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.
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 (rho(cr) = 0.85) and temporal stability (kappa(w) = 0.77). Yet, convergent validity was not achieved (average variance extracted <0.50; rho(ve) = 0.45). Using Kendall's Tau-b correlations, the CASE was positively associated with two other instruments assessing DVAE (H/S-EAST: tau(b) = 0.13; and CTS-1 subscales: tau(b) = 0.15-0.37); caregiver burden (Zarit BI: tau(b) = 0.40); and depression (GDS: tau(b) = 0.32).


CONCLUSIONS
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.
Reichenheim
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Epidemiology Department, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Brazil. michael@ims.uerj.br
Paixão
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Moraes
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D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D004552:Elder Abuse / Q000175:diagnosis*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D018570:Risk Assessment; D014177:Translations