Adapting the Elder Abuse Suspicion Index© for Use in Long-Term Care: A Mixed-Methods Approach

Abstract

Currently available elder abuse screening and identification tools have limitations for use in long-term care (LTC). This mixed-methods study sought to explore the appropriateness of using the Elder Abuse Suspicion Index© (a suspicion tool originally created for use with older adults in the ambulatory setting with Mini-Mental State Examination scores ≥ 24) with similarly cognitively functioning persons residing in LTC. Results were informed by a literature review, Internet-based consultations with elder abuse experts across Canada ( n = 19), and data obtained from two purposively selected focus groups ( n = 7 local elder abuse experts; n = 7 experienced front-line LTC clinicians). Analyses resulted in the development of a nine-question tool, the EASI-ltc, designed to raise suspicion of EA in cognitively intact older adults residing in LTC (with little or no cognitive impairment). Notable modifications to the original Elder Abuse Suspicion Index

Validation of REAGERA-S: a new self-administered instrument to identify elder abuse and lifetime experiences of abuse in hospitalized older adults

“…The WHO definition does not require the caregiver's intention to abuse which is suggested by the words "prevent" and "refuse". This is consistent with the development of the long-term care version of EASI, where a similar adjustment was made after discussion in focus groups (Ballard, Yaffe, August, Cetin-Sahin, & Wilchesky, 2019). This mitigation is further supported by the low sensitivity of 4% on the very similar question from EASI: "Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids or medical care, or from being with people you wanted to be with?"…”

Development and psychometric properties of the hospitalized elder abuse questionnaire (HEAQ): a mixed methods study

“…Moreover, the tools were not comprehensive as they only addressed one aspect of EA. Little has been published on the psychometric properties of these tools and thus there is still a lack of appropriate diagnostic tools dedicated to screening EA in various care facilities [ 36 ]. Except for the EPAS, other tools were designed and developed based on a review of the available literature, whereas the questionnaire in our study was developed using the inductive-deductive method.…”

“…Kottwitz and Bowling developed the Elder Abuse Questionnaire (EAQ) and piloted it among the residents and personnel of a long-term care facility [78]. Ballard and colleagues (2017) developed a 9-item questionnaire called Elder Abuse Suspicion Index for Use in Long-Term Care (EASI-ltc) [36] and Hsieh et al, (2009) developed and examined the Caregiver Psychological Elder Abuse Behavior Scale (CPEAB) [79]. However, these tools were merely designed to examine abuse from the perspective of healthcare personnel or family caregivers rather than from the perspective of the elderly themselves.…”

“…Due to the lack of a comprehensive screening tool, there are only limited studies on the identification of EA and its prevalence at long-term care institutions. As a direct result, the extent of institutional abuse has not been fully understood [ 36 ]. It is therefore essential to develop valid and reliable tools to address this issue and gain a better understanding of institutional EA.…”