The design and evaluation of psychometric properties for a questionnaire on elderly abuse by family caregivers among older adults on hemodialysis

ERASE: a feasible early warning tool for elder abuse, developed for use in the Dutch emergency department

BACKGROUND

Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE) in the emergency department (ED) setting. ERASE is an early warning tool for elder abuse self-administered by the healthcare professional in patients ≥ 70 years.

METHODS

A systematic literature review was previously conducted to identify potential available instruments on elder abuse for use in the ED. Furthermore, a field consultation in Dutch hospitals was performed to identify practice tools and potential questions on the recognition of elder abuse that were available in clinical practice. Based on this input, in three subsequent rounds the ERASE tool was developed. The ERASE tool was tested in a pilot feasibility study in healthcare professionals (n = 28) working in the ED in three Dutch hospitals. A semi-structured online questionnaire was used to determine acceptability and appropriateness of the ERASE tool.

RESULTS

The systematic literature review revealed seven screening instruments developed for use in the hospital and/or ED setting. In total n = 32 (44%) hospitals responded to the field search. No suitable and validated instruments for the detection of elder abuse in the ED were identified. The ERASE tool was developed, with a gut feeling awareness question, that encompassed all forms of elder abuse as starting question. Subsequently six signalling questions were developed to collect information on observed signs and symptoms of elder abuse and neglect. The pilot study showed that the ERASE tool raised the recognition of healthcare professionals for elder abuse. The tool was evaluated acceptable and appropriate for use in the ED setting.

CONCLUSIONS

ERASE as early warning tool is guided by an initial gut feeling awareness question and six signalling questions. The ERASE tool raised the recognition of healthcare professionals for elder abuse, and was feasible to use in the ED setting. The next step will be to investigate the reliability and validity of the ERASE early warning tool.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.

Structural equation model of affecting factors on elder abuse to patients under hemodialysis by family caregivers

BACKGROUND

The objectives of the present study were to determine the prevalence of older adults with hemodialysis (HD) abuse by family caregivers and the factors affecting it.

METHOD

This is a correlational-causal study, which is conducted in 2018 in Iran. The sample size was 367 in both groups (the older adults and their family caregivers). Data collection was done using an individual-social information questionnaire for the older adults under hemodialysis and their family caregivers, the questionnaire of elder abuse by family caregivers to the older people under hemodialysis, Zarit Burden Interview and the scale of instrumental activities of daily living (IADL). Data were analyzed by the structural equation model (SEM) method. The Fitness of proposed pattern was measured using the following indexes: chi-square/degree of freedom ratio (CMIN/DF), Normed Fit Index (NFI), comparative fit index (CFI), goodness of fit index (GFI), and standardized root mean squared residual (SRMR). The significant level in this study was considered p < 0.05.

RESULTS

The results of the present study showed that more than 70 % of the older adults suffer from elder abuse by family caregivers on average. The highest median elder abuse was related to emotional misbehavior (21.46 ± 6.09) and financial misbehavior (19.07 ± 5.33), respectively. Moderate care burden was experienced by 63.2 % of caregivers. The percentage of older women and men, who needed help with daily activities was 81.4 and 80.5 %, respectively. The results showed that the caregivers' level of education and care burden with standard beta coefficient of -0.251 and 0.200 and the educational level of older adults and IADL with the best beta coefficient of -0.299 and - 0.234, had the highest regression effect on elder abuse respectively. According to the results, the model-fit indices of the hypothesized model was meet the criteria, with the NFI = 0.951, GFI = 0.970, CFI = 0.967, and SRMR = 0.041. The outcome was suitable for the recommended level, so the hypothetical model appeared to fit the data.

CONCLUSIONS

The results of the present study showed that the prevalence of elder abuse by family caregivers among the older adults under hemodialysis is high. Providing psychological counseling can reduce the consequences of elder abuse.

Validation of an Instrument for Assessing Elder Care Needs in Iran

BACKGROUND

The notable growth of the senior citizens population has caused problems and concerns in areas like healthcare, social care, and participation in society. The present paper is aimed at validating a Farsi version of the "International classification of functioning, disability, and health" for assessing elderly care needs in Kermanshah, Iran.

METHODS

The original version of the tool was translated into Farsi using forward-backward method. The study group consisted of 301 senior citizens who were selected through cluster sampling. Validity of the tool was examined using Waltz and Basel's content validity index, face validity, and confirmatory factor analysis. The reliability of the tool was examined using Cronbach's alpha and internal correlation. Data analyses were performed in SPSS-25 and Amoss-16.

RESULTS

Following confirmatory factor analysis, the number of factors decreased from nine to eight. The R2 index in the above model was estimated equal to 0.99; this indicates that 99% of the dependent variable changes (total score of ICF) are explained by the independent variables (eight items). All the indices were above 0.9, which indicates significance of the model (χ2/DF=2.7, CFI, NFI, GFI, TLI=0.9, REMSEA=0.078, R2=0.99). In addition, using internal correlation, the reliability of the tool obtained was equal to 0.77 for the whole tool and 0.7-0.87 for the sub-scales.

CONCLUSION

The Farsi version of ICF had acceptable and applied specifications to assess the care needs of senior citizens and it can be used as a valid tool in different areas of nursing performance and elderly health.

Nutrition self-efficacy assessment: designing and psychometric evaluation in a community-dwelling elderly population

BACKGROUND

Awareness of nutrition self-efficacy dimensions can enable healthcare providers to guide their use in screening and providing a context for positive changes such as in promoting a healthy lifestyle and quality care among elderly people.

OBJECTIVES

Developing an instrument for assessing nutrition self-efficacy among Iranian elderly population.

METHODS

A sequential mixed exploratory design was applied to clarify and determine dimensions of nutrition self-efficacy in a community-dwelling elderly population in two phases. The first phase included a related literature review and a qualitative study. The validity and reliability of the tool were investigated in the second phase. The instrument's content validity was assessed by experts in nutrition self-efficacy's field and reliability was determined by internal consistency and construct reliability.

RESULTS

Three factors (adherence efficacy, preventive behaviors, and information effectiveness) and 29 items were obtained after assessing the face, content, and construct validity. The reliability of the nutrition self-efficacy questionnaire (NSEQ) exceeded α > 0.7. Concerning the cumulative percent of the variance, the three factors determined 64.05% of the total variance.

CONCLUSIONS

The NSEQ designed in this study, using the background experiences of the elderly living in the community and a review of related texts, and has acceptable reliability and validity. However, the diet self-efficacy questionnaire cannot yet be used as a gold standard, but it can be recommended for use as a measurement of individual diet self-efficacy in a community-dwelling elderly population.