What we know about screening older adults for mistreatment: results from the SAVE Project literature review

Abstract

Background: Elder abuse is a widespread phenomenon worldwide. Using screening tools to identify suspected cases of abuse could be a helpful strategy to support professionals in recognising the signals and indicators of mistreatment and base the decision to request more comprehensive assessments. This literature review aims to answer three questions: 1) what arguments can be used in favour or against the screening process?; 2) what professionals conduct screening, in what contexts and how is screening perceived by professionals and older adults? and; 3) what screening instruments are used, in what countries, and what are their psychometric characteristics? Method: A systematic review of the literature was conducted. Eight databases were searched, using multiple combinations of the keywords “elder abuse”, “mistreatment”, “older adults”, “violence”, “screening”, “assessment”, and “measurement”. Results: We found 7386 references, then analysed according to pre-established criteria resulting in 19 papers with relevant information for question 1, 25 for question 2 and 87 for question 3. As arguments in favour of screening, results indicate that identification of cases is key for intervention. Screening promotes the safety and well-being of older people and, when applicable, helps with legal reporting responsibilities. It also provides a base for assessment, heightens the professional awareness of the problem, and guides users through a systematic process of observation and documentation to ensure that manifestations of elder mistreatment will not be overlooked. As arguments against screening, the resulting point to the timeconsuming application process, the false negative/positive results, and its potential consequences for the older persons, their families, and professionals. The absence of knowledge about the frequency of adverse effects of elder abuse screening and their impact on clinical processes, costs and time requirements are also indicated as points against screening. Screening is mainly conducted by healthcare and social professionals. Nurses, physicians, and social workers were frequently reported as the primary professionals who screen for mistreatment. Very little information was found regarding the opinion of older adults about the screening process. Regarding screening tools, thirty-seven instruments were cited in the literature. Of these, eight tools were only used in research and are not yet field-tested. The twenty-nine remaining tools can be organized into four categories: 1) screening tools based on direct questioning that are short and versatile yes/no questionnaires used in multiple contexts by different professionals; 2) screening procedures based on observation or in-depth assessment, which are time-consuming and require extensive training and professional skills, but are also more accurate; 3) screening tools that specify the abuser, focusing on specific relationships and often require the evaluation of the alleged abuser; and 4) Screening tools for assessing a single form of abuse. Of these four categories, direct questioning tools are more flexible, adaptable, and easier to use but are also less reliable. Conclusion: The literature on elder abuse screening points to several compelling arguments both in favour and against screening. Though it is understood that screening is an important tool to raise suspicion on elder abuse, the lack of effective and practical tools and the unknown extent of potential negative consequences of screening are important factors to consider when thinking about the implementation of screening programmes. More research is necessary to fill these gaps and help professionals to make informed decisions. The use of screening tools beyond their distal possible positive effects on older adults is particularly useful to train social and healthcare professionals who deal with older adults more frequently. As such, training these professionals in good screening practices is essential to make screening feasible, raise awareness about elder abuse, and promote a broader view of the circumstances and factors around and within the older adult that can determine elder abuse.