Detection of maltreatment of people with dementia in Spain: usefulness of the Caregiver Abuse Screen (CASE)

Abstract

The objective of our study is to validate the Caregiver Abuse Screen (CASE) as an instrument for detecting the maltreatment of people with dementia in Spain. In total, 326 informal caregivers of people with different types of dementia were interviewed in several cities in northwest Spain. The caregivers were selected from outpatient neurology clinics and associations of relatives of people with Alzheimer's disease and other dementias. A comprehensive sociodemographic questionnaire was administered to all participants, and several standardized scales were used to assess burden, anxiety, depression, social support and resilience. The "Psychological Aggression" and "Physical Assault" dimensions of the Revised Conflicts Tactics Scale were used as risk factors of caregivers' maltreatment for the construct validation. To establish the probability of maltreatment, a latent class analysis was carried out according to the item responses obtained from the CASE. The internal consistency (Cronbach's alpha) of the CASE was 0.71. The construct validity was explored through factorial analysis, and we found that two dimensions of CASE-i.e., interpersonal abuse and neglect/dependency-explained 62.5% of the variability. According to the latent class probabilities, 20.4% of participants were categorized as possible abusers and 21.4% as non-abusers. The optimal maltreatment cutoff point was six points on the CASE. The validation of the CASE provides us a brief and easy instrument for detecting possible cases of maltreatment of Spanish people with dementia.

Resilience and social support as protective factors against abuse of patients with dementia: A study on family caregivers

“…However, 2 studies of validation have shown that the CASE has adequate psychometric properties to detect risk of abuse in Spanish elders with dementia. 25,46 Second, the CASE emphasizes physical items (excluding emotional or financial forms), and no external resources (eg, hospital records) were available to corroborate the ARB. However, CASE is a well-recognized tool, not only suggestive of different forms of abuse (interpersonal and neglect), but also indicative of stress that could lead to abusive behavior in the future.…”

“…However, CASE is a well-recognized tool, not only suggestive of different forms of abuse (interpersonal and neglect), but also indicative of stress that could lead to abusive behavior in the future. 24,46 Besides, detection of abuse, a hidden phenomenon, remains a challenge itself, and there is no established gold standard for detection.…”

“…Thus, regardless of burden, the resilient caregiver has less probability of abuse, even considering the effect of all covariates. First, the CASE is a brief selfreport measure, and the sensitivity of the information provided may have led to the loss of relevant information and influenced its veracity.However, 2 studies of validation have shown that the CASE has adequate psychometric properties to detect risk of abuse in Spanish elders with dementia 25,46. Further, only some types of social support (eg, social interaction) are effective in highly demanding situations.…”

“…These results are in accordance with the results of other studies, whose findings show that high levels of resilience reduce abusive behavior in the families 44. However, CASE is a well-recognized tool, not only suggestive of different forms of abuse (interpersonal and neglect), but also indicative of stress that could lead to abusive behavior in the future 24,46. When social support is not sufficiently relevant (eg, lack of meaningful support), its effect can disappear due to the mediation effect of other powerful predictors such as burden 45.…”

Caregiver Burden is Reduced by Personalized Social Support for Non-Dependent Old Persons: a Longitudinal Study of 876 Old Persons and Their Caregivers

“…Chronic stress has a negative effect on the caregiver's mental and perceived health (depression, anxiety, psychosomatic and immunological disorders, cardiovascular problems...) and increases the risk of chronic health problems (heart disease, high blood pressure…) and the development of new diseases. In addition, the stress and emotional distress of caregivers has serious consequences for them, in particular their progressive inability to fulfill their role as caregivers, resulting in early institutionalization or unplanned hospitalization of the old person (9) and the risk of abuse or mistreatment for the care recipient, particularly those with dementia and or disruptive behavioral symptoms (10)(11)(12)(13)(14). Because of these consequences for caregivers and at a second level for the care recipient, it is necessary to introduce interventions and support for the caregiver (3,(15)(16)(17).…”