Elder Abuse Workshop: Measurement and Data: Screening Tool Development - Reports from Current Research Projects

Panel Presentations:

Ken Conrad — Conceptualizing and Measuring Financial Exploitation and Psychological Abuse of Elderly Individuals

Goals:

  • Conceptualize the financial exploitation and psychological abuse of elders and develop item banks that represent these constructs.
  • Refine procedures for obtaining sensitive information concerning abuse in the community.
  • Develop new items and refine existing items assessing financial exploitation and psychological abuse.
  • Conduct a full-scale field test.
  • Conduct Rasch (item response theory) analysis.

Study Design:

  • Phase I (completed): Develop construct maps describing financial and psychological abuse and arrange the items in a hierarchical order from most severe to least severe. Develop concept maps for financial and psychological abuse and use these to develop questionnaires.
  • Phase II (completed): Convene professional and consumer focus groups to establish face validity and ease of use, test the interpretation of questions and responses through cognitive interviews, and finalize the measures through review by the Survey Research Lab at the University of Chicago.
  • Phase III (ongoing): Field-test the measures with 200 people with substantiated elder abuse by June 1, 2008. Rasch analysis of results will place items on rulers of severity based on input from clients and staff.

Observations: Measurement is important because measurement quality significantly affects both treatment delivery and research. The strength of concept mapping is that it enables a quantitative and objective analysis of items that were generated by 17 experts in the field of elder abuse. Measurement is the key to opening a field for scientific study. It is by using the items and the hierarchy developed in this study that behaviors can be located on rulers of severity to help with more precise prevalence measurements that lead to more appropriate interventions.

Conclusions: None yet.

Terry Fulmer — Primary Care Clinics for Estimating Prevalence and Incidence of Elder Abuse

Goals: Improve the health and well-being of older adults by detecting and treating elder mistreatment in the areas of physical abuse, psychological abuse and neglect by a person of trust. Primary goals of the study include:

  • Estimate the prevalence of elder mistreatment.
  • Estimate the six-month incidence of elder mistreatment.
  • Compare standardized, valid, reliable instruments (EAI-R and HS-EAST) with a newly developed single-item screening question that was used with domestic violence and captured 51 percent with one item.

Study Design: Enroll 250 participants ages 65+ from primary care clinics who are willing to undergo initial screening and rescreening at six months using the above screening instruments. A-CASI technology will be employed.

Observations: Elder mistreatment is a potentially fatal public health problem that causes human suffering and preventable morbidity and mortality.

Conclusions: Preliminary data: 38 cases, one withdrawal, and 129 refusals. Top reasons for refusal include: not interested, not enough time, ineligible, and did not like the incentive ($10–15 gift card).

Yeates Conwell — Detection of Elder Mistreatment in the Aging Services Network

Goal: To develop a set of tools for the detection of elder mistreatment that is specifically designed for use in the aging services setting.

Study Design:

  • Have instrument development panel develop a preliminary care management-based screening tool (CMEM) to identify elder mistreatment and vet the CMEM by using focus groups and cognitive interviews.
  • Pilot test the preliminary CMEM tool on CM clients (n=13) and EAPP (Elder Abuse Prevention Program) clients weighted toward people identified as mistreated (n=27), and revise the tool based on pilot results.
  • Establish the performance characteristics of the CMEM scale by comparison with LEAD Panel assessments on ES (Elder Source) clients (n=40) and EAPP clients (n=80).

Observations: Work with the Aging Services Network (ASN) to develop a collaborative approach and innovative intervention for older adults with mental disorders. The research addresses the need to step across the boundaries between health and human services. Preliminary empirical work indicates that 30 percent of in-home adults have depressive episodes, some with suicidal ideation. The partnership with ASN in this research is to find a tool to help them detect and intervene more effectively in elder mistreatment with this high-risk population.

Conclusions: None yet.

Discussant, Alex Crosby

Dr. Crosby stated that the funding at the Centers for Disease Control and Prevention (CDC) is lower than middling, but there is much commitment from the CDC to go forward and convince the administrators to allocate resources to elder abuse. CDC does monitoring and surveillance as well as applied research, and this area could benefit from some of the CDC strategies.

Here is what Dr. Crosby said that he heard today:

There is a strong belief that this is a bigger problem than we have been able to measure so far. This pressures us to do more in measuring.

Our definition of elder abuse won't fit all of the disciplines involved in elder mistreatment, and this may offer us an opportunity for consistency. At CDC we know that public health often looks at something in a way very different from criminal justice, and in a way even more different from social services. We need a definition to give us the parameters.

How are we going to measure? How are we going to look at the validity and reliability of our instruments? How do victims define the problem? How do caregivers define it? As we are moving from how we define to how we measure, we need written, standardized definitions, as consistent as possible, across disciplines.

We can get to conceptual models if we understand our ultimate goals and the difference between interventions in the clinical and the community setting.

As we develop our elder mistreatment model, if we take existing models from family violence, we must do pilots to ensure that we are measuring what we think we are measuring.

We must take cultural, ethnic and geographic diversity into account — it will be a challenge to develop a definition of elder mistreatment that accounts for these issues.

We must take lessons from the fields of intimate partner violence and child mistreatment — these fields are decades ahead and can help us move our field ahead that much faster.

Question/Answer/Comment Period:

Dr. Stahl asked whether it is possible to look for a gold standard. Dr. Conrad replied there is no gold standard, but it is possible to develop good, valid measures for things like financial exploitation. One can put all the levels of severity on a yardstick or ruler and validate this as being a measure of this type of exploitation. Dr. Mosqueda suggested that a gold standard for research is necessary, but asked how this translates to policy issues. Dr. Fred Newman observed that it would be preferable to have a gold standard that was accepted across states and disciplines and it may well happen if funding for research continues, but it should be noted that to this day there are not gold standards of medical diagnoses across states, so we are no further behind than general medicine or psychiatry. Ms. Quinn suggested that there is no consistency among states because there are no incentives for legislators, as there is not enough evidence to present to them to make the case that this is a good idea. Dr. Fulmer stated that things must happen that either build on or refute theories. The momentum is to see what constructs continue to make sense. Busy clinicians are looking for one or two salient points to be made in the 10 minutes or so that they have with the patient. Dr. Acierno noted the difference in the approaches of clinicians and epidemiological researchers. Clinicians need to get information in a short time so they wish the gold standard to be narrow, and then if they get an indication of abuse, go deeper. But epidemiologists want the opposite — to cast a wide net with no gold standard for specific questions, but instead have the leeway to ask enough questions to cover all elements and risk factors of the problem in a way that will capture everyone.

Ms. Jane Raymond called for more precision in terminology. She noted that caregivers provide care and suggested that there is a need to recognize that family members are not necessarily caregivers.

Dr. Maggie Baker referred to the unregulated adult family homes in Washington state and pointed out that although there is some overlap with nursing homes, there is a need to consider this population as well.

Date Created: August 11, 2008