NICE Tools: Archive

IOA: Indicators of Abuse


The Indicators of Abuse (IOA) checklist signals mistreatment of seniors. The IOA (pronounced Iowa) also helps sensitize the practitioner to important abuse issues. The IOA is practical for busy practitioners and useful in training intervenors and volunteers in cases of abuse to recognize the signs of abuse. The IOA is a summary of abuse high-risk signals. It is not, however, a substitute for becoming knowledgeable about abuse signs through education.


For Discriminating Abuse and Non-Abuse Cases Indicators of abuse are listed on the next two panels,

in order of importance*. After a two–to three-hour home assessment (or other intensive assessment), rate each of the following items on a scale of 0 - 4

(as described below). Do not omit any items. Rate according to your current opinion.


0 = non-existent
1 = slight
2 = moderate
3 = probably/severe Caregiver Age years
4 = yes/severe
00 = not applicable
000 = don’t know


______ Has behaviour problems

______ Is financially dependent

______ Has mental/emotional difficulties

______ Has alcohol/substance abuse problem Has unrealistic expectations

______ Lacks understanding of medical condition Caregiving reluctancy

______ Has marital/family conflict

______ Has poor current relationship

______ Caregiving inexperience

______ Is a blamer

______ Had poor past relationship

______ Is financially dependent

______ Has unrealistic expectations

______ Has alcohol/medication problems Has poor current relationship

______ Has suspicious falls/injuries

______ Has mental/emotional difficulties Is a blamer

______ Is emotionally dependent

______ No regular doctor


______ Has been abused in the past

______ Has marital/family conflict

______ Lacks understanding of medical condition

______ Is socially isolated

______ Lacks social support

______ Has behaviour problems


Total the sum of ratings for all items (range: 0 - 108). INTERPRETING THE RESULTS

The abuse indicators are listed in rough order of importance. In general, the caregiver indicators carry more weight than care-receiver indicators. However, it is the total list of indicators together that signal abuse. Thus, the higher the total score (0 - 108), the more likely it is that abuse is occurring. Total scores close to 16 and higher are suggestive of abuse. Total scores of 4 or less indicate that there probably is no abuse.

Each indicator that is rated by the interviewer as being between 1 and 4 on the scale should be explored clinically. However, each individual indicator does not, by itself, indicate abuse.

Extracted from Myrna Reis and Daphne Nahmiash, When Seniors Are Abused (Toronto: Captus Press, 1995, pp. 15-26). Reproduced with permission.

Ouvrir le fichier pdf >
This Information Tool is currently being updated, and some of the content may be out of date.
Receive notifications for new Information Tool releases:
Follow on FacebookFollow on X (Twitter)Subscribe for email updates

You should not rely on information tools for medical, financial or legal advice. It provides general information only. NICE is not responsible for any use of the information other than for general educational/informational purposes and no claim can be made against NICE or any of its personnel for any such use.

Stay in touch

Subscribe to our eNewsletter for Online Information Tool updates.
* indicates required