receiver risk factors were most important in predicting abuse and neglect. Using a cutoff of 16, about 22 percent of cases were missed (compared to 36 percent of cases missed by the Hwalek-Sengstock Elder Abuse Screening Test, see below, which is completed by seniors, not interviewers). A notable strength of this tool is that it assesses multiple forms of abuse and assesses both caregiver and care-receiver. Weaknesses include a high false negative rate, limited applicability of the scale to assess domestic violence in elder marital relationships (the Conflict Tactics Scale is useful for this, see below), and the requirement of in depth knowledge of both caregiver and care receiver.
While risk factor assessment is most certainly a clinically valid tool for social service workers, its usefulness in epidemiological studies, particularly in initial investigations, is limited. This is because epidemiological studies are often conducted with the aim, at least in part, of identifying risk factors. Thus, using risk factors to select perpetrators in order to identify additional risk factors is a tautological methodology, and should be avoided in epidemiological efforts.
The Caregiver Abuse Screen (CAS) (Reis and Nahmiash, 1995) is completed by caregivers, not interviewers, as was the case with the IOA. The CAS is very short, only eight items, which somewhat superficially assess forms of abuse and neglect. That is, direct questions regarding mistreatment behaviors are avoided. The authors state that wording is based on “control theory” in which a perpetrator’s sense of external locus of control predicts abuse (Bendik, 1992). Conceptualization is also based on neutralization theory, in which abuse is seen as justified and rationalized by the abuser (Tomita, 1990). The CAS is specifically worded so as to be nonblaming. The instrument was validated on 44 abusive caregivers and 45 nonabusive caregivers (the abusive caregivers and 45 controls were receiving services from a social services center). Designation as an abuser was made on the basis of a thorough interview. Results indicated that overall scores of abusers were significantly higher on the CAS (mean = 3.2) than nonabusers (mean = 1.9). CAS scores were positively correlated (0.41) with IOA scores. Unfortunately, no discriminant analyses were conducted, and classification accuracy and optimal cutoff scores for detecting abuse and neglect were not available (rather, only the mean scores of each group were reported as significantly different; note, however, that scores differed by only about one point). Weakness of this measure in terms of its applicability to epidemiological efforts mirrors those of the IOA. Specifically, it is clinically relevant but lacks detailed descriptions of mistreatment events, as well as comprehensive psychometric validation.
The health, attitudes toward aging, living arrangements, and finances (HALF) is presented by Ferguson and Beck (1983) with no psychometric data. This is a clinician-based tool to identify elders at risk in a health