Development of an Elder Abuse Recognition (EAR) screening tool for use in the emergency department

Introduction Elder abuse remains under-recognized in emergency department (ED) settings, in part due to the lack of brief, practical screening tools that can be integrated into fast-paced clinical workflows. Aim The primary aim was to evaluate the content validity of the Elder Abuse Recognition (EAR) tool for use in emergency care. Secondary aims were to describe clinicians' perceived usability of the tool and to examine the internal consistency of the supplemental clinician-report measures administered alongside it. Methods An explanatory sequential mixed-methods design was used. Clinicians ( N = 16) evaluated item relevance to establish content validity using the Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI/Ave). Semi-structured interviews ( n = 12) were conducted to explore perceptions of relevance, clarity, and feasibility. Qualitative data were analyzed using reflexive thematic analysis. Results The EAR tool demonstrated acceptable-to-good content validity (S-CVI/Ave = 0.88), with higher validity for physical assessment items (0.95) compared to subjective items (0.83); four of thirteen subjective items were subsequently removed for falling below the I-CVI threshold. Internal consistency was high for the two supplemental clinician-report measures, the clinical frequency scale (α = 0.906, 95% CI [0.739, 0.960]) and the confidence/usability scale (α = 0.928, 95% CI [0.866, 0.957]). Qualitative findings supported the relevance of the tool while identifying the need for clearer wording, brevity, and trauma-informed delivery. Integration of findings informed refinement to a streamlined set of clearly defined screening items. Conclusion The EAR tool demonstrates acceptable-to-good content validity and clinician-perceived usability as a brief screening aid for identifying potential elder abuse. These findings represent an initial development and content-validation phase. Prospective evaluation in the intended population and setting, particularly with bedside emergency nurses and older adults presenting for emergency care, is required to establish clinical feasibility, diagnostic accuracy, and implementation outcomes.