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Reassessing the construct validity of a Brazilian version of the instrument Caregiver Abuse Screen (CASE) used to identify risk of domestic violence against the elderly
  1. M E Reichenheim1,
  2. C M Paixão, Jr1,2,
  3. C L Moraes1,3
  1. 1
    Epidemiology Department, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Brazil
  2. 2
    Geriatrics Sector—University Hospital Clementino Fraga Filho (HUCFF), Federal University of Rio de Janeiro (UFRJ), Brazil
  3. 3
    Medical School and Master in Family Health, Estácio de Sá University (UESA), Rio de Janeiro, Brazil
  1. Correspondence to Dr M E Reichenheim, Instituto de Medicina Social, UERJ, Rua Francisco Xavier 524, 7° andar, Bloco D. 20550-900, Maracanã, Rio de Janeiro, RJ, Brazil; michael{at}


Background: Domestic violence against the elderly (DVAE) is an increasingly recognised problem and its appropriate detection is imperative. As part of an ongoing cross-cultural adaptation process, this study evaluates the construct validity of a Brazilian Portuguese version of the instrument Caregiver Abuse Screen (CASE).

Methods: A cross-sectional study comprising 507 pairs of caregivers/elderly patients was carried out in three geriatric outpatient units. A multidimensional questionnaire was completed for each pair of interviewees covering DVAE, sociodemographic characteristics and several theory-related variables (alcohol misuse, burden, depression, social support, cognitive status, instrumental activities of daily living, general health status and living arrangements). Sequential confirmatory and exploratory factor analyses (CFA/EFA) were implemented to assess construct validity through an in-depth exploration of the instrument’s dimensional structure. Construct validity was also assessed through relationships with other variables.

Results: The initial CFA did not support the postulated two-factor solution. A one-dimensional solution suggested by an EFA was followed by a CFA, which showed adequate fit (WRMR = 0.985, RMSEA = 0.056, CFI = 0.967 and TLI = 0.969), internal consistency (ρcr = 0.85) and temporal stability (κw = 0.77). Yet, convergent validity was not achieved (average variance extracted <0.50; ρve = 0.45). Using Kendall’s Tau-b correlations, the CASE was positively associated with two other instruments assessing DVAE (H/S-EAST: τb = 0.13; and CTS-1 subscales: τb = 0.15−0.37); caregiver burden (Zarit BI: τb = 0.40); and depression (GDS: τb = 0.32).

Conclusion: In spite of some remaining dimensionality issues needing refinement and the relatively restricted correlations with expected variables, the CASE may be reaffirmed as a promising detection tool for risk of abuse in clinical practice and applied research.

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  • Contributors All authors (MER, CMPJ and CLM) contributed to the interpretation of the results and drafting of the manuscript, as well as to the conception and design of the study. MER and CMPJ conducted statistical analysis and manuscript preparation.

  • Funding This work was supported financially by grants from the Brazilian National Research Council (CNPQ), process no. 024/2004. CMPJ was partially supported by Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), process no. E-26/150.727/2002. MER was partially supported by CNPq, process no. 300234/94-5, no. 306939/2003-7 and no. 306909/2006-5.

  • Competing interests None.

  • Ethics approval In conformity with the principles embodied in the Declaration of Helsinki, the study was approved by the respective health centres’ ethics committees and the research institution that coordinated the project. Written informed consent was given and read out to each enrolled subject.

  • Provenance and peer review Not commissioned; externally peer reviewed.