Measurement Tools for Elder Abuse and Neglect Essay

Elder Assessment Instrument (EAI) is a 41-item Likert scale instrument which consists of seven sections that reviews signs, symptoms and subjective complaints of elder abuse, neglect, exploitation, and abandonment (Fulmer, 2008, p. 1). The EAI can be used in any clinical setting to detect elder abuse and neglect and is accomplished by a professional such as a caregiver, emergency doctor or practitioner. The seven sections are General Assessment (5 items), Possible Abuse Indicators (7 items), Possible Neglect Indicators (14 items), Possible Exploitation Indicators (6 items), Possible Abandonment Indicators (4 items) and Summary (5 items), each section accompanied with an area for comments and follow-up. The summary section directs the user to indicate the likelihood of the presence of each type of mistreatment. The summary is derived from clinical interpretations of the findings in the previous sections. (Fulmer, et al, 2004; Fulmer, 2008). Permission is given to download a copy of the EAI only for non-profit educational purposes from the website of The Hartford Institute for Geriatric Nursing, College of Nursing, New York University, and only if the Institute is cited as the source. Copy of the instrument can be purchased from the Clearinghouse on Abuse and Neglect of the Elderly (CANE). Indicators of Abuse (IOA) The IOA is a 29-item in-home assessment tool (12 abuse risk items about the caregiver, 15 abuse risk items about the care receiver, and 2 demographic questions) used by professionals to determine incidences of elder abuse. Focusing on mental and psychosocial attributes of both caregiver and care receiver, it examines three dimensions of elder abuse: the intrapersonal problems and issues of the caregiver, interpersonal problems of the caregiver, and support issues and history of abuse of the elder. (Cohen, et al. , 2006, p. 663; University of California at Berkeley, School of Social Welfare – BASSC, 2007, p. 7). Although it is not intended for diagnostic purposes, professionals use the IOA to unreported incidences of elder abuse for timely intervention. Research Findings EAI Revised in 2008, the EAI has been used since the early 1980’s and in health care settings such as in the emergency department (Fulmer, et al, 2000; as cited in Fulmer, 2004) and in an acute hospital setting (Carr, et al, 1986; as cited in Fulmer, 2004). Psychometric results show that the EAI, like other popular screening instruments (the EAI is one of the three most frequently cited elder mistreatment tools), lack evidences of overall validity and reliability as it has not been used in a variety of clinical settings (BASSC, 2007, p. 7), however, it is reported that it has a relatively high internal consistency reliability at 0. 84 (Cronbach’s alpha) and test-retest reliability at 0. 83 (Fulmer, 2008, p. 1) Other psychometric data for EAI show its content validity index at 0. 83, interrater agreement at 0. 83, sensitivity at 71%, and specificity at 93% (Fulmer, et al. , 2004, p. 299). IOA The items of the IOA were evaluated for content and construct validity by a multidisciplinary panel. In the original study conducted by the developers of the instrument and which involved 341 participants results show that the IOA was successful in correctly identifying 84. 4% of abuse cases and 99. 2% of non-abuse cases (Reis and Nahmiash,1998, p. 1). Psychometric studies on the IOA show very high internal consistency of . 91 and . 92 (Cronbach’s alpha). Studies also show divergent, concurrent and construct related evidence of validity as it is able to discriminate abuse from non-abuse (BASSC, 2007, p. 9). Clinical Utility EAI The use of EAI in the emergency department has shown auspicious results in abuse identification and reporting (Fulmer, et al. , 2004, p. 299). Although the EAI meets practicality concerns because it can be administered only from 12-15 minutes, it is reported to be weak on scoring system and specificity (Fulmer, et al; 2004). The EAI is expected to be more advantageous than open-ended instruments that are time-consuming. Another strength of the EAI is that it able to make the clinician more sensitive to screening for elder mistreatment and be more receptive to abuse indicators (Fulmer, 2004; Fulmer, 2008). IOA The IOA is an effective tool in identifying abuse risk even before it is reported allowing for timely and exigent intervention (Cohen, et al. , 2006, p. 663). Data show that its use in health and social services organizations has led to the identification of 78% to 84% abuse cases (Wolf, 2000; as cited in Fulmer, et al. , 2004, p. 299). One limitation of the tool however is that it is a subjective evaluation focusing only on indicators (Cohen, et al. , 2006, p. 664). Since it is administered through open clinical interview, differences in interview and evaluation skills of the administrators may pose discrepancies in observations (Cohen, et al. , 2006, p. 664). Another weakness is that it takes around two to three hours to finish the assessment. Because of its length, Fulmer, et al. (2004) assert that the IOA is appropriate for research studies but may pose difficulties in medical and social service settings. Conclusion Both EAI and the E-IOA are clear about the type of risk being assessed, e. g. risk to a victim’s well-being and safety, hence, they are good instruments to be administered in nursing facilities. Elderly people are very vulnerable to abuse and neglect not only by their families. It has also been found out that elder mistreatment could also happen in nursing facilities. It is reported that nurses and caregivers sometimes are the perpetrators of the abuse ((McLafferty & Morrison, 2004; Nahmiash and Reis; 2000). Other instruments that measure elder abuse and neglect are the following: 1. Conflict Tactics Scale (CTS) 2. Brief Abuse Screen for the Elderly (BASE) 3. Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) 4. Based on the list an aggregate list of instruments that could screen or measure elderly neglect, the following are also being considered for inclusion in my study: References Cohen, M. , et al. (2006). Development of a screening tool for identifying elderly people at risk of abuse by their caregivers. The Journal of Aging and Health. 18: 660-686. Retrieve September 25, 2008 from http://jah. sagepub. com/cgi/content/abstract/18/5/660. University of California at Berkeley, School of Social Welfare (BASSC). (2007). Instruments for assessing elder mistreatment: implications for adult protective services. Evidence for Practice: An Executive Summary, No. 9, Sept 2007. Retrieved March 9, 2009 from, http://cssr. berkeley. edu/research_units/bassc/documents/C61602_9_web. pdf. Fulmer, T. (2008). Elder mistreatment assessment. The Hartford Institute for Geriatric Nursing. No. 15, Retrieved September 28, 2008 from, http://www. hartfordign. org/publications/trythis/issue15. pdf. Fulmer, T. , et al. (2004). Progress in elder abuse screening and assessment instruments. Journal of the American Geriatrics Society. Vol 52, No 2. Retrieved September 25, 2008 from http://jah. sagepub. com/cgi/content/abstract/18/5/660.. McLafferty, I. and Morrison, F. (2004). Attitudes towards hospitalized older adults.