Screening for Vulnerability to Abuse Among Older Women: Women's Health Australia Study (original) (raw)
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Mortality and Disability Outcomes of Self-Reported Elder Abuse: A 12-Year Prospective Investigation
Journal of the American Geriatrics Society, 2013
OBJECTIVES: To determine whether elder abuse can predict mortality and disability over the ensuing 12 years. DESIGN: Population-based prospective cohort study of women aged 70 to 75 in 1996; survival analysis. SETTING: Australia. PARTICIPANTS: Twelve thousand sixty-six women with complete data on elder abuse. MEASUREMENTS: Elder abuse was assessed using the 12-item Vulnerability to Abuse Screening Scale (VASS) subscales: vulnerability, coercion, dependence, and dejection. Outcomes were death and disability (defined as an affirmative response to "Do you regularly need help with daily tasks because of long-term illness, disability or frailty?"). RESULTS: In 1996, 8% reported vulnerability, 6% coercion, 18% dependence, and 22% dejection. By October 2008, 3,488 (29%) had died. Mortality was associated with coercion (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.06-1.40) and dejection (HR = 1.12, 95% CI = 1.03-1.23), after controlling for demographic characteristics, social support, and health behavior but not after adding chronic conditions to the coercion model. Over the 12 years, 2,158 of 11,027 women who had reported no disability in 1996 reported disability. Women who reported vulnerability (HR = 1.25, 95% CI = 1.06-1.49) or dejection (HR = 1.55, 95% CI = 1.38-1.73) were at greater risk of disability, after controlling for demographic characteristics, social support, and health behavior. The relationship remained significant for dejection when chronic conditions and mental health were included in the model (HR = 1.40, 95% CI = 1.24-1.58). CONCLUSION: Specific components of vulnerability to elder abuse were differently associated with rates of disability and mortality over the ensuing 12 years. J Am Geriatr Soc 61:679-685, 2013.
Development and Testing of Screening Indicators for Psychological Abuse of Older People
Archives of Psychiatric Nursing, 2007
Abuse of older people is a serious and growing social problem. Although physical abuse is the easiest to identify, covert acts of psychological abuse are of concern to elders' health care providers. The assessment of psychological abuse in elders is an important, but difficult, aspect of concern for these older adults. This article describes the development and testing of a screening instrument for elders' psychological abuse. The Elders' Psychological Abuse Scale (EPAS) was developed from many abuse indicators that have been identified in past research and from inputs from a focus group discussion. The content validity index of .92 was established through expert panel evaluation. Psychometric findings provided support for the efficacy of the 32-indicator EPAS in screening for the presence of psychological abuse in elders. Significant inverse relationships between the EPAS, the Short Portable Mental State Questionnaire (r = À.32, P b .001), and Barthel's Index (r = À.36, P b .001) provided confirmation of criterionrelated validity. A high test-retest agreement percentage and the finding that 26 of 32 j values exceeded 0.6 confirmed the reliability of the EPAS. We concluded that the EPAS appears to be a promising tool, providing reliable and valid screening data to help determine psychological abuse among elders in long-term care facilities and domestic settings, as well as facilitating researchers' better understanding of the phenomenon of elders' abuse. D
Revista de Saúde Pública
OBJECTIVE Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil. METHODS The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20). RESULTS The average age of the participants...
Objectives: There have been no previous studies measuring the prevalence of elder abuse in New Zealand. The aim of this study was to provide an evidence base of the prevalence of elder abuse, some of the populations most affected and the observed impacts of it. Methods: The second wave of the New Zealand Longitudinal Study of Ageing (NZLSA) in 2012 had a national random sample of 2,987 older New Zealanders aged aged between 52 and 86 years, 1,699 of whom were 65 years and older. The Vulnerability to Abuse Screening Scale (VASS) which was developed for the Australian Longitudinal Study of Women's Health as a self-report screening scale for elder abuse was applied. Four sub-scales: vulnerability; dependence; dejection; and coercion, each containing 3 questions, enabled the identification of different types of elder abuse. The responses also enabled the calculation of an evidence based measure of prevalence and a base to apply future projections from. The responses were assessed for associations with gender, marital status and ethnicity and then further tested for statistical associations with a range of health and wellbeing measures, including CASP-12, WHOQoL-8, SF-12 Physical and Mental Health components, CES-D Screening Test for Depression and the De Jong Gierveld Loneliness Scale Findings: The study demonstrated that elder abuse, as measured by VASS, was prevalent for at least 1 in 10 participants aged 65 years and over on each of the four sub-scales. Items concerning psychological abuse were more frequent than those associated with coercion and physical abuse. Women experienced significantly more abuse than men on three subscales, but surprisingly men were significantly more coerced than women. Māori experienced significantly more elder abuse when compared with non-Māori on all four subscales. Divorced, separated and widowed older people experienced a greater level of dejection with sad and lonely feelings, whereas partnered people showed lower levels. Consistent statistical correlations were found between elder abuse and lower levels of health and wellbeing, and higher levels of depression and loneliness. Regression analysis identified the variables most strongly associated with each elder abuse component. Loneliness was the only one very closely associated with all four. An exponential increase in elder abuse was identified using population projection data if nothing is done to reduce it. A 40 percent increase in the decade to 2023 and a 32 percent increase from that enlarged base from 2023 to 2033 was projected. Conclusion: Elder abuse is pervasive in New Zealand, even though the vast majority of elderly people don't experience it. Furthermore it further marginalises people who are already marginalised. The damage to people of elder abuse is consistently negative and costly to health and welfare services as a consequence.
The Gerontologist, 2006
Purpose: This study assessed the extent of different types of abuse, repeated and multiple abuse experiences among women aged 60 and older, and their effects on the women's self-reported health. Design and Methods: A cross-sectional study of a clinical sample of 842 community-dwelling women aged 60 and older completed a telephone survey about type and frequency of abuse, self-reported health status and health conditions, and demographic characteristics. Bivariate and multivariate analyses were performed using SPSS 11.5 and STATA 7.0. Results: Nearly half of the women had experienced at least one type of abuse-psychological/emotional, control, threat, physical, or sexual-since turning 55 years old. Sizable proportions were victims of repeat abuse. Many women experienced multiple types of abuse and experienced abuse often. Abused older women were significantly more likely to report more health conditions than those who were not abused. Women who experienced psychological/emotional abuse-alone, repeatedly, or with other types of abuse-had significantly increased odds of reporting bone or joint problems, digestive problems, depression or anxiety, chronic pain, and high blood pressure or heart problems. Implications: It is important that health care and service providers acknowledge psychological/emotional, control, threat, physical, and sexual abuse against older women and understand their health implications. In addition, it is important for providers to be trained in both aging and domestic violence services and resources.
Development of a Screening Tool for Identifying Elderly People at Risk of Abuse by Their Caregivers
Journal of Aging and Health, 2006
Objective: This study developed and assessed an instrument to identify older people at high risk of abuse based on Reis and Nahmiash's Indicators of Abuse (IOA) screen. Method: A total of 108 people 65 and older, hospitalized in internal medicine departments at two major hospitals in Israel, were screened together with their principal caregivers. The interview was based on the expanded IOA (E-IOA) and a list of evident signs of abuse. Results: Reliability and validity of the E-IOA were tested and confirmed. Indicators proved to be a significant predictor of evident signs of abuse. The E-IOA correctly discerned 92.7% of those at high risk for abuse and 97.9% of those who did not suffer abuse. The main indicators for risk were behavioral problems, emotional problems, and family problems of the caregiver and the elderly person. Fourteen (13%) experienced abuse. Discussion: The proposed assessment tool can be an instrumental guide to identify elderly people who suffer abuse (unidentified) or who are at high risk.
Measuring Older Adults' Abuse: Evaluation of Formative Indicators to Promote Brevity
Educational Gerontology, 2014
Some literature on elder abuse recommends, and practitioners claim, that there should be better assessment and screening tools. In order to improve the accuracy of measurement instruments, the purpose of this article is threefold: (a) describing the construction of an instrument with formative indicators and the survey design about the sensitive topic of elder abuse, (b) development of an analytic strategy to improve the precision of the measures by (c) evaluating the measurement instrument through quality criteria against outcomes of the instrument. We randomly selected 2,880 home-dwelling older women aged 60 and above from five European Union countries who participated in a survey on elder abuse. Prevalence data on abuse against older women was gathered using a postal (BE, FI, PT), face-to-face (BE, LT), and telephone survey (AT) but using an identical instrument. A table with outcome measures was calculated to evaluate the formative indicators of the measurement instrument, and a decision strategy for item reduction was developed. The results suggest that 12 (35%) of the original 34-indicators instrument can be omitted. The adapted version can provide the same elder abuse prevalence rates (reliability) with the same negative associations in terms of life quality There are no conflicts of interest and the views expressed here are those of the researchers and not the European Union. Special thanks are given to the older women in all five countries who participated in the study, for sharing their views and reporting their experiences.
Journal of the American Geriatrics Society, 2000
OBJECTIVES: To assess and compare three types of assessment tools for identifying elder abuse: direct questions to elicit disclosure of abuse if it exists, identification of evident signs of abuse, and assessment of high risk for abuse. DESIGN: Cross-sectional. SETTING: Rambam and Hadassah medical centers, Israel. PARTICIPANTS: Seven hundred thirty persons aged 70 and older hospitalized in general hospitals in 2004/05 and their principal caregivers. MEASUREMENTS: Expanded indicator of abuse (E-IOA) tool, questionnaires looking for evident signs of abuse, and direct experience of abusive behavior. RESULTS: Although 5.9% of respondents disclosed experiencing abusive behaviors, 21.4% were identified with evident signs of abuse, and 32.6% were classified as being at high risk for abuse. More than 70% of those who disclosed abuse were identified with evident signs and were at high risk for abuse. Those who disclosed being abused suffered particularly from physical and sexual abuse. According to logistic regression, higher caregiver subjective burden was a predictor of disclosure (odds ratio (OR) 5 1.81, 95% confidence interval (CI) 5 1.19-2.74), evident signs of abuse (OR 5 1.86, 95% CI 5 1.45-2.35), and high risk of abuse (OR 5 1.55, 95% CI 5 1.27-1.88); heavier objective caregiver load was a predictor of evident signs of abuse (OR 5 1.14, 95% CI 5 1.05-1.24) and of high risk (OR 5 1.18, 95% CI 5 1.06-1.38) only; and respondent functional status was a predictor of evident signs of abuse (OR 5 1.88, 95% CI 5 1.70-2.37). CONCLUSION: The use of the three assessment tools is needed for optimal identification of abuse, whereas assessment for high risk proved an efficient method in the absence of respondent disclosure or professional detection of signs of abuse. Hospitalization provides an excellent opportunity for identifying elderly persons at risk of abuse.
A Comparison of Three Measures of Elder Abuse
Journal of Nursing Scholarship, 2004
Purpose: To present a comparison of three measures for assessing elder abuse. Design and Methods: Three measures for assessing elder abuse were identified through a literature review. The characteristics and uses of each measure were reviewed and evaluated. Findings: The Indicators of Abuse (IOA) is a 22-item tool for discriminating abuse and nonabuse cases; it is completed by a health care professional after a home assessment is conducted. The Elder Abuse and Neglect Assessment (EAI) is a 44-item scale comprised of seven sections to review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment; it can be used by health care providers in all clinical settings. The Elder Abuse Screening Test (EAST) is a 15-item tool to be completed by a health care provider based on the patient's responses. This screening tool is limited because of the small unrepresentative samples used to test it, the low internal consistency, and a relatively high false-negative rate. Conclusions: An instrument to accurately assess elder abuse in long-term care is needed. Proper identification of elder abuse is the first step in assisting victims in dealing with abusive situations.
Validation of the Hwalek-Sengstock elder abuse screening test
Journal of applied …, 1991
Elder abuse is recognized a,. an under-detected and under-reported social problem. Difficulties in detecting elder abuse are compounded by the lack of a standardized, psychometrically valid instrument for case finding. The development of the Hwalek-Sengstoc't Elder Abuse Screening Test (H-S/EAST) followed a larger effort to identify indicators and actual symptoms of elder abuse using a pool of over 1,000 items selected from various elder abuse protocols which were currently being used throughout the United States and Canada. This study examined the construct validity of the 15-item H-S/East. Results of the analyses indicated that 9 of the 15 items of the H-S/EAST significantly discriminated between three groups: (1) elders whose reported abuse was substantiated by Adult Protective Services (APS) caseworkers; (2) elders whose reported abuse was not substantiated by APS workers; and (3) a community-based comparison group. The data suggest that this short, easily administered screening device can be useful to service providers interested in identifying people at high risk of the need for protective services. The H-S/EAST should not be used to predict specific types of abuse or neglect, or to make the final decision about the substantiation of abuse or neglect in any particular case. A positive indication suggests the need for further examination rather than the actual presence of the condition. (AuthorALL)