Improving Reporting Reliability of Elder Abuse among Veterans

May 12, 2026

Takeaway: The "Reporting Concerns of Suspected Abuse and Neglect" note template is now "strongly encouraged" whenever a VA provider makes a report to an outside authority, which improves clinical care coordination for Veterans by bringing providers into alignment with VHA Directive1199, Reporting Cases of Abuse and Neglect. In the first 10 months after its launch in February 2025, the reporting note template was used across 109 VHA facilities for 6,196 reports in 5,186 unique Veterans.

Background

Elder abuse is a common problem with devastating health consequences for older adults. Statistics on elder abuse in the United States range from 1 in 10 for persons aged 60+ to 1 in 5 during the COVID pandemic (NOCA). Elder abuse can include: physical abuse, sexual abuse, emotional/psychological abuse, confinement, passive neglect, willful deprivation, and/or financial exploitation. VA serves more than 4 million Veterans ages 65 years and older, many of whom are at particularly high risk for elder abuse (Makaroun et al., 2017). Although healthcare encounters present opportunities for detection and intervention, there is limited knowledge about the facilitators and barriers experienced by the different clinicians involved in responding to elder abuse in integrated health systems.

Lena Makaroun, MD, MS, HSR Career Development Awardee (CDA) and core investigator with HSR's Center for Healthcare Evaluation, Research, and Promotion (CHERP), and colleagues conducted an HSR-funded study to understand perceived barriers and facilitators to managing all phases of elder abuse within the VA healthcare system. Investigators interviewed 37 frontline clinicians from a range of different disciplines (10 social workers, 9 physicians, 7 psychologists, 6 nurses, and 5 advanced practice providers) from different clinical sites within two large VA medical centers located in Pittsburgh, PA and Puget Sound, WA. Investigators then identified five inter-related themes that cut across the different stages of elder abuse care:

• Situational context,
• Degree of trust in familial and healthcare relationships,
• Extent of education and skills,
• Existing system infrastructure, and
• Clinician empowerment and motivation toward action.

One important need that clinicians identified was for standardized documentation of abuse and/or neglect concerns in the medical record, as reflected in this quote:

You know, it might be helpful, and I'm not sure if they already do this, especially among social work, that once there's a concern, that it's flagged somewhere so their primary care PACT team is aware and that they're monitoring it, too. I mean, I don't know if there's a central spot where that is put into the chart. It would be good to have, though. -VA physician

This study was the first to explore the experiences of a wide range of different clinicians across the entirety of the process of addressing elder abuse-from detection to intervention, within an integrated national healthcare system.

"Reporting Concerns of Suspected Abuse and Neglect" Note Template

Dr. Makaroun partnered with VA's Office of Care Management and Social Work and the Elder Justice Clinical Implementation Team to develop the "Reporting Concerns of Suspected Abuse and Neglect" note template. Usability studies showed that VA staff found the note to be easy to access and use, describing it as "really straightforward," "simple," and "self-explanatory." Participants reported the standardized note made it easier to identify that a report was made and facilitated follow-up care for Veterans who needed it. Half of participants completed the note in ≤5 minutes. Staff at one location said that the template streamlined the reporting process, making it "quicker and easier."

Implications

This "Reporting Concerns of Suspected Abuse and Neglect" note template is now "strongly encouraged" for use whenever a provider makes a report to an outside authority, which improves clinical care coordination by bringing providers into alignment with VHA Directive1199, Reporting Cases of Abuse and Neglect.In the first 10 months after its launch in February 2025, the reporting note template was used across 109 VHA facilities for 6,196 reports in 5,186 unique Veterans. In addition, it makes significant contributions to VA research by improving the reliability of data on elder and other forms of abuse and/or neglect among Veterans.

Partners

The VHA Office of Care Management and Social Work Services and the Elder Justice Clinical Implementation Team.

Investigator

Lena Makaroun, MD, MS, HSR Career Development Awardee (CDA) and core investigator with HSR's Center for Healthcare Evaluation, Research, and Promotion (CHERP).

Citations

• Makaroun L, Shin N, Hruska K, et al. Healthcare clinicians' perspectives on managing suspected elder abuse: "We don't want to just swoop in and do what we think is best." Innovation in Aging. February 10, 2025;9(5):igaf012.
• Webster A, Webb S, Sperber N, et al., and Makaroun L. Documenting reports of suspect abuse and neglect: The evaluation of a standardized patient note. Innovation in Aging. December 31, 2024;8(Suppl 1): 1235.