Introduction
The Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST) is a brief 15-item screening instrument that helps identify older adults who may be experiencing abuse, neglect or exploitation, or who are at higher risk and may need further protective-services assessment. It grew from Melanie Hwalek and Mary Sengstock's 1986 development work and was validated by Neale and colleagues in 1991.
The H-S/EAST has received more than 260 citations. This guide explains its items, scoring, cut-off and limitations.
Key Features of the Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST)
Purpose and Use
The H-S/EAST screens for elder abuse, neglect and exploitation. A positive result is an indication for further investigation, not confirmation of abuse.
Target Population
The H-S/EAST is intended for older adults aged 60 and over.
Structure
The H-S/EAST has 15 items with a three-dimensional structure:
Direct abuse: overt abuse and violation of personal rightsCharacteristics of vulnerability: features that increase an older person's vulnerability to abusePotentially abusive situation: features of situations that may be abusiveItems also address physical, psychological or emotional, sexual and financial abuse, neglect, social isolation, dependence, trust, privacy and some service needs.
Scoring Method
Questions are answered yes or no. One point is scored in the "abused" direction for:
A "no" to items 1, 6, 12 and 14A response of "someone else" to item 4A "yes" to all other itemsScores range from 0 to 15, and a higher score means a higher risk of abuse. A total of 3 or more was suggested as indicating that an older person may be at higher risk of abuse, neglect or exploitation and may warrant further investigation.
Administration Format
The H-S/EAST is a brief screening questionnaire with yes/no answers.
Applications of the Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST)
The H-S/EAST supports several uses:
Screening: identifying older adults who may need further assessment.Protective services: flagging cases for further protective-services assessment.Research: studying elder abuse in different settings, such as public housing and geriatric outpatient clinics.Languages and availability
The H-S/EAST has been adapted into other languages:
Turkish: adaptation studyPersian (Iran): reliability and validity in geriatric outpatientsA copy of the H-S/EAST is available from the University of Iowa.
Reliability and Validity
The 1991 validation study gave preliminary evidence of construct and concurrent validity, but internal consistency was low (Cronbach's alpha = 0.29), and the authors stressed that further psychometric research was needed.
Validation studies:
Assessing the probability of abuse of the elderly: toward development of a clinical screening instrument (1986): study linkValidation of the Hwalek-Sengstock Elder Abuse Screening Test (1991): study linkScreening for elder abuse in geriatric outpatients: the Iranian H-S/EAST (2020): study linkLimitations and Considerations
Keep these points in mind:
Low internal consistency: Cronbach's alpha was 0.29 in the original study.Preliminary evidence: the authors emphasized the need for further psychometric research.Screening only: a positive result calls for further investigation, not a conclusion that abuse has occurred.Other Versions And Related Questionnaires
Shortened 9-item and 5-item versions have been derived from the H-S/EAST.
These questionnaires are related:
Conflict Tactics ScaleH.A.L.F., a tool to assess elder abuse in the familyAdditional Resources
The validation article: linkAssessing abuse among the elderly living in public housing (2000): linkElder mistreatment detection and screening instruments from the National Center on Elder Abuse: linkFor inquiries, contact Melanie Hwalek, SPEC Associates, 18000 West Nine Mile Road, Suite 525, Southfield, MI 48075, at mhwalek@specassociates.org.Browse more public health questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Hwalek–Sengstock Elder Abuse Screening Test measure?The H-S/EAST screens older adults for signs of abuse, neglect or exploitation, covering direct abuse, characteristics of vulnerability and potentially abusive situations across 15 yes/no items.
How is the H-S/EAST scored?One point is given for each answer in the "abused" direction: "no" to items 1, 6, 12 and 14, "someone else" to item 4, and "yes" to the rest. Scores range from 0 to 15.
What is the H-S/EAST cut-off score?A total of 3 or more was suggested as indicating that an older person may be at higher risk of abuse, neglect or exploitation and may warrant further investigation.
Does a positive H-S/EAST mean abuse has occurred?No. The H-S/EAST is a screening tool. A positive result should be treated as an indication for further investigation rather than confirmation of abuse.
A Word from ResRef About the Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST)
The H-S/EAST is a brief screening tool designed to identify older adults who may require further assessment for abuse, neglect or exploitation. The original study provided preliminary construct and concurrent validity evidence, but internal consistency was low (Cronbach's alpha = 0.29), and the authors emphasized that further psychometric research was needed. A positive result should therefore be treated as an indication for further investigation rather than confirmation of abuse.
References
Neale, A. V., Hwalek, M. A., Scott, R. O., Sengstock, M. C., & Stahl, C. (1991). Validation of the Hwalek-Sengstock Elder Abuse Screening Test. Journal of Applied Gerontology, 10(4), 406–418. https://doi.org/10.1177/073346489101000403Hwalek, M. A., & Sengstock, M. C. (1986). Assessing the Probability of Abuse of the Elderly: Toward Development of a Clinical Screening Instrument. Journal of Applied Gerontology, 5(2), 153–173. https://doi.org/10.1177/073346488600500205Moody, L. E., Voss, A., & Lengacher, C. A. (2000). Assessing abuse among the elderly living in public housing. Journal of Nursing Measurement, 8(1), 61–70. https://pubmed.ncbi.nlm.nih.gov/11026166/Aminalroaya, R., Alizadeh-Khoei, M., Hormozi, S., Sharifi, F., & Taati, F. (2020). Screening for elder abuse in geriatric outpatients: reliability and validity of the Iranian version Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST). Journal of Elder Abuse & Neglect, 32(1), 84–96. https://doi.org/10.1080/08946566.2020.1719564Ozmete, E. (2016). The Hwalek-Sengstock Elder Abuse Screening Test: The adaptation study into Turkish. Anatolian Journal of Psychiatry, 17(1), 45. https://doi.org/10.5455/apd.200727