Reliability of the longitudinal experts all data (LEAD) methodology for determining the presence of elder mistreatment.

Developing reliable screening tools to identify elder mistreatment requires an accurate and reproducible reference standard. This study sought to investigate the reliability of the Longitudinal, Experts, All Data (LEAD) methodology as a reference standard in confirming presence of elder mistreatment. We analyzed data from a large, emergency department-based study that used a LEAD panel to determine the reference standard. For this study, a second, blinded LEAD panel reviewed clinical material for 40 patients. For each panel, five content experts voted on whether elder mistreatment was present. We found moderate agreement between the two LEAD panels in determining presence of elder mistreatment: 85% agreement; k = 0.58; 95% Confidence Interval 0.28-0.87. Individual raters for both LEAD panels reported being mostly certain or certain >90% of votes. Efforts to further characterize and improve the reliability of the LEAD methodology in this context are warranted.

Identifying gaps and improving investigation of fatal elder abuse and/or neglect.

Death investigator and autopsy reports for decedents 65 years and older within a major metropolitan area over a five-year period were assessed for the possibility of elder abuse and/or neglect. The study consisted of two stages. A simple two-question screening criteria was used to determine whether the decedent was (1) dependent on another for at least one activity of daily living and (2) had a presence of at least one indicator of abuse and/or neglect. Second, only cases with affirmative criteria responses were reviewed to identify inconsistent or deficient variables that precluded (or if present, allowed) determination of abuse and/or neglect. A multidisciplinary panel of local and national experts, including forensic pathologists, law enforcement, and geriatricians assessed these indicators as indicative of presence of abuse/neglect, and these indicators were subsequently developed as a supplemental data collection tool. Of a possible 2798 cases, 2324 (83%) were excluded using the screening criteria. This reduced the number of cases that warranted further investigation to 474 (17% of elderly deaths in this timeframe). All 474 decedents were dependent on another for at least one ADL and 322 (68%) had unexplained injuries. In 180 (38%) cases had recorded notation of a suspicion of abuse and/or neglect at the time of death. The results support the premise that a simple, two-criterion screening can effectively identify cases of potential abuse and/or neglect and, when followed by a supplemental data collection tool, cases can be efficiently evaluated.

Maltrato financiero a los adultos mayores. Policlínico "Carlos Manuel Portuondo", La Habana / Financial abuse of the elderly. "Carlos Manuel Portuondo" Polyclinic, Havana

Introducción: El envejecimiento poblacional impone complejos retos a la familia cubana. Uno de ellos es el maltrato financiero a los adultos mayores, tema insuficientemente abordado. Objetivos: Determinar la presencia de maltrato financiero en los adultos mayores, así como sus características. Material y Métodos: Se llevó a cabo un estudio descriptivo transversal que incluyó a 175 adultos mayores de 60 años del policlínico Carlos Manuel Portuondo, entre enero y diciembre de 2018. Resultados: Se identificó maltrato financiero en 53.1 por ciento de los adultos mayores. Entre estos, predominó el sexo femenino, las edades entre 70 y 79 años, el padecer al menos una enfermedad crónica no transmisible, los viudos y jubilados. Las principales manifestaciones de maltrato reportadas fueron los préstamos sin devolución, las compras no autorizadas, negación de acceso al dinero propio y la presión para realizar trámites legales. Fueron los hijos los señalados como maltratadores con más frecuencia. Imperó además el sexo femenino, las edades entre 40 y 59 años, el nivel secundario de escolarización, los divorciados, las amas de casa. La mayoría tenía más de una persona a su cargo, no recibe ayuda económica externa y refirió antecedentes de atención por Salud Mental, mayormente debido a trastornos depresivo-ansiosos. Conclusiones: Se identificó la presencia de maltrato financiero en las personas mayores estudiadas, sus características, así como las de los presuntos maltratadores. Esta forma de violencia, a pesar de ser una de las menos abordadas, afecta a la población anciana y puede constituir un problema de salud(AU)

Introduction: Population aging imposes complex challenges to the Cuban family. One of them is financial abuse of the elderly, an issue that has been insufficiently addressed. Objectives: To determine the presence of financial abuse of the elderly as well as its characteristics. Material and Methods: A cross-sectional descriptive study that included 175 adults older than 60 years attended at Carlos Manuel Portuondo polyclinic was carried out between January and December 2018. Results: Financial abuse was identified in 53.1percent of the elderly. Female sex, ages between 70 and 79 years, having at least one chronic non-communicable disease, widows and retirees predominated among them. The main manifestations of mistreatment reported were loans without refund, unauthorized purchases, denial of access to their own money and pressure to perform legal proceedings. The progenies were identified as the most frequent abusers. There was a prevalence of the female sex, ages between 40 and 59 years old, secondary level of education, divorced people, and housewives. Most of them had more than one person under their care, received no external financial help and reported a history of mental health care mainly due to depressive/anxious disorders. Conclusions: Financial abuse was identified in the elderly studied. This form of violence, despite being one of the least addressed, affects the elderly population and constitutes a health problem(AU)

Competências dos médicos no atendimento a idosos em situação de violência: revisão de escopo / Doctors' competences in caring for older people in situations of violence: scope review

Resumo Objetivo descrever, por meio das evidências da literatura, as competências dos médicos de serviços hospitalares diante de situações de violência contra a pessoa idosa (VCPI). Método revisão de escopo com busca em bases de dados/plataformas/buscadores e literatura cinzenta abrangendo Medline; BVS; Embase; CINAHL; Web of Science; BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal e Theses Canada Portal (catálogos Aurora e Voilà). Os descritores e palavras-chave utilizados, combinados com os operadores booleanos OR, AND e NOT, foram: "Physicians", "Médicos", "Atitude", "Attitude", "Conhecimento", "Knowledge", "Behavior", "Atendimento Médico", "Cuidados Médicos", "Medical Care", "Serviços Hospitalares", "Hospital Services", "Hospital", "Hospitalists", "Médicos Hospitalares", "Maus-Tratos ao Idoso", "Elder Abuse", "Physical Abuse", "Elder Neglect", "Aged Abuse", "Elder Mistreatment". Resultados seis trabalhos foram selecionados. Evidenciou-se falta de conhecimento sobre o tema e a abordagem, e de treinamento específico. Quanto às habilidades, os achados que mais levaram os médicos a suspeitarem de abuso foram achados físicos ligados à aparência, higiene e lesões - problemas de comunicação e relacionamento foram pouco apontados. Na atitude houve pesquisa de abusos em apenas 44% das suspeitas e percentuais baixos ou nulos de denúncia de casos. Apenas um estudo explorou a atitude frente às negligências, onde 24,8% relataram aos serviços sociais e 21,3% informaram à polícia. Conclusão a maioria dos casos de VCPI continua não percebida e, consequentemente, não reportada ou manejada. Há múltiplos problemas quanto às competências dos médicos hospitalares ao abordarem tais situações, cenário que expõe a demanda por medidas de sensibilização, capacitação e incentivo ao adequado enfrentamento da VCPI.

Abstract Objective describing by means of the evidence in the literature, the competences of doctors in hospital services in situations of violence against older people (VAOP). Method scope review with search in databases/platforms/searchers and grey literature covering Medline; VHL; Embase; CINAHL; Web of Science; BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal and Theses Canada Portal (Aurora and Voilà catalogs). The descriptors and keywords used, combined with the Boolean operators OR, AND, NOT were: "Physicians", "Doctors", "Attitude", "Attitude", "Knowledge", "Knowledge", "Behavior", "Medical Care", "Medical Care", "Medical Care", "Hospital Services", "Hospital Services", "Hospital", "Hospitalists", "Hospital Doctors", "Older People Abuse", "Older People Abuse", "Physical Abuse", "Older People Neglect ", "Aged Abuse", "Older People Mistreatment". Results six papers were selected. There was a lack of knowledge on the topic and the approach, and of specific training. As for skills, the findings that most led doctors to suspect abuse were physical findings linked to appearance, hygiene and injuries - communication and relationship problems were little mentioned. In the attitude, there was a research of abuse in only 44% of the suspicions and low or null percentages on case reporting. Only one study explored the attitude towards negligence, where 24.8% reported to social services and 21.3% informed the police. Conclusion most cases of VAOP remain unnoticed and therefore unreported or unhandled. There are multiple problems regarding the competences of hospital doctors when dealing with such situations, a scenario that exposes the demand for measures to raise awareness, training, and encouragement to adequately deal with VAOP.

Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol.

INTRODUCTION: Elder mistreatment (EM) is a high prevalence threat to the health and well-being of older adults in the USA. Medics are well-positioned to help with identification of older adults at risk for EM, however, field robust screening tools appropriate for efficient, observation-based screening are lacking. Prior work by this team focused on the development and initial pilot testing of an observation-based EM screening tool named detection of elder abuse through emergency care technicians (DETECT), designed to be implemented by medics during the course of an emergency response (911) call. The objective of the present work is to validate and further refine this tool in preparation for clinical dissemination. METHODS AND ANALYSIS: Approximately 59 400 community-dwelling older adults who place 911 calls during the 36-month study observation period will be screened by medics responding to the call using the DETECT tool. Next, a random subsample of 2520 of the 59 400 older adults screened will be selected to participate in a follow-up interview approximately 2 weeks following the completion of the screening. Follow-up interviews will consist of a medic-led semistructured interview designed to assess the older adult's likelihood of abuse exposure, physical/mental health status, cognitive functioning, and to systematically evaluate the quality and condition of their physical and social living environment. The data from 25% (n=648) of these follow-up interviews will be presented to a longitudinal, experts and all data panel for a final determination of EM exposure status, representing the closest proxy to a 'gold standard' measure available. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas School of Public Health. The results will be disseminated through formal presentations at local, national and international conferences and through publication in peer-reviewed scientific journals.

Screening for elder mistreatment in emergency departments: current progress and recommendations for next steps.

Emergency Department (ED) visits provide an important but seldom realized opportunity to identify elder mistreatment. Many screening tools exist, including several that are brief and may be effective, but few have been specifically designed for or tested in EDs. In addition to the absence of validated tools, other challenges with implementing ED elder mistreatment screening include difficulty integrating anything longer than a few questions into a busy clinical encounter and resources required to respond to positive screens. The Electronic Health Record (EHR) offers a critical tool to facilitate elder mistreatment screening through required data entry and real-time monitoring of compliance and results. We describe current work in the field and recommend next steps including design and testing of a two-step screening process, implementation research to accelerate adoption, development of ED-based interventions and referral protocols for positive cases, and consideration of the important role of pre-hospital providers in case identification.

Screening for elder abuse in geriatric outpatients: reliability and validity of the Iranian version Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).

The present research seeks the notion of the appropriateness of "Hwalek-Sengstock Elder Abuse Screening Test (H-S/East)", and psychometric properties to analyses cultural aspects of elder abuse in the Iranian community dwellers referred to clinics. In this cross-sectional validation study 364 participants, 60 years and over were selected from outpatient' clinics. The SF-36, GDS-15, and AMT scores were used for concurrent validity. The Brief Abuse Screen for the Elderly (BASE) scale was examined to determine the sensitivity and specificity of the Iranian version H-S/East. The elder abuse rate in participants was 29.4% based on cutoff ≥4, while a significant correlation was found in Iranian version H-S/EAST with depression and SF-36 subscale MCS at P < .01, and four factors observed. Optimal cutoff ≥4 obtained with 82.8% sensitivity and 84.5% specificity. It seems the Iranian version of H-S/East demonstrates concurrent validity and fair reliability in elderly outpatients, while construct validity should be carried out in the Iranian elder illiterate population and other languages/cultures.

Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review.

This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.

Developing the Emergency Department Elder Mistreatment Assessment Tool for Social Workers Using a Modified Delphi Technique.

Elder mistreatment is common and has serious consequences. The emergency department (ED) may provide a unique opportunity to detect this mistreatment, with social workers often asked to take the lead in assessment and intervention. Despite this, social workers may feel ill-equipped to conduct assessments for potential mistreatment, due in part to a lack of education and training. As a result, the authors created the Emergency Department Elder Mistreatment Assessment Tool for Social Workers (ED-EMATS) using a multiphase, modified Delphi technique with a national group of experts. This tool consists of both an initial and comprehensive component, with 11 and 17 items, respectively. To our knowledge, this represents the first elder abuse assessment tool for social workers designed specifically for use in the ED. The hope is that the ED-EMATS will increase the confidence of ED social workers in assessing for elder mistreatment and help ensure standardization between professionals.

Developing the Geriatric Injury Documentation Tool (Geri-IDT) to Improve Documentation of Physical Findings in Injured Older Adults.

BACKGROUND: Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse. OBJECTIVE: To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice. DESIGN: Two-phase, exploratory qualitative study. Phase 1: individual interviews with elder abuse experts from various specialties in medicine and criminal justice. Phase 2: focus groups with anticipated end users of the tool. PARTICIPANTS: Phase 1 telephone-based key informant interviews were conducted with 11 elder abuse experts (2 detectives, 3 prosecutors, 1 forensic pathologist, 2 geriatricians, and 3 emergency medicine physicians). Phase 2 focus groups were conducted among emergency medicine (n = 10) and primary care (n = 8) providers. APPROACH: Key informant interviews were conducted telephonically while the two focus groups were held in-person at an emergency medicine site in New York, NY, and a primary care site in Los Angeles, CA. KEY RESULTS: Experts agreed that medical providers' documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records. CONCLUSION: A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome.

Pilot testing the detection of elder abuse through emergency care technicians (DETECT) screening tool: results from the DETECT pilot project.

OBJECTIVE: To pilot test the feasibility of implementing an elder abuse (EA) screening tool (DETECT) designed for medics. METHODS: Testing occurred between September 17th, 2015 and October 26th, 2015. MedStar Mobile Healthcare medics completed the DETECT tool when responding to calls for community-dwelling patients 65 years of age or older. RESULTS: The DETECT tool was used 1,248 times by 97% of medics responding to an eligible 911 call. Medics responded affirmatively to at least one screening item on 209 of the completed screenings (16.8%). Immediately following the introduction of the DETECT tool, there was an increase of 5.4 (226% above baseline) reports per month (p = 0.0056). CONCLUSIONS: The DETECT tool was easily incorporated into medic's field-based practice and resulted in an increase in medic generated reports of EA to APS. Future research designed to evaluate the tool's validity and reliability are warranted.

Development and Validity Testing of an Assessment Tool for Domestic Elder Abuse.

BACKGROUND: The older adult population is increasing in number, and elder abuse is expected to become a more pressing problem. Developing tools to assess the presence and severity of elder abuse is important to both effectively prevent this abuse and provide increased support for families. PURPOSE: This study was intended to test the validity of an Assessment Tool for Domestic Elder Abuse (ATDEA). The items that constitute this tool were derived from a literature review. METHODS: Two rounds of self-administered questionnaire surveys were conducted with nurses working at home-visit nursing stations. Round 1 was used to evaluate the face validity, and Round 2 was used to test the content using the content validity index (CVI). RESULTS: Two hundred forty nurses participated in the two studies. In Round 1, 56 nurses evaluated 38 items derived from a literature review, resulting in the development of a 36-item ATDEA. In Round 2, 184 nurses evaluated the content validity of the 36-item ATDEA. The Item-CVI (I-CVI) scores ranged from .61 to 1. Twenty-eight of the items met or exceeded the I-CVI threshold of .78, whereas the eight items assessing self-neglect did not. The overall Scale-CVI score for the assessment tool was .90, which met the threshold of .90. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of validity testing established the preliminary validity of this assessment tool. In addition, as self-neglect is known to damage the well-being of older adults, six of the eight items assessing self-neglect were retained in the ATDEA despite their failure to meet the threshold I-CVI of .78. The remaining two self-neglect items were not included in the ATDEA because of excessively low I-CVI scores (< .70). Thus, the final version of the ATDEA includes 34 items. The authors recommend that nursing professionals use the ATDEA as a checklist to assess the presence of elder abuse and to discern the subtypes and severity of this abuse. When evaluating elder abuse, the higher the degree of severity, the greater the urgency to provide support.

Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Intimate partner violence (IPV), elder abuse, and abuse of vulnerable adults are common and result in adverse health outcomes. Objective: To review the evidence on screening and interventions for IPV, elder abuse, and abuse of vulnerable adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through October 4, 2017; references; experts; literature surveillance through August 1, 2018. Study Selection: English-language randomized clinical trials (RCTs), studies evaluating test accuracy, and cohort studies with a concurrent control group assessing harms. Data Extraction and Synthesis: Dual review of titles and abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled, primarily because of heterogeneity of populations, interventions, and outcomes. Main Outcomes and Measures: Abuse or neglect, morbidity caused by abuse, test accuracy, and harms. Results: Thirty studies were included (N = 14 959). Three RCTs (n = 3759) compared IPV screening with no screening; none found significant improvements in outcomes (eg, IPV or quality of life) over 3 to 18 months and 2 (n = 935) reported no harms of screening. Nine studies assessed tools to detect any past-year or current IPV in women; for past-year IPV (5 studies [n = 6331]), sensitivity of 5 tools ranged from 65% to 87% and specificity ranged from 80% to 95%. The accuracy of 5 tools (4 studies [n = 1795]) for detecting current abuse varied widely; sensitivity ranged from 46% to 94% and specificity ranged from 38% to 95%. Eleven RCTs (n = 6740) evaluated interventions for women with screen-detected IPV. Two enrolling pregnant women (n = 575) found significantly less IPV among women in the intervention group: 1 home visiting intervention (standardized mean difference [SMD], -0.34 [95% CI, -0.59 to -0.08]) and 1 behavioral counseling intervention for multiple risks (IPV, smoking, depression, tobacco exposure) (SMD, -0.40 [95% CI, -0.68 to -0.12]). No studies evaluated screening or interventions for elder abuse or abuse of vulnerable adults. One study assessing a screening tool for elder abuse had poor accuracy (sensitivity, 46% and specificity, 73% for detecting physical or verbal abuse). Conclusions and Relevance: Although available screening tools may reasonably identify women experiencing IPV, trials of IPV screening in adult women did not show a reduction in IPV or improvement in quality of life over 3 to 18 months. Limited evidence suggested that home visiting and behavioral counseling interventions that address multiple risk factors may lead to reduced IPV among pregnant or postpartum women. No studies assessed screening or treatment for elder abuse and abuse of vulnerable adults.

Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement.

Importance: Intimate partner violence (IPV) and abuse of older or vulnerable adults are common in the United States but often remain undetected. In addition to the immediate effects of IPV, such as injury and death, there are other health consequences, many with long-term effects, including development of mental health conditions such as depression, posttraumatic stress disorder, anxiety disorders, substance abuse, and suicidal behavior; sexually transmitted infections; unintended pregnancy; and chronic pain and other disabilities. Long-term negative health effects from elder abuse include death, higher risk of nursing home placement, and adverse psychological consequences. Objective: To update the US Preventive Services Task Force (USPSTF) 2013 recommendation on screening for IPV, elder abuse, and abuse of vulnerable adults. Evidence Review: The USPSTF commissioned a review of the evidence on screening for IPV in adolescents, women, and men; for elder abuse; and for abuse of vulnerable adults. Findings: The USPSTF concludes with moderate certainty that screening for IPV in women of reproductive age and providing or referring women who screen positive to ongoing support services has a moderate net benefit. There is adequate evidence that available screening instruments can identify IPV in women. The evidence does not support the effectiveness of brief interventions or the provision of information about referral options in the absence of ongoing supportive intervention components. The evidence demonstrating benefit of ongoing support services is predominantly found in studies of pregnant or postpartum women. The benefits and harms of screening for elder abuse and abuse of vulnerable adults are uncertain, and the balance of benefits and harms cannot be determined. Conclusions and Recommendation: The USPSTF recommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults. (I statement).

Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention. / Violência contra idosos: concepções dos profissionais de enfermagem acerca da detecção e prevenção.

OBJECTIVE: To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly. METHODS: Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed. RESULTS: Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context. FINAL CONSIDERATIONS: There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool.

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71-100%) and 90% (95% CI 85-93%), respectively. These results inform a proposed screening tool for multisite validation testing.

Elder abuse: The role of general practitioners in community-based screening and multidisciplinary action

BACKGROUND: There are growing calls for elder abuse screening to be conducted by a range of community-based service providers, including general practitioners (GPs), practice nurses, home care workers and lawyers. Improved screening may be a valuable first step towards improving elder abuse detection and response; however, practitioners need evidence-based strategies for screening and follow-up. OBJECTIVE: This article summarises several brief screening tools for various forms of elder abuse. Screening tool properties and evidence gaps are noted. As elder abuse often requires multidisciplinary responses, initiatives to connect health, legal and other service providers are highlighted. DISCUSSION: GPs are trusted professionals who are well placed to identify older patients at risk of, or experiencing, various forms of abuse. They should be aware of available screening tools and consider how best to incorporate them into their own practice. They also play an important role in multidisciplinary action to address elder abuse.

Development and validation of a Screening Questionnaire of Family Mistreatment against Older Adults for use in primary care settings in Mexico.

The abuse of older adults is a serious public health issue that can be difficult to identify at the first level of care. Medical and nursing personnel are sometimes unable to identify older adults who suffer family mistreatment. This can occur when victims feel shame or as a result of cultural factors. In the light of this, healthcare personnel require a screening tool that can be used to identify signs of mistreatment. The aim of this study was to develop and validate a screening tool for detecting the familial mistreatment of older adults in primary care settings. A mixed method cross-sectional study was carried out in three phases between 2009 and 2012 in Mexico. The formative phase involved using a qualitative methodology to identify terms that older adults use to identify practices defined as forms of mistreatment. On this basis, the second phase involved the design of a screening tool through the formation of items in collaboration with a panel of experts. These items were tested on older adults to ensure their intelligibility. Finally, validity and reliability levels were evaluated through the application of the screening tool to a sample of older adults at a primary care facility and at a legal centre. These findings were discussed with gerontologists, and the data were analysed through an exploratory factor analysis with orthogonal rotation and Cronbach's alpha using STATA v13. From the results, we generated a screening tool that is culturally and socially tailored to older adults in Mexico. The tool has a Cronbach's alpha of 0.89, a sensitivity value of 86% (p < .05) and a specificity value of 90% (p < .05) for positive answers to the tool's 15 items. Applying this tool at the first level of care could limit damage to older adults' health and could lower the frequency of emergency room use in hospitals.