Elder Abuse Assessment Tools and Interventions for use in the Home Environment: a Scoping Review

Figures & data

Figure 1 Flow chart of search strategy for new tools.

Table 1 Assessment Tools for Elder Abuse, Including Eight Tools Based on Gallione, Dal Molin, Cristina, Ferns, Mattioli, Suardi¹³ and Seven New Tools^a

Assessment Tool	Purpose	Phase of the Prevention	Method	Items/Subscales	Target Group	Psychometric Properties
Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST)^Citation22	To identify people at high risk of the need for protective services	Primary prevention	Interview using a questionnaire	5 item questionnaire measuring 3 forms of abuse: violations of personal rights or direct abuse, characteristics of vulnerability, and potentially abusive situations	Service providers	Content, concurrent and construct validity has been established (USA)^Citation61 Reliability is poor with Cronbach’s alpha = 0.29
Vulnerability Abuse Screening Scale (VASS)^Citation23	To identify older women at risk of elder abuse	Primary prevention	Self-report questionnaire	12 item Likert Scale with 4 subscales: Vulnerability Dependence Dejection Coercion	Older women	Content and construct validity has been established (Australia)^Citation23 Reliability: Vulnerability α = 0.45 Dependence α = 0.74 Dejection α = 0.44 Coercion α = 0.31
Elder Abuse Suspicion Index (EASI)^Citation24	To identify victims of elder abuse	Secondary prevention	Interview using a questionnaire	5 patient items (types of abuse, general dependency) + 1 item for evaluation by clinician (observed indicators of abuse). Question with yes/no response format	General practitioner	Correlation between EASI and Social Worker Evaluation (SWE) indicated a sensitivity and specificity rate of 0.47 and 0.75, respectively (Canada)^Citation24
Caregiver Abuse Screen for the Elderly (CASE)^Citation25	To identify abuse of older people by an informal caregiver	Secondary prevention	Self-report questionnaire	8-item to be completed by caregivers. Yes/No response options. The questionnaire was reduced to 6 items to improve validity	Informal caregivers	Good construct, concurrent and convergent validity (Canada) Reliability: α = 0.71 for the 6-item tool^Citation25
Brief Abuse Screen for the Elderly (BASE)^Citation26	To assess the risk of elder abuse	Primary prevention	Telephone interview (followed by home visit and plenary evaluation by multidisciplinary team)	5 questions to be completed by a health professional after training. Evaluation about presence or absence of physical, psychosocial, financial abuse or neglect	Health care professionals	Validity was supported by significant correlations with other measurements and expected differences in the correct direction between abusive and non-abusive caregivers (Canada) Reliability: Cronbach’s alpha = 0.91 Predictive validity from 0.89 to 0.91 ^Citation26,Citation62
Caregiver Psychological Elder Abuse Behavior (CPEAB)^Citation27	To identify psychological abusive behavior by the caregiver	Secondary prevention	Self-report questionnaire	20 items Each item is rated on a 4-point Likert-type scale	Caregiver	Content validity has been established (China).^Citation27 The expert content validity index for the CPEAB was 0.95; Cronbach’s alpha for internal consistency =0.85. The test-retest reliability over a 2-week period was estimated by the intraclass correlation coefficient (ICC=0.64, P<0.001)
Older Adult Abuse Psychological Measure (OAPAM)^Citation28	To identify psychological abuse	Secondary prevention	Self-report questionnaire	31 items (long form) 18 items (short form) Yes/no/suspected/unknown with 5 concepts included: isolation, threats and intimidation, Insensitivity & disrespect, Shaming & blaming, Risk factors	Older people	Construct validity has been established (USA)^Citation28 Reliability Cronbach’s alpha for OAPAM was 0.92 (long form) and 0.87 (short form)
Older Adult Financial Exploitation Measure (OAFEM)^Citation29	To identify financial abuse	Secondary prevention	Interview using a questionnaire	Full form: 79 items Short forms: 54 items and 30 items Dichotomous: yes/no	Social services	Construct validity has been established (USA)^Citation29 Reliability Cronbach’s alpha for OAFEM was 0.96 (full form), 0.95 (54-items) and 0.93 (30-items)
Assessment Tool for Domestic Elder Abuse (ATDEA)^Citation34	Detection and prevention of elder abuse	Primary and secondary prevention	Checklist	34 items (checklist) no scale	Health care professionals	Face and Content validity has been established (Japan)^Citation34 Overall Sale-Content Validity score index was 0.90 No testing of reliability
Risk on Elder Abuse and Mistreatment Instrument (REAMI)^Citation33	To identify people at risk of elder abuse	Primary prevention	Questionnaire	For the professional to evaluate 22 statements whether they apply to their client. Answer categories range from completely disagree (1) to completely agree (4).	Domestic helpers, healthcare professionals, social workers	Internal validity has been established (Belgium). Reliability for the 3 scales very acceptable Risk factors of the older person α = 0.74 Risk factors of the environment/possible perpetrator α = 0.84 Signals of elder abuse α = 0.89
QualCare Scale^Citation35,Citation40	To identify people at risk or experiencing abuse due to caregiver behaviors	Primary and secondary prevention	Direct observational rating scale	QualCare scale measures ‘quality of elder caregiving’. Scale consists of 6 dimensions of caregiving responsibilities: environmental care, physical care, medical care maintenance, psychological care, human rights violations and financial care.	Nurses and social workers	Sensitivity and specificity for each of the 6 QualCare subscales with high sensitivity (≥0.811) but a wide range for specificity (0.167–1.000) (USA)^Citation35 No testing of reliability
Elder Abuse Risk Assessment and Evaluation (EARAE) tool^Citation36	To capture elder abuse indicators, track contributing risk factors, measure multiple case outcomes, and track types of interventions utilized	Primary and secondary prevention	Checklist with abuse indicators	The tool is comprised of 6 sections: client demographics, indicators, contributing risk factors, overall level of risk, interventions, and outcomes. For the abuse indicators, caseworkers review each case, checking off all indicators that apply.	Community-based caseworkers working with older adults	The tool is developed and comprehensive, but only face validity has been established (USA)^Citation36 No testing of reliability
Older Adult Financial Exploitation Measure (OAFEM) Short Form; Older Adult Emotional Abuse Measure (OAEAM) Short Form; Older Adult Physical Abuse Measure (OAPAM) Short Form; Older Adult Neglect Measure (OANM) Short Form^Citation37	Short-form measures to assess four types of elder abuse: financial, emotional/psychological, physical, and neglect.	Secondary prevention	Questionnaire	OAFEM: 11 items OAEAM: 11 items OAPAM: 6 items OANM: 8 items	Adult protection services (APS) caseworkers	All short-form measures appear to be valid for detecting real cases of elder abuse (USA); the AUCs of OAFEM, OAEAM, OAPAM, and OANM were 94.5%, 97.4%, 96.1%, and 95.0%, respectively.^Citation37 Cronbach’s alpha for OAFEM, OAEAM, OAPAM, and OANM were 0.89, 0.88, 0.86, and 0.66, respectively.
Lichtenberg Financial Decision Screening Scale (LFDSS)^Citation38	To assess financial decision making and preventing financial exploitation	Primary and secondary prevention	A structured, multiple—choice interview	7 items are used for an overall risk score	APS workers or other professionals who assist older adults in making significant financial decisions	Evidence for convergent and criterion validity; sensitivity, specificity, and the ROC curve were 0.88, 0.91, and 0.93 for the ordinal scale (USA)^Citation38 Ordinal coefficient alpha: 0.91
Family Members Mistreatment of Older Adults Screening Questionnaire (FAMOASQ)^Citation39	Early identification of the familial mistreatment of older adults	Secondary prevention	Questionnaire to be conducted by means of an interview	15 items with yes/no response format	The FAMOASQ does not need to be administered by an expert or highly trained healthcare professional	Construct and concurrent validity (sensitivity: 86%; specificity: 90%; AUC: 0.93) has been established (Mexico) Cronbach’s alpha: 0.89^Citation39

Note: ^aSeven new tools under triple line.

Table 2 Community-Based Interventions for Elder Abuse, Including Nine Interventions Based on Fearing, Sheppard, McDonald, Beaulieu, Hitzig¹² and Three New Interventions^a

Study	Target Group	Phase of the Prevention	Purpose	Intervention	Results	Level of Evidence ^b
Livingston et al^Citation47	Family caregivers of people with dementia	Primary prevention	To examine the effectiveness of the Strategies for Relatives (START) intervention in reducing anxiety and depression	8-session manual-based individual coping intervention based on the Coping with Caregiver programme	Lower levels of anxiety and depression among family caregivers As a secondary outcome a decrease in abusive behaviour (UK)	1
Cooper et al^Citation45	Family caregivers of people with dementia	Primary prevention (and secondary)	To examine whether reductions in depression and anxiety reduces abusive behavior toward people with dementia	8-session manual-based individual coping intervention (cf. Livingston et al 2013 but with abusive behavior as an outcome); included strategies were: communication, relaxation, behavioral management, etc.	No evidence that START, which reduced caregiver anxiety and depression, reduced caregiver abusive behavior (UK)	1
Drossel et al^Citation46	Family caregivers of people with dementia	Primary prevention	To examine the impact of Dialectical Behavioral Therapy (DBT) on high-risk caregivers for elder abuse	9-week group (2.5 hour sessions) for caregivers of a family member with dementia; included: interpersonal effectiveness, skills in mindfulness, emotional regulation and distress.	Significant effects on problem-focused coping, emotional well-being, and energy level (USA)	4
Alon & Berg-Warman^Citation48	Victims of elder abuse	Secondary/tertiary prevention	To examine the impact of the Israeli multisystem model to treat and prevent elder abuse	Components of the Israeli model: unit dedicated to treatment and prevention of elder abuse; a social work assistant; multidisciplinary advisory team	The model significantly improved outcomes in cases of neglect. In 18% of all cases, the abuse stopped (Israel)	5
Ernst & Smith^Citation51	Persons investigated for abuse	Secondary/tertiary prevention	To examine the difference between a multidisciplinary approach (nurse and social worker) and social worker alone	Multidisciplinary team approach (nurse and social worker) and social worker alone	Social workers alone were more likely to confirm elder abuse. Recidivism rate of re-investigation of abuse was lower for social worker alone The multidisciplinary team yielded the largest risk reduction for abuse (USA)	5
Navarro et al^Citation53	Persons seen by the forensic center (FC) or referred to adult protection services (APS) for alleged financial exploitation	Tertiary intervention	To examine whether an elder abuse FC increases prosecution of elder financial abuse	Multidisciplinary team that includes legal, medical and behavioral experts to review and consult on cases of elder abuse aiming to prevent and protect victims as well as prosecute perpetrators	The FC group was more likely to be referred to the district attorney’s (DA) office (USA)	4
Gassoumis et al^Citation52	Persons who have not received services from the FC and referred to APS	Secondary and tertiary prevention	To examine the role of an elder abuse forensic center in referring financial exploitation abuse victims to conservatorship through the public guardian (PG)	A multidisciplinary team (FC) that includes legal, medical and behavioral experts to review and consult on cases of elder abuse aiming to prevent and protect victims as well as prosecute perpetrators	FC gave more conservatorship referrals to PG compared to APS 52.9% of FC referred cases were conserved, compared to 41.7% APS referred cases Cases of FC investigation were 7x more likely to be referred to PG (USA)	4
Mariam et al^Citation49	Suspected victims of elder abuse and their caregivers	Secondary and tertiary prevention	To examine the effectiveness of the elder abuse intervention and prevention program (E-CARE) in assisting suspected victims of elder abuse	E-CARE is a community based program for elder abuse victims and caregivers to minimize to risk of abuse and to focus on building relationships between older person and caregiver, connecting the older person to social supports and helping people overcome difficult life changes	Decrease in overall risk factors of elder abuse Decrease in abuse risk factors associated with economic and housing, social/community and dependency/isolation (USA)	4
Bagshaw et al^Citation50	Chief executive officers (CEO) and practitioners providing services to older people and their family members	Primary, secondary, tertiary and quaternary prevention	To examine the role of elder mediation in preventing or ending financial abuse in older persons	Mediation that involves an impartial mediator to facilitate communication, listening, sharing and assisting in creating options and planning	Over half stated that mediation prevented or stopped the financial abuse (Australia)	5
Khanlary et al^Citation42	Abused older persons and their families	Secondary prevention	To examine the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse	FBCBSW is a home-based intervention consisting of five sessions focusing on all family members. Topics are: raise awareness about caretaking for older people and on conflict resolution techniques	The intervention had a positive effect on reducing the instances of elder abuse, financial neglect, curtailment of personal autonomy, and psychological abuse (Iran)	2
Pickering et al^Citation43	Social workers and nurses providing in-home services	Secondary prevention	To develop, implement and evaluate a virtual-reality based educational intervention for health care providers to improve recognition and reporting of elder abuse and neglect	The Elder Abuser Training Institute Island (EATI Island) is an interdisciplinary educational intervention including an introductory course as well as an advanced training in virtual reality, focusing on using the QualCare Scale.	The participants made progress in knowledge about identification; in addition, their overall decisions whether to report potential elder abuse had 99% accuracy relative to the gold standard (USA).	5
Ejaz et al^Citation44	Healthcare professionals (e.g. nurses) and social workers	Secondary prevention	To develop and implement an online training to improve identification, reporting, and prevention of abuse, neglect, and exploitation	A online training program comprising three modules (background on abuse, screening for abuse, reporting protocol for cases of abuse).	With respect to Module 1 and 3 there was a statistically improvement in care managers’ knowledge about how to identify and report abuse, neglect, and exploitation (USA).	4

Notes: ^aThree new interventions under triple line. ^bLevels of evidence based on Modified Sackett Scale.⁴⁰ Level 1, RCTs with a PEDro scale ≥6. Level 2, RCTs with a PEDro scale <6. Level 3, case control studies. Level 4, pre–post or post-intervention and case series. Level 5, case reports, clinical consensus, or observational studies.

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