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    Gironda, Melanie W. Nguyen, Annie L. and Mosqueda, Laura M. 2016. Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures. Journal of the American Geriatrics Society,

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    Pickering, Carolyn E. Z. Mentes, Janet C. Moon, Ailee Pieters, Huibrie C. and Phillips, Linda R. 2015. Adult Daughters’ Descriptions of Their Mother–Daughter Relationship in the Context of Chronic Conflict. Journal of Elder Abuse & Neglect, Vol. 27, Issue. 4-5, p. 356.

    Livingston, Gill Barber, Julie Rapaport, Penny Knapp, Martin Griffin, Mark Romeo, Renee King, Derek Livingston, Debbie Lewis-Holmes, Elanor Mummery, Cath Walker, Zuzana Hoe, Juanita and Cooper, Claudia 2014. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technology Assessment, Vol. 18, Issue. 61, p. 1.

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The sensitivity and specificity of the Modified Conflict Tactics Scale for detecting clinically significant elder abuse

  • Claudia Cooper (a1), Kate Maxmin (a1), Amber Selwood (a1), Martin Blanchard (a1) and Gill Livingston (a1)
  • DOI:
  • Published online: 01 August 2009

Background: A third of family carers of people with dementia describe acting abusively in research studies, but far fewer cases of abuse are currently detected in clinical situations. This discrepancy may be explained by inadequate detection by health professionals, or disagreement regarding what constitutes elder abuse. This study was undertaken to determine the sensitivity and specificity of the revised Modified Conflict Tactics Scale (MCTS) for detecting clinically significant abuse.

Methods: We interviewed 220 family carers of people consecutively referred to psychiatric services with dementia in Essex and London (U.K.), using the MCTS to measure abuse. We defined abuse cases using (1) the MCTS conventional scoring system; (2) the Pillemer criteria; and (3) clinical judgment of an expert panel.

Results: Our panel judged that 15 (6.8%) of carers reported potentially clinical concerning abusive behavior; but 47 (21%) were cases according to the Pillemer criteria and 74 (34%) using the MCTS conventional scoring system. We developed a weighted MCTS scoring system, with high sensitivity and specificity for detecting clinically concerning abuse.

Conclusions: The MCTS could be used routinely in clinical practice with carers of people with dementia to detect clinically concerning cases of abuse, many of which are currently being missed.

Corresponding author
Correspondence should be addressed to: Claudia Cooper, Dept of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, U.K. Phone: +44 (0) 207 2885931. Email:
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S. R. Beach , R. Schulz , G. M. Williamson , L. S. Miller , M. F. Weiner and C. E. Lance (2005). Risk factors for potentially harmful informal caregiver behavior. Journal of the American Geriatrics Society, 53, 255261.

C. Cooper , M. Manela , C. Katona and G. Livingston (2008a). Screening for elder abuse in dementia in the LASER-AD study: prevalence, correlates and validation of instruments. International Journal of Geriatric Psychiatry, 23, 283288.

C. Cooper , A. Selwood and G. Livingston (2008b). The prevalence of elder abuse and neglect: a systematic review. Age and Ageing, 37, 151160.

C. Cooper , A. Selwood , M. Blanchard , Z. Walker , R. Blizard and G. Livingston (2009) Abuse of people with dementia by family carers: representative cross sectional survey. BMJ, 338, b155; doi: 10.1136/bmj.b155.

T. Fulmer (2005). Dyadic vulnerability/risk profiling for elder neglect. Gerontologist, 45, 498.

M. S. Lachs , C. S. Williams , S. O'Brien , K. A. Pillemer and M. E. Charlson (1998). The mortality of elder mistreatment. JAMA, 280, 428432.

D. Nelson (2002). Violence against elderly people: a neglected problem. Lancet, 360, 1094.

R. A. Oswald , G. J. Jogerst , J. M. Daly and S. E. Bentler (2004). Iowa family physician's reporting of elder abuse. Journal of Elder Abuse and Neglect, 16, 7588.

K. Pillemer and D. Finkelhor (1988). The prevalence of elder abuse: a random sample survey. Gerontologist, 28, 5157.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
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