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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

Abstract

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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