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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
cal abuse, exploitation, and neglect, no specific assessment of any type of mistreatment is made. One replication study of 100 elders in public housing (Moody et al., 2000) was recently completed to measure discriminant ability of the test again. Factor analysis indicated some differences in loadings from the original study; however, discriminant analyses indicated that the test again classified correctly about 70 percent of respondents as abused or not abused. False positives (17 percent) were more likely in this study than false negatives (12 percent).
The HSEAST suffers from some specific deficits. Several items are extremely vague and lack behavioral specificity when describing events. That is, actual events cannot be determined from this screen, as they can from the Conflict Tactics Scale. However, this screen is designed to be followed by a more in-depth interview when indicated by higher scores. Some items are not directly related to abuse (e.g., a response of “someone else” to the question, “who makes decisions about your life?” or the question, “Do you feel that nobody wants you around?”). Some questions measure potentially abusive situations instead of actual events (e.g., “Can you take your own medication and get around by yourself?” “Are you helping to support someone?”). As a screen, the typical preference is that false-positive rates exceed false-negative rates, and the opposite was observed here. Moreover, there is limited replication of discriminant ability at this point. Overall, this tool may be useful more clinically than epidemiologically.
According to the NEAIS, two-thirds of elder mistreatment cases involved spouses or children. Similarly, Pillemer and Finkelhor (1988) found that 65 percent of elder abuse cases involved spouses as perpetrators. For this reason, and for the conceptual similarities between domestic violence and mistreatment of non-cognitively impaired elders, inclusion of domestic violence assessment methods when measuring elder mistreatment is justified.
The Conflict Tactics Scale (CTS) (Straus, 1979) and the Revised Conflict Tactics Scale (CTS2) are well known, studied, and used indexes of relationship violence. The CTS2 (Straus et al., 1996), originally developed by Straus (1979), is a widely used (over 70,000 empirical studies have used it) and thoroughly evaluated (approximately 400 papers) measure of interpersonal violence for married or cohabiting partners; it has been modified for use with caregivers to the elderly (Pillemer and Finkelhor, 1988). Note that it is not a measure of attitudes toward violence, but rather a measure of conflict-resolution events that involve violence. The scale also measures psychological abusiveness and the use of negotiation and reasoning by either party to reduce conflict. Although the CTS has undergone numerous revisions in the past 15 years, its basic structure has remained the same. The most recent version contains several scales: reasoning/negotiation (6