The SOAR project: Developing a framework for screening for older adults' abuse risk

Globally one in six older adults experience abuse; however, abuse of older people (AOP) remains under-detected and under-reported. Existing screening instruments often lack sufficient psychometric robustness and cultural responsiveness to effectively identify those at risk. This study aimed to identify key physical and psychosocial variables associated with AOP to inform development of a concise, evidence-based screening tool for use in Aotearoa New Zealand.

First, Principal Component Analysis (PCA) of International Resident Assessment Instrument, Home Care (interRAI-HC) data was conducted to identify variables explaining the greatest variance across the Abuse - Clinical Assessment Protocol (A-CAP). Second, a Delphi consensus survey engaged multidisciplinary experts and stakeholders to prioritise variables from the A-CAP subset for inclusion in the screening tool.

PCA identified four primary indicators explaining the greatest variability in AOP risk: fear, neglect, conflict with family, and poor hygiene. Secondary indicators included low body mass index, weight loss, reduced social interactions and informal helper stress. The Delphi panel endorsed seven key variables: five derived from the A-CAP (fear, neglect, poor hygiene, conflict with family, and informal helper stress) and two additional items (financial abuse and lack of independence in decision making). These variables informed a framework of six evidence-based domains across three categories: relational, physical and psychological impacts of AOP.

These findings support development of a short screening tool guided by the Screening for Older adults' Abuse Risk (SOAR) framework. Validation and integration of SOAR into routine community healthcare practice may enhance early detection and response to AOP.