Home and Community Care Digest
Methods: The proposed screening method was constructed using a population of 22 non-hospitalized elderly where presence of abuse was known and then tested for reliability in a new population recruited from two major Israeli hospitals. One hundred and eight caregiver-care recipient pairs agreed to participate. Participants had to be Hebrew-speaking, over the age of 65, and mentally able to communicate with interviewers. All caregivers in the sample were blood relatives of the elderly care recipient. To determine the risk of abuse, interviews lasting approximately two hours in total were conducted by social workers with the caregivers and care recipients separately, and were based on a 27- question screening tool called the Expanded Indicators of Abuse (E-IOA). A second interview and physical assessment was conducted by hospital nurses with the care recipient to determine the likelihood that abuse was present. The results were then analyzed to determine the extent to which the measured risk of abuse predicted the likelihood that abuse in fact took place, and which risk factors had the strongest predictive power.
Findings: Of the 108 participants in the main study, 14 showed evidence of abuse. The E-IOA tool identified 13 of these 14 (92.9%) as at high risk of abuse. Among the 94 remaining that probably did not suffer abuse, the E-IOA identified 93 (97.9%) as low risk. The most important indicators of abuse from the 27-question tool related to the caregiver's behavioural (e.g. outbursts and conflicts), emotional (e.g. helplessness, irritability), and family problems. Also important were a blaming attitude on the part of the care recipient, as well as the caregiver's ability (e.g. understanding of the nature of the required treatment) and financial situation.
Conclusions: The results of this study suggest that caregiver traits are the principal indicators of high risk of caregiver-care recipient abuse. The apparent accuracy of the screening tool indicates the potential for a systematic assessment of risk of abuse in caregiver-care recipient relationships. In Ontario - and universally - informal caregivers are a critical contributor to the health development of the elderly, both positively and negatively. Comprehensive and effective formal care programs need to take into account the nature of the caregiving relationship and to possibly intervene where necessary. The tool introduced in this study would require testing in a Canadian setting. Should such testing confirm the accuracy found in this study, the screen could help health organizations and professionals to effectively target potential interventions to the benefit of caregivers and care recipients alike.
Reference: Cohen M, Halevi-Levin S, Gagin R, Friedman G. "Development of a Screening Tool for Identifying Elderly People at Risk of Abuse by Their Caregivers." Journal of Aging and Health. 2006;18(5):660-85.
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