Abuse in older adults with communicating disorders: a step forward in this understanding?

Background and aims. Elders' abuse is a matter of growing public and heath care concern. So far, the real magnitude of the problem is unexplored, especially in frail patients with dementia who experience communicating problems. Self-report screening tools for abuse limited their diagnostic accuracy in persons with dementia. Starting from this background, here we aimed at comparing the diagnostic accuracy of Elder Assessment Instrument (EAI) and the Indicator of Abuse (IOA) tools to assess elders' abuse in real world older adults with dementia or communication impairment at in hospital admittance and to preliminary explore the potential abusive home environment. Methods. This is an observational prospective study on 70 consecutive patients aged 75 years and more, with mostly dementia of Alzheimer's type admitted at the Geriatric clinic of the IRCCS Policlinico San Martino Hospital of Genoa, Italy. All patients received psychogeriatric assessment. The size of home environment was assessed, including caregiver' age, cohabitation, and average economic income. Results. EAI tool showed a good diagnostic accuracy compared with IOA (AUC 0.83) (95% CI: 0.73-0.95); sensitivity of 78.6%; specificity of 76.8%) and a cut off score of 45 for EAI was also identified for the detection of elder's abuse risk. Conclusions. This is the first report to compare the diagnostic accuracy of two observational tools for elders abuse in dementia or communication impairment. Moreover, the identification of a specific cut off score for EAI screening tool may contribute to the earlier identification of a potential abuse in such a highly vulnerable population, with potential implications in this neglected field.