing essential self-care like obtaining food, maintaining hygiene, managing finances, or following through on medical treatment. It is the most common category of reports to Adult Protective Services in many jurisdictions, and it deserves its own assessment because the intervention is different: connecting the person with support services rather than removing an abuser.

Ask about daily routines (“walk me through a typical day”), missed medical appointments, and unpaid bills. Physical indicators include unkempt appearance, unusual wounds, unexplained weight loss, and frequent acute flare-ups of chronic conditions. The home often tells the story: dangerous clutter, no food, expired medications, or utility shutoffs.

Capacity is the pivotal question. An older adult who fully understands the risks of their situation and chooses to accept them has the right to do so. An older adult whose cognitive decline prevents them from appreciating the danger may need protective intervention. Use both the articulate approach (can the person explain their decisions and the consequences?) and the demonstrate approach (can they actually perform the self-care they describe?) to distinguish choice from inability.

Financial Exploitation Questions

Financial exploitation is the unauthorized or improper use of an older adult’s money, property, or other resources for someone else’s benefit.⁶ Federal law defines it as a fraudulent, illegal, or unauthorized act using an elder’s resources for monetary or personal gain, or depriving the elder of rightful access to their own assets.⁷ It is often perpetrated by family members, which makes reporting harder. Questions need to probe control, consent, and sudden changes.

Who manages your money, and are you comfortable with that arrangement? Establishes the baseline and the person’s feelings about it in one question.
Has anyone pressured you to sign documents, change your will, or give them money? Coercion around legal documents is a hallmark of exploitation.
Have you noticed unexpected changes in your bank accounts or missing bills? Many victims first notice something wrong through unfamiliar transactions or statements that stop arriving.
Are any of your belongings or valuables missing? Theft of physical property is exploitation too.
Can you afford to pay for your food, medications, and utilities? Exploitation often leaves the person unable to cover basics even when their income should be sufficient.

Ask whether a power of attorney exists, who holds it, and whether the older adult understood what they were signing. Recent changes to deeds, beneficiary designations, or bank signatories should trigger extra scrutiny. When cognitive impairment is present, distinguish legitimate management from exploitation by comparing the older adult’s expressed wishes with how the money is actually being spent.

Psychological and Emotional Abuse Questions

Emotional abuse includes verbal attacks, threats, intimidation, humiliation, and isolation from friends and family.⁵ It rarely leaves physical marks, so direct questioning matters. It also tends to co-occur with other types of abuse, which means signs of emotional harm should push you to dig deeper across every domain.

Do you feel safe and respected in your home? An open-ended start that lets the person describe their environment in their own words.
Are you able to have visitors or make phone calls whenever you want? Restricting contact is both a form of emotional abuse and a way of concealing other abuse.
Has anyone threatened to punish you, put you in a nursing home, or send you away? Threats of institutionalization are a common control tactic.
Has anyone spoken to you in a way that made you feel worthless or humiliated? Persistent verbal degradation can be as damaging as physical violence.
What happens when you and your caregiver disagree? The answer reveals the power dynamic.

Behavioral cues carry as much weight as verbal answers. Withdrawal, flinching when a caregiver enters the room, avoiding eye contact, and flat or guarded responses all suggest emotional abuse. Note whether the person’s affect changes when a particular name comes up, and whether they seem to be monitoring what they say.

Sexual Abuse Questions

Sexual abuse of older adults is significantly underdetected because assessors are uncomfortable asking and older adults are reluctant to disclose. Leaving it out of a comprehensive evaluation is a serious omission. Sexual abuse involves any unwanted sexual contact or forcing an older adult to witness sexual activity, and it can come from caregivers, family members, or other residents in institutional settings.

Introduce the questions with a normalizing statement: “I ask these questions of everyone because this type of harm is more common than people realize.” That framing reduces shame and signals that disclosure will be taken seriously.

Has anyone touched you in a way that made you uncomfortable or that you did not want? Broad enough to capture unwanted contact without requiring explicit language.
Has anyone forced you to watch sexual material or activity? Non-contact sexual abuse is still sexual abuse.
Is there anyone you are afraid to be alone with? Avoidance behavior around a specific person is a strong indicator.
Have you noticed any pain or unusual symptoms in your genital area? Unexplained genital injuries, sexually transmitted infections, or urinary symptoms in someone not sexually active warrant investigation.

Behavioral indicators matter here. Sudden withdrawal, sleep disturbances, new-onset anxiety around specific individuals, and reluctance to be undressed for medical examinations should all prompt follow-up. In long-term care, ask whether staff or other residents have entered the room without permission during personal care or bathing.

How to Conduct the Interview

Setting and Privacy

Interview the older adult alone, with no suspected abuser or caregiver present or within earshot. This is not negotiable. Someone who has been coached or intimidated will not disclose otherwise. If a caregiver insists on staying, that resistance is itself a warning sign to document. The space should be quiet and well-lit. Noise, poor lighting, and interruptions directly reduce the reliability of answers from someone with hearing loss or cognitive impairment.

Building Trust

Introduce yourself, explain why you are there, and be transparent about what will happen with the information. Many older adults fear that disclosure will lead to institutionalization, loss of a caregiver they depend on, or family conflict. Acknowledging those fears directly (“I understand you may be worried about what happens if you tell me something”) can open a conversation that a checklist cannot. Use the person’s preferred name, keep eye contact, and skip the medical jargon.

Adapting to Cognitive and Sensory Needs

Schedule the interview when the person is most alert. For those with dementia, cognitive function often declines as the day goes on, so mornings tend to yield more reliable responses. Use short, concrete sentences and one question at a time. Provide hearing amplification, large-print materials, or an interpreter if needed. If direct interviewing is not possible, collateral information from neighbors, other family members, home health aides, and medical records becomes the primary evidence.

Interview the Caregiver Separately

Always interview the caregiver on their own. It prevents them from influencing the older adult’s answers and gathers their perspective. Caregiver stress, substance use, financial dependence on the older adult, and unrealistic expectations about caregiving are all risk factors worth exploring. Discrepancies between the two accounts are significant findings.

Document What You Find

Documentation is what turns assessment into evidence that can support protective intervention, prosecution, or both. Record every finding as close to the time of observation as possible.

For physical findings, describe and photograph every injury: location, size, shape, color, and stage of healing. Measurements matter. “Bruise on the left forearm, approximately 3 inches by 2 inches, consistent with a grip pattern” carries far more evidentiary weight than “bruising noted on arm.” Photographs should include a ruler or coin for scale and be taken from multiple angles.⁸

Environmental documentation matters as much. Check the kitchen for food, the medicine cabinet for current prescriptions, and the bathroom for hygiene supplies. Note whether medication counts match the expected refill schedule. Soiled bedding, absence of a telephone, missing mobility devices, and generally unsafe conditions should all be recorded.⁸ These details are easy to forget and hard to reconstruct later.

Record the older adult’s statements in their exact words whenever possible. “He hits me when I ask for lunch” is far more powerful than a clinician’s summary that “patient reports physical altercation related to mealtimes.” If the person cannot provide a reliable interview because of cognitive impairment, document that limitation and note who provided collateral information.

Reporting and What Happens Next

The assessment does not protect anyone on its own. What comes next depends on who is conducting it and where the older adult lives.

Federal Reporting Requirements

Federal law imposes mandatory reporting on anyone working in a long-term care facility that receives at least $10,000 in federal funds annually. Under the Elder Justice Act, every owner, operator, employee, manager, agent, or contractor of such a facility must report any reasonable suspicion of a crime against a resident to both the Secretary of Health and Human Services and local law enforcement. If the suspected crime resulted in serious bodily injury, the report must be filed within two hours. For all other suspected crimes, the deadline is 24 hours.⁹

Penalties are severe. A covered individual who fails to report faces a civil penalty of up to $200,000 and possible exclusion from federal health care programs. If the failure to report worsens the harm to the victim or causes harm to someone else, the penalty rises to $300,000.⁹

State Reporting Obligations

Every state has its own mandatory reporting law. Most require a broad range of professionals, including health care workers, social workers, law enforcement, and long-term care staff, to report suspected elder abuse. The specific categories of mandated reporters, reporting timelines, and the receiving agency vary. In most states, reports go to Adult Protective Services, which reviews the report, decides whether it meets criteria for investigation, and assigns an investigator who typically initiates contact within 24 to 72 hours depending on the level of danger. Know your state’s requirements before you begin an assessment. The clock starts when suspicion forms, not when the assessment is complete.

Safety Planning

When an assessment confirms abuse, the older adult’s safety is the immediate priority. That can mean a connection to Adult Protective Services, alternative housing, a protective order, or coordination with law enforcement. Protective orders for elder abuse are available in every state, and courts generally waive filing fees for abuse victims. For older adults who lack capacity to petition on their own, a conservator, guardian, or Adult Protective Services representative can typically file on their behalf.

Safety planning has to account for the older adult’s own wishes. Someone with full decision-making capacity has the right to decline intervention even when you believe they are in danger. Document the choice, and give them information about resources they can access later if they change their mind, including the national Eldercare Locator at 1-800-677-1116.

1
Centers for Disease Control and Prevention. About Abuse of Older Persons
2
McGill University. Elder Abuse Suspicion Index (EASI)
3
Hartford Institute for Geriatric Nursing. Elder Mistreatment Assessment
4
United States Department of Justice. Decision-Making Capacity Resource Guide
5
National Institute on Aging. Elder Abuse
6
Consumer Financial Protection Bureau. Reporting Elder Financial Abuse
7
Office of the Law Revision Counsel. 42 USC 1397j – Definitions
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United States Department of Justice COPS Office. Collecting Evidence in Elder Abuse and Neglect Cases
9
GovInfo. 42 USC 1320b-25 – Reporting to Law Enforcement of Crimes Occurring in Federally Funded Long-Term Care Facilities