title: 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 (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.
authors.affiliation: Epidemiology Department, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Brazil. michael@ims.uerj.br
authors.forename: M E
authors.initials: ME
authors.lastname: Reichenheim
authors.forename: C M
authors.initials: CM
authors.lastname: Paixão
authors.forename: C L
authors.initials: CL
authors.lastname: Moraes
mesh_terms: 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