Elder abuse: Disparities between older people's disclosure of abuse, evident signs of abuse, and high risk of abuse

OBJECTIVES: To assess and compare three types of assessment tools for identifying elder abuse: direct questions to elicit disclosure of abuse if it exists, identification of evident signs of abuse, and assessment of high risk for abuse. DESIGN: Cross-sectional. SETTING: Rambam and Hadassah medical centers, Israel. PARTICIPANTS: Seven hundred thirty persons aged 70 and older hospitalized in general hospitals in 2004/05 and their principal caregivers. MEASUREMENTS: Expanded indicator of abuse (E-IOA) tool, questionnaires looking for evident signs of abuse, and direct experience of abusive behavior. RESULTS: Although 5.9% of respondents disclosed experiencing abusive behaviors, 21.4% were identified with evident signs of abuse, and 32.6% were classified as being at high risk for abuse. More than 70% of those who disclosed abuse were identified with evident signs and were at high risk for abuse. Those who disclosed being abused suffered particularly from physical and sexual abuse. According to logistic regression, higher caregiver subjective burden was a predictor of disclosure (odds ratio (OR)=1.81, 95% confidence interval (CI)=1.19-2.74), evident signs of abuse (OR=1.86, 95% CI=1.45-2.35), and high risk of abuse (OR=1.55, 95% CI=1.27-1.88); heavier objective caregiver load was a predictor of evident signs of abuse (OR=1.14, 95% CI=1.05-1.24) and of high risk (OR=1.18, 95% CI=1.06-1.38) only; and respondent functional status was a predictor of evident signs of abuse (OR=1.88, 95% CI=1.70-2.37). CONCLUSION: The use of the three assessment tools is needed for optimal identification of abuse, whereas assessment for high risk proved an efficient method in the absence of respondent disclosure or professional detection of signs of abuse. Hospitalization provides an excellent opportunity for identifying elderly persons at risk of abuse.