The process of validation of a three-dimensional model for the identification of abuse in older adults

Professional screening for abuse among older persons has been suggested as an efficient way to reach more individuals who are experiencing abuse, but effective screening depends on the use of succinct, structured and validated tools. The aim of the paper is to describe a process of constructing and validating a three-dimensional screening tool for identification of abuse in older persons. It describes four studies that were conducted in the process of development and assessment of a three-dimensional screening tool for identification of abuse that consisted of direct questioning, identification of risk indicators and identification of signs of abuse. The study participants were, respectively, 108, 730 and 1317 community-dwelling individuals, aged ≥65, cognitively intact, and 71 residents of long-term care facilities. Questionnaires included the three dimensional tool for identification of abuse, Expanded Indicators of Abuse (E-IOA), list of signs of abuse, direct questioning for disclosure of abuse, and personal, medical and functioning details. Discriminant function analyses (DFA) and receiver-operating curve (ROC) analyses in each of the described steps showed good psychometric properties of the risk indicators. Regression analyses adjusted for socio-demographic and health variables showed that risk indicators significantly increased likelihood of abuse in individuals living in the community and in long-term care facilities. The three dimensions of identification of abuse were partially overlapped in their identification of different rates of abuse. In conclusion, the three-dimensional identification tool is efficient for identifying older adults experiencing abuse or at risk of abuse.