Translation, validity, and reliability of the Arabic-language version of the 11- item Neglect and Abuse Scale (NAS) in Community Older Adults

Translation, validity, and reliability of the Arabic-language version of the 11- item Neglect and Abuse Scale (NAS) in Community Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Translation, validity, and reliability of the Arabic-language version of the 11- item Neglect and Abuse Scale (NAS) in Community Older Adults Marwa Ibrahim Mahfouz Khalil, Reem Said Shaala, Mayar Elnakeeb, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4565016/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Divergent cultural contexts and norms shape perceptions of elder abuse and neglect in Western and Arab societies. The psychometric properties of instruments measuring elder neglect and abuse in Arabic have not been previously examined. Validating these instruments can enhance the consistency of elder neglect and abuse (NA) prevalence estimates and contribute to a more comprehensive understanding of the issue at national, regional, and global levels. This study represents the first attempt to validate the Arabic version of the 11-item Neglect and Abuse Scale (NAS) and establish its psychometric soundness in a sample of Arabic-speaking Older Adults in the Community. Method A cross-sectional study encompassed 539 Arabic-speaking older Egyptians, with 50.3% being female and 60.7% aged between 65 and 75. Participants completed an anonymous Google form-based questionnaire that included the NAS, the Older People's Quality of Life-brief (OPQOL-brief) Questionnaire, 15-item Resilience Scale of Older Adults (RSOA), and sociodemographic inquiries. The forward-backward translation method was employed to ensure accurate translation. Results Exploratory Factor analysis with Varimax rotation unveiled two factors from the NAS, reflecting the multidimensional nature of the scale. Confirmatory factor analysis validated the two-factor solution, demonstrating a good fit to the data. Reliability assessments showed a satisfactory level of internal consistency for the overall score and the two factors (Cronbach’s α = .83 − .88 / McDonald’s ω = .83 − .89). Sex invariance tests indicated that male and female participants did not significantly differ in the measurement features, suggesting the scale's applicability and interpretability across sexes. Concurrent validity analysis revealed a moderate negative correlation between the Arabic NAS scores, RSOA (r =-.28, p < .001) and OPQOL-brief (r =-.41, p < .001) scores. Conclusion This study provides a valid and reliable tool to identify and evaluate older adults’ abuse and neglect in Arabic-speaking communities, supporting effective intervention and prevention efforts. It also facilitates cross-cultural comparisons of abuse and neglect rates, risk factors, and outcomes between Arabic-speaking community-dwelling older adults and other language groups, advancing the global understanding of this issue. Abuse and Neglect Scale psychometric properties Validity Reliability Older adults Arabic Figures Figure 1 Figure 2 Introduction The aging process is one of the most delicate times of a person's life [1]. The number of individuals in the world who are 60 years of age or older is steadily rising worldwide, and is expected to double, to around 2.1 billion, by the year 2050 [2]. In a response, various governing bodies have instituted aging-in-place policies, resulting in a shift towards home-based care and assigning substantial roles to care partners and home care services [3-5]. However, the connections between older people and their family members have actually suffered greatly as a result of breakthroughs in technology, financial welfare, and family structure [6]. In their advanced age, older adults may be inadequately prepared and/or less inclined to establish new social connections, resulting in disengagement. Family members, contending with conflicting role obligations, often grapple with managing the stress associated with caregiving. This marginalization, coupled with insufficient social support, renders them susceptible to maltreatment and neglect - an issue of global concern that demands prompt attention [7]. Definition, prevalence, risk factors and consequences of older adults’ abuse and neglect According to the World Health Organization (WHO), older adults’ abuse is defined as "a single or repeated act, or lack of appropriate action, which causes harm or distress to an older person". Abuse on all fronts—physical, sexual, psychological, emotional, financial, and material—as well as neglect and major loss of respect and dignity are all included in this category of violence [8]. Operationally, neglect is defined as “the refusal or failure of responsible caregivers to provide a care dependent older adult with assistance in daily living tasks or essential support such as food, clothing, shelter, health and medical care” [9]. According to data from the WHO [8], one in six older adults aged 60 years and over have experienced abuse at least once in their lives, and the prevalence of abuse among this demographic is rising. Older adults’ abuse in communities is on the rise, according to a systematic review and meta-analysis of 52 studies from 28 different countries [10]. A review by Yon, Mikton, Gassoumis, and Wilber (2017) showed that the overall prevalence of abuse among community-dwelling older persons was 15.7%, and estimated the prevalence of neglect to be 4.2% based on 30 studies conducted in 20 different countries [11]. Due to the world's old population's rapid growth and the societal changes, older adults’ abuse and neglect are becoming a major social issue [12], and a matter of significant concern within the realm of public health, bearing serious implications for social, economic, and health domains [11]. Advanced age, female gender, higher educational status, lower economic status, dependency, loneliness, dementia, social isolation, and a violent family background are risk factors for older adults’ abuse [13, 14]. Ageism against older people and specific cultural norms (e.g., normalization of violence) are community- and societal-level elements that have been connected to older adults’ abuse instances [15]. Furthermore, a previous study showed significant correlations between abuse and the health and resilience of older adults [16]. This study suggested that a lower probability of exposure to abuse among older adults is associated with higher resiliency scores, indicating that as participants become more resilient, they are less likely to experience physical, anxiety, depression, and fatigue issues. Conversely, there is a negative moderate correlation between experience of abuse and health, meaning that as exposure to abuse decreases, the health of older adults improves. The adverse health outcomes resulting from the mistreatment of older individuals can be particularly serious. This form of abuse has the potential to diminish an individual's functional capacity, increase their dependence, contribute to cognitive impairment, and elevate the risk of malnutrition, polypharmacy, morbidities, or premature death [15, 17]. It raises the likelihood of hospital admission and institutionalization, both of which have a major, detrimental financial impact on health, families, and society at large, encompassing healthcare expenses for medical care and recovery, along with the delivery of support and assistance by the judicial and societal framework [18, 19]. Despite its widespread prevalence and serious consequences on physical and mental health, older adults’ abuse is inadequately reported, and its precise rate remains uncertain [20]. A report from the US Department of Justice asserts that a significantly larger proportion of harassment and inappropriate behavior is perpetrated against senior citizens than is officially documented. Only one out of every 23 incidents are reported to the relevant governing bodies [21]. Discrepancies in the statistical data related to this issue stem from a lack of consensus on the assessment of older adults’ abuse [15]. Measurement of abuse and neglect among older adults Multiple methodologies are available for evaluating abuse and neglect in older individuals. Presently, there is no universally acknowledged standard for appraising older adults’ abuse. There is an important diversity of legal definitions, a broad spectrum of clinical experiences and scenarios, and a significant overlap between indicators of abuse and disease markers, in addition to the variations in standards across different regions. Consequently, a compelling need exists for further validation testing of the existing assessment tools [22, 23]. Overall, the majority of published tools were predicated on inadequate construct descriptions (abuse-focused tools) and tests of validity with older adults [24, 25]. Many previously developed scales constituted components of generic older adults’ abuse measurements [25-27]. For instance, the Conflict Tactics Scale was initially designed to assess abuse and neglect in the older population, but it was predominantly appraised with students [28, 29]. The Elder Abuse Instrument (EAI, [30]) and the Elderly Indicators of Abuse (E-IOA, [31]) have not been validated in a sample of community-dwelling older people. In addition, some measures may not encompass all types of abuse, such as the Older Adult Abuse Psychological Measure (OAPAM) [32] and the Older Adult Financial Exploitation Measure (OAFEM) [33]. Another measure recently developed in Japan, i.e. the 36-item Assessment Tool for Domestic Elder Abuse (ATDEA), encompasses different types of domestic abuse among older adults; however, it can be burdensome as a lengthy assessment [34]. Few were culturally and socially tailored instruments to specific older adults (such as the Family Members Mistreatment of Older Adults Screening Questionnaire, for Mexican older adults) [35]. Some tools can be utilized to appraise abuse among older adults either in nursing homes [36] or in acute care settings [37]. It is notable that no antecedent measurement scales tailored to evaluate neglect and abuse within local communities have come to light, and an Arabic version of such a scale remains unidentified. In 2020, Asiamah et al. [38] developed the Neglect and Abuse Scale (NAS). The NAS represents the inaugural endeavor to quantitatively assess instances of neglect and abuse experienced by older adults within their respective communities. The scale is composed of 11 items, each accompanied by three descriptive anchors denoting "not at all" (1), "sometimes" (2), and "always" (3) [38]. The analytical process yielded a bifactorial solution labeling its extracted factors as "neglect and assault" (N&A) and "discrimination and exploitation" (D&E). Factor 1 (D&E) encompasses eight items, each emblematic of diverse forms of abusive behaviors, inclusive of age-based discrimination, cheating, deceit for personal gain, instilling fear and panic, sexual harassment, denial of rights or privileges, stealing or defrauding, and betrayal. Factor 2 (N&A) comprises three items, pertaining to neglect (i.e. the deficiency in ensuring an individual's well-being), verbal abuse/disparaging remarks, and physical battery and assault, (i.e. acts causing bodily harm or injury to older adults). The scale has evinced commendable internal consistency and validity, thus endowing it with utility as a discerning instrument for appraising neglect and abuse experienced by older adults at the community level [38].The NAS has, therefore, a broad scope ensuring it captures the multifaceted nature of older adults’ abuse. Rationale of the present study The demographic landscape of Egypt is changing quickly. According to projections, the proportion of seniors (60 and over) in the population would more than double between 2020 and 2050, from 8.4 million, or 8% of the total, to 22 million, or 14% [39]. Despite the traditional collectivist nature of its culture, Egypt is currently witnessing a rise in the prevalence of older adults’ abuse, impacting the perception of nursing care quality among older adults [40]. For instance, a cross-sectional survey found that 43.7% of Egyptian older adults reported experiencing abuse at the hands of family members, with neglect accounting for the majority of cases (42.4%) [41]. Because a high proportion of older adults’ abuse cases remain undetected, it is imperative for healthcare providers and social workers providing at-home care services to have access to validated tools to identify elder abuse, given their apt positioning to recognize instances of abuse. This study addresses older adults’ abuse and neglect within the context of a psychometric analysis of the Arabic version of the scale, directly contributing to the objectives of the UN Decade of Healthy Ageing [42]. The absence of linguistic and culturally equivalent measurement instruments that retain the same meaning and conceptual relevance through the examination of psychometric properties used to measure the prevalence of elder abuse in Arabic-speaking countries has been identified [22, 43, 44]. Validating this neglect and abuse scale for use with Arabic-speaking older adult populations is crucial to ensure its cultural appropriateness, linguistic equivalence, and contextual applicability across the diverse Arab world, where no such measure previously existed. This process can strengthen the scale's utility and adoption for research and clinical practice in Arabic-speaking settings, and can assist researchers and practitioners in better detecting and addressing this important public health issue. In this context, the present study aimed to examine the psychometric properties of a new Arabic translation of the NAS in a sample of Arabic-speaking sample of community older adults from Egypt. It is expected that the two-factor solution will be supported, and that the Arabic NAS will show good reliability and concurrent validity. Methods Study design The investigation utilized a descriptive correlational design with a cross-sectional approach to examine a cohort of individuals aged 60 years or older, who possessed Egyptian citizenship and were proficient in the Arabic language. The study encompassed 539 participants, inclusive of individuals of both male and female genders. Prior to their participation, each individual provided informed consent and affirmed the absence of cognitive, communication, or neurodegenerative impairments. Exclusion criteria were applied to individuals with visual impairments such as severe retinopathy, glaucoma, or cataracts, as well as those demonstrating mental incapacity or acute illnesses necessitating inpatient care. Participants were recruited through face-to-face interviews at one-day clinics affiliated with General Alexandria Main University Hospital and via an online survey distributed through social media platforms such as Facebook, Messenger, and WhatsApp. Written permissions were obtained from official authorities and heads of the one-day clinics prior to participant enrollment. Participants were apprised of the study's objectives, as well as the confidentiality and anonymity of their responses. Those meeting the inclusion criteria provided digital informed consent and completed the online form. The survey was conducted between August and October 2023, and participation was voluntary. Data were collected using a Google Form link. Measures The 11-item Neglect and abuse scale of older adults in the community The NAS, developed by Asiamah et al. in 2021, comprises 11 items divided into two factors ("neglect and assault", N&A; and "discrimination and exploitation", D&E), that constitute two potential indicators of neglect and abuse of older adults at the community level [38]. The translation of the NAS was carried out by two translators whose native language is Arabic and who were proficient in both English and Arabic. These translators were then validated by a committee consisting of a linguistics expert and healthcare professionals. The objective of this validation was to guarantee that the translated Arabic version of the NAS was free from any inconsistencies and ambiguities. To this end, the Arabic version of the scale was blindly back-translated into English by two independent translators who were proficient in both English and Arabic. The back-translated measure was then reviewed by the expert committee to reconcile any discrepancies between the translations. It is important to note that the translation of the RSOA was done in Standard Arabic, which is universally understood by all Arabic-speaking countries, regardless of the specific accent used. This translation followed a guideline in translation, adaptation, and validation as outlined by Sousa and Rojjanasrirat (2011). The research team intervened to resolve the inconsistency in case of disagreement between translators. The Older People's Quality of Life-brief (OPQOL-brief) Questionnaire This questionnaire is intended for the self-assessment of the quality of life (QOL) among the aging population [45]. It encompasses thirteen questions that evaluate various domains such as leisure activities, home and neighborhood environment, social interactions, autonomy, mental and emotional well-being, and overall health. Typically, participants rate their experiences and feelings over a specified period using a Likert scale with five points, ranging from "strongly agree" to "strongly disagree." The total score on the OPQOL-brief is calculated by summing all the items, with higher scores indicating a higher quality of life, ranging from 13 to 65 [46, 47]. The OPQOL-brief is considered a valid and reliable tool for assessing QOL in older individuals [45]. The Arabic version of the scale was used in our study [48]. The Resilience Scale of Older Adults (RSOA)- Arabic version. The RSOA is a versatile survey designed to evaluate older individuals' protective resilience characteristics from their own perspective. It comprises fifteen items, and respondents rate each item on a five-point Likert scale from one (never) to five (always). The RSOA has demonstrated strong reliability with a Cronbach’s alpha of 0.882. The item reliability of each subscale ranges from 0.25 to 0.83. Higher scores on all RSOA variables as well as the overall score indicate higher resilience levels in older individuals [49]. The Arabic version of the scale was used in our study [50]. Statistical analysis The factor structure of the NAS was explored using the EFA and CFA using RStudio (Version 4.2.2.). First, we checked the original 11-items unidimensional version, showing a very bad fit to the present data. Consequently, we decided to divide the sample into two subsamples of 33% (n=178) and 67% (n=361) randomly. EFA was performed on the first half sample (n=178) based on the principal component extraction approach and the orthogonal “Varimax” rotation. Factors were extracted for further analysis based on eigenvalues on the Scree plot (Factors with eigenvalues >1) (Figure 1). The data viability for factorability was evaluated through Kaiser–Meyer–Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett’s test of Sphericity (P<0.05) [51]. After that, we performed a CFA on the other subsample (n=361) to confirm the derived factor structure from EFA. A confirm[52]atory factor analysis was conducted using the “Lavaan” and “SemTools” package [52]. Values greater than 0.90 and 0.95 for the CFI and TLI, values closer to 1.00 for the GFI indicate good model fit. However, values for the RMSEA are expected to be at or below 0.08 to represent a good model fit, whereas values ≤0.10 are indicative of an acceptable fit [53]. To examine gender invariance of the NA scores, we conducted multi-group CFA assessed at the configural, metric, and scalar levels. Following the recommendations of (Chen, 2007), we accepted ΔCFI ≤ 0.010 and ΔRMSEA ≤ 0.015 or ΔSRMR ≤ 0.010 (0.030 for factorial invariance) as evidence of invariance. Results Exploratory Factor Analysis (sample 1) First, the original 11-items unidimensional version, revealed a bad fit: RMSEA of 0.12 [90% CI 0.11, 0.13], CFI of 0.86, TLI of 0.82 and a GFI of 0.84. EFA with Varimax rotation extracted two factors from the NAS measure. Table 1 below shows the factor loadings of 11 items of the NA measure for two extracted factors from the EFA. The internal consistency was adequate for F1 (α = .84 / ω = .84) and F2 (α = .84 / ω = .85). Table 1 Factor loadings of the Neglect and Abuse scale items following the Exploratory Factor Analysis. The Neglect and Abuse scale (NAS) Extracted factors* Items F1 F2 1 Neglect you though they have an obligation toward your welfare 0.51 2 Insult you or say demeaning things about you 0.56 3 Physically assault you 0.81 4 Discriminate you based on your age 0.52 5 Cheat you 0.62 6 Deceive you for personal interests 0.73 7 Instill fear and panic in you 0.65 8 Sexually harass you 0.62 9 Have your rights or privileges denied 0.71 10 Steal from you or defraud you 0.68 11 Betray you 0.62 *Exploratory factor analysis with Varimax rotation; Factor loadings < 0.4 are not shown for simplicity Confirmatory Factor Analysis (sample 2) A CFA was conducted in using the “Lavaan” and “SemTools” package. The two-factor solution of the NAS showed a χ2 = 157.537, df = 42, CFI of 0.93, TLI of 0.91 and a GFI of 0.92, and a good RMSEA of 0.08 [90% CI 0.07, 0.10]. The second order CFA of the NAS showed good fit indices as follows: χ2 = 157.537, df = 39, CFI of 0.93, TLI of 0.90 and a GFI of 0.93, and a good RMSEA of 0.09 [90% CI 0.08, 0.11] (Fig. 1 ). The internal consistency was adequate for F1 (α = .83 / ω = .83), F2 (α = .83 / ω = .84) and the total score (α = .88 / ω = .89). Sex invariance (total sample) Sex invariance for the two-dimensional NA scale was confirmed at the configural, metric and scalar models. Results were shown in Table 2 . No significant difference in terms of neglect and abuse scores was seen between males and females (16.15 ± 4.93 vs 15.54 ± 4.64, t(537) = 1.49, p = .137). Concurrent validity (total sample) Higher neglect and abuse were significantly and moderately associated with lower resilience (r = − .28; p < 0.001) and lower quality of life (r = − .41; p < 0.001). Table 2 Measurement invariance across sexes. Model χ 2 df CFI RMSEA SRMR GFI TLI Model Comparison Δχ 2 ΔCFI ΔRMSEA ΔSRMR Δdf p Configural 294.55 102 0.922 0.084 0.060 0.971 0.916 Configural and metric 9.403 < 0.001 0.003 < 0.001 8 0.310 Metric 285.14 94 0.923 0.087 0.060 0.972 0.910 Metric and scalar 9.403 < 0.001 0.003 < 0.001 8 0.310 Scalar 294.55 102 0.922 0.084 0.060 0.971 0.916 Discussion To the best of our knowledge, this is the first foreign language adaptation study of the NAS, and represents the inaugural effort to address older adults’ abuse and neglect through a psychometric analysis of the Arabic version of the scale. The objectives of the present study were to explore the factor structure, reliability, gender invariance, and concurrent validity of the NAS, which stands as the primary instrument developed to assess community-level abuse and neglect of older adults. Given its status as the inaugural tool designed to measure a significant obstacle to walkable neighborhoods, defined as communities that support neighborhood-level active behaviors such as walking, bicycling, skating, and other forms of active transportation [ 54 , 55 ], this scale has the potential to exert a substantial impact on gerontology, research, and public health policy. Findings showed that the Arabic-language version of the NAS is a valid, reliable and easily applicable scale for assessing abuse and neglect in older individuals within the community. CFA yielded a two-factor structure, supporting the originally proposed factorial model. The reliability or internal consistency of the scales was estimated using two primary psychometric indicators, namely the Cronbach’s α coefficient and McDonald's omega (≥ .7 and factor loading ≥ 0.5). Our reliability assessments of the validated scale indicated a commendable level of internal consistency for the overall score (α = .88 / ω = .89), as well as for F1 (α = .83 / ω = .83), F2 (α = .83 / ω = .84). Furthermore, every item of this scale [ 38 ] demonstrated a factor loading ≥ 0.5 (0.51–0.81). In comparison, the English version of the scale displayed an overall Cronbach’s α of .9, with the "N&A" and "D&E" domains yielding alpha values of .74 and .92, respectively. Furthermore, every item of this scale exhibited a factor loading ≥ 0.5 (0.52–0.84). Consequently, the scale demonstrated good structural validity and internal consistency, and can serve as a valuable instrument for measuring neglect and abuse among Arabic-speaking older individuals. Sex invariance tests indicated that male and female participants did not significantly differ in the measurement features, suggesting the scale's applicability and interpretability across sexes. Research findings suggest that the majority of older individuals are female, and more older adult females experience abuse than their male counterparts [ 56 ]. According to meta-analyses of older adults’ abuse, older females, particularly those residing in non-Western countries such as in Asia and the Eastern Mediterranean, are more likely to be abused, whereas the rate of older adults’ abuse does not differ by sex in Western developed countries [ 10 , 11 ]. These sex differences can be due to several factors, including higher educational attainment and better self-rated health in males compared to females [ 57 ]. Concurrent validity analysis unveiled a moderate negative correlation (r = − .28, p < .001), (r = − .41, p < .001) between the NAS scores [ 38 ] and resilience and quality of life scores, suggesting that neglect and abuse is closely related to lower resilience, poorer quality of life, and indicating its utility in evaluating crucial aspects of neglect and abuse among older Arabic-speaking individuals.In agreement with our findings, the work of Chokkanathan & Natarajan [ 58 ] indicated that mistreatment was associated with diminished quality of life. older individuals with a history of abuse tend to exhibit lower levels of resilience [ 16 ], even when confounding factors are adjusted [ 59 ]. According to the World Report on Violence and Health [ 60 ], older adults become less resilient toward abuse because of their physical limitations. Other vulnerabilities related to old age can also lead to poor resilience in the face of abuse, including economic dependency, lower mental health well-being and social connectedness [ 16 ] Strengths and limitations Strengths of this study lie in its cultural relevance, comprehensive evaluation, adequate sample size, and methodological rigor. However, several limitations, such as generalizability, language and translation issues, concurrent validity measures, lack of longitudinal assessment, and limited participant characteristics such as their health and mental status, presence of chronic illnesses, frailty, levels of dependency, and caregiver-level factors, should be acknowledged. These factors may influence NA and could have implications for the interpretation of the scale's results. Clinical implications and future research The Arabic translation of the NAShas several clinical implications, including its usefulness as an assessment tool, its potential for cross-cultural comparisons, and its application in intervention and prevention planning. Additionally, researchers can utilize the scale in studies examining the factors influencing abuse and neglect in Arabic-speaking older adults, which can lead to evidence-based interventions and policies, guide the allocation of resources, and develop targeted programs. Future studies should focus on further validation, cultural adaptation, and longitudinal studies. Comparative studies, predictive validity, and intervention development can enhance our understanding of and preventing abuse and neglect in older Arabic-speaking individuals. This should include examining its sensitivity and responsiveness in diverse Arabic-speaking populations and different settings, such as acute care settings and nursing home residents. Conclusion In conclusion, this research contributes to addressing the absence of valid and well-suited models for analyzing abuse and neglect in community-dwelling older Arabic-speaking individuals. The present results demonstrated the scale's reliability and robustness as a tool for assessing abuse and neglect among the Arabic-speaking older people in the community settings. The results derived from CFA provided evidence for a consistent factorial structure, indicating that the scale can accurately measure the phenomena of elder abuse and neglect in this population. Furthermore, reliability analyses supported the internal consistency of the scale's subscales and total score, indicating its reliability and usefulness in measuring the abuse and neglect constructs. Sex invariance analysis indicated that the scale operates similarly across both sexes, making it applicable and interpretable for both males and females. The concurrent validity analysis demonstrated a strong relationship between the Arabic NAS and associated metrics, confirming its ability to capture important aspects of NAS among Arabic-speaking older individuals. In sum, the study's conclusions support the validity and reliability of the Arabic NAS as a method for accurately evaluating abuse and neglect of the older Arabic-speaking population. Declarations Ethics Approval and Consent to Participate : Ethical permission was acquired with the IRB code 00013620 (AU-20-5-239) from the Research Ethics Committee of the Faculty of Nursing, Alexandria University, Egypt. Written informed permission was given by all subjects, and submitting a soft copy online was regarded as providing written informed consent as well. The study's methodology complied with all applicable rules and regulations. Consent for publication: Not applicable. Availability of data and materials: All of the data created or examined for this work are not publicly available, however they can be obtained from the corresponding author upon justifiable request. Competing interests: The authors have nothing to reveal. Funding: nonexistent. Author contributions: The study was conceptualized by FFR, MIMK, and SH. MIMK, EFSM, and RSS formulated the initial draft of the text. RSS and EFSM were responsible for data collection. ZB and SH conducted the analysis and provided their interpretation. MIMK, EFSM, RSS, ME, RFMM, FFR, and SH made substantial contributions to the final draft through their writing. All authors granted their final approval of the work subsequent to an evaluation of its intellectual merit. Acknowledgements: The authors extend their heartfelt gratitude to every older adult participant who graciously assisted with the study. 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Ruelas-González MG, Pelcastre-Villafuerte BE, Monterrubio-Flores E, Alcalde-Rabanal JE, Ortega-Altamirano DV, Ruano AL, Saturno Hernández PJ: Development and validation of a Screening Questionnaire of Family Mistreatment against Older Adults for use in primary care settings in Mexico . Health & social care in the community 2018, 26 (1):102-112. Bužgová R, Ivanová K: Violation of ethical principles in institutional care for older people . Nursing ethics 2011, 18 (1):64-78. Naderi Z, Gholamzadeh S, Ebadi A, Zarshenas L: Development and psychometric properties of the hospitalized elder abuse questionnaire (HEAQ): a mixed methods study . BMC geriatrics 2022, 22 (1):715. Asiamah N, Kouveliotis K, Eduafo R, Borkey R: Psychometric Properties of a New Scale Measuring Neglect and Abuse of Older Adults in the Community: Implications for Social Activity . International quarterly of community health education 2021, 41 (2):163-172. United Nations Population Fund (UNFPA): The rights and wellbeing of older persons in Egypt : UNFPA; 2021. Mahmoud ES, Mohamed SA, Abozied AM, El-Sayed NM: The Relationship between Elderly Abuse and Quality of Nursing Care in Outpatient Clinics . NILES journal for Geriatric and Gerontology 2024, 7 (1):26-50. Abdel Rahman TT, El Gaafary MM: Elder mistreatment in a rural area in Egypt . Geriatrics & gerontology international 2012, 12 (3):532-537. World Health Organization (WHO): Tackling Abuse of Older People: Five Priorities for the United Nations Decade of Healthy Ageing (2021–2030) : WHO; 2022. Malmedal W, Kilvik A, Steinsheim G, Botngård A: A literature review of survey instruments used to measure staff-to-resident elder abuse in residential care settings . Nursing open 2020, 7 (6):1650-1660. Mydin FH, Mikton C, Choo WY, Shanmugam RH, Murray A, Yon Y, Yunus R, Hairi NN, Hairi F, Beaulieu M, Phelan A: PROTOCOL: Psychometric properties of instruments for measuring elder abuse and neglect in community and institutional settings: A systematic review . Campbell systematic reviews 2023, 19 (3):e1342. Bowling A, Hankins M, Windle G, Bilotta C, Grant R: A short measure of quality of life in older age: the performance of the brief Older People's Quality of Life questionnaire (OPQOL-brief) . Archives of gerontology and geriatrics 2013, 56 (1):181-187. Bowling A, Stenner P: Which measure of quality of life performs best in older age? A comparison of the OPQOL, CASP-19 and WHOQOL-OLD . Journal of epidemiology and community health 2011, 65 (3):273-280. Bilotta C, Bowling A, Nicolini P, Casè A, Pina G, Rossi SV, Vergani C: Older People's Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up. A prospective cohort study on older outpatients living in the community in Italy . Health and quality of life outcomes 2011, 9 :72. Khalil M, Hallit S, Fekih-Romdhane F, Bitar Z, Shaala R, Mousa E, Menessy R, Elnakeeb M: Psychometric Properties of an Arabic Translation of the older people’s quality of life-brief (OPQOL-brief) scale . Research Square 2024, 1 :1-19. Li YT, Ow YSY: Development of resilience scale for older adults . Aging & mental health 2022, 26 (1):159-168. Elnakeeb M, Hallit S, Fekih-Romdhane F, Shaala R, Sayed Mousa E, Khalil M: Psychometric Properties of an Arabic Translation of the Resilience Scale for Older Adults . Aging and Mental Health 2024. Hu Lt, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives . Structural Equation Modeling: A Multidisciplinary Journal 1999, 6 (1):1-55. Package ‘semTools’ [https://cran.r-project.org/web/packages/semTools/semTools.pdf. [Accessed in: May, 2024]] Mulaik S, James L, Alstine J, Bennett N, Lind S, Stilwell C: Evaluation of Goodness-of-Fit Indices for Structural Equation Models . Psychological Bulletin 1989, 105 :430-445. Barnett DW, Barnett A, Nathan A, Van Cauwenberg J, Cerin E: Built environmental correlates of older adults' total physical activity and walking: a systematic review and meta-analysis . The international journal of behavioral nutrition and physical activity 2017, 14 (1):103. Chen BI, Hsueh MC, Rutherford R, Park JH, Liao Y: The associations between neighborhood walkability attributes and objectively measured physical activity in older adults . PloS one 2019, 14 (9):e0222268. Penhale B: Gender Issues in Elder Abuse . In: Advances in elder abuse research. edn. Edited by Phelan A: Springer; 2020: 165-180. Jeon GS, Cho SI, Choi K, Jang KS: Gender Differences in the Prevalence and Correlates of Elder Abuse in a Community-Dwelling Older Population in Korea . International journal of environmental research and public health 2019, 16 (1):100. Chokkanathan S, Natarajan A: Perceived Quality of Life following Elder Mistreatment in Rural India . The journals of gerontology Series B, Psychological sciences and social sciences 2018, 73 (5):e69-e80. Yang Y, Salari S: Elder mistreatment and psychological resilience: the moderating role of social support . J Elder Abuse Negl 2024:1-16. WHO: World Report on Violence and Health. . WHO Press 2019. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4565016","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317878878,"identity":"b05e53e5-7cf8-4e7a-a800-63458d5e9052","order_by":0,"name":"Marwa Ibrahim Mahfouz Khalil","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Marwa","middleName":"Ibrahim Mahfouz","lastName":"Khalil","suffix":""},{"id":317878879,"identity":"ef161c94-8fe5-4e4a-8b40-bfe00d9330c7","order_by":1,"name":"Reem Said Shaala","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"Said","lastName":"Shaala","suffix":""},{"id":317878880,"identity":"506ce1ca-2ae1-481c-a910-67144e192e1f","order_by":2,"name":"Mayar Elnakeeb","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Mayar","middleName":"","lastName":"Elnakeeb","suffix":""},{"id":317878881,"identity":"d7127c95-fd33-4007-b06a-84969b6c78e7","order_by":3,"name":"Reem Farag Mahrous Menessy","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"Farag Mahrous","lastName":"Menessy","suffix":""},{"id":317878882,"identity":"47bf0025-72d2-4b79-a30c-0fa9e46b719b","order_by":4,"name":"Souheil Hallit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYHACNgYGA4sEBnbmhgMMFUA+DwTLGODXIpHAwMzYcODAGYQWHvxaGCBaGA62EaFFvr3H7MGHAok8/mbGxsMf5x225+c5wPjgbRsDjzkOLQZnzpgbzjCQKJY4DHTYwW2HE2f2NjAbzgVqsWzAoUUix0yax0AisQGqJcHgPAObNC9Qi8EBHA6bAdTyB6hlPljLnMP29ucZ2H/j08JwA6gFaFfiBrAWoF0beBvYmPFpMThzrEyyB6hlI0jLmWPpiTPOHGyWnHNOAqdf5Nubt0n8+GOTOO948+EPFTXW9vw9yQc/vCmzkcMVYtgAI8h4CRI0jIJRMApGwShABwD8Clzecqzy/AAAAABJRU5ErkJggg==","orcid":"","institution":"Holy Spirit University of Kaslik","correspondingAuthor":true,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""},{"id":317878883,"identity":"46b44df5-14b6-4d42-b032-c42efde40c48","order_by":5,"name":"Feten Fekih-Romdhane","email":"","orcid":"","institution":"Tunis El Manar University","correspondingAuthor":false,"prefix":"","firstName":"Feten","middleName":"","lastName":"Fekih-Romdhane","suffix":""},{"id":317878884,"identity":"6386f608-d6f5-4ee5-949c-e8fafa39dd72","order_by":6,"name":"Zeinab Bitar","email":"","orcid":"","institution":"Univ Rennes, EHESP, Irset (Institut de recherche en santé","correspondingAuthor":false,"prefix":"","firstName":"Zeinab","middleName":"","lastName":"Bitar","suffix":""},{"id":317878885,"identity":"2d6124ba-5fe4-498a-9aa9-328fc6ae3c54","order_by":7,"name":"Enas Fouad Sayed Mousa","email":"","orcid":"","institution":"Helwan University","correspondingAuthor":false,"prefix":"","firstName":"Enas","middleName":"Fouad Sayed","lastName":"Mousa","suffix":""}],"badges":[],"createdAt":"2024-06-11 14:55:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4565016/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4565016/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60184399,"identity":"a62a871a-50dc-48be-8a7e-7ddb9e7b3783","added_by":"auto","created_at":"2024-07-12 18:37:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19675,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParallel analysis Scree Plots\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4565016/v1/6152c87f1c2162f947d4bdfe.png"},{"id":60184398,"identity":"b9193443-5b98-4dc5-82b4-50c500cad176","added_by":"auto","created_at":"2024-07-12 18:37:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85315,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1. Standardized Factor loadings of the Neglect and Abuse scale (NAS) items following a first- and second-order confirmatory factor analysis.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4565016/v1/997accad1d2e0e4b966143e9.png"},{"id":70438183,"identity":"49cc78f7-c01a-4072-affc-7ffd2be24ac3","added_by":"auto","created_at":"2024-12-03 07:24:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1918630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4565016/v1/f762ac81-2c87-4bbc-a130-931ba8a7e640.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Translation, validity, and reliability of the Arabic-language version of the 11- item Neglect and Abuse Scale (NAS) in Community Older Adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe aging process is one of the most delicate times of a person\u0026apos;s life\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e[1]. The number of individuals in the world who are 60 years of age or older is steadily rising worldwide, and is expected to double, to around 2.1 billion, by the year 2050 [2]. In a response, various governing bodies have instituted aging-in-place policies, resulting in a shift towards home-based care and assigning substantial roles to care partners and home care services [3-5]. However, the connections between older people and their family members have actually suffered greatly as a result of breakthroughs in technology, financial welfare, and family structure [6]. In their advanced age, older adults may be inadequately prepared and/or less inclined to establish new social connections, resulting in disengagement. Family members, contending with conflicting role obligations, often grapple with managing the stress associated with caregiving. This marginalization, coupled with insufficient social support, renders them susceptible to maltreatment and neglect - an issue of global concern that demands prompt attention [7].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDefinition, prevalence, risk factors and consequences of older adults\u0026rsquo; abuse and neglect\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the World Health Organization (WHO), older adults\u0026rsquo; abuse is defined as \u0026quot;a single or repeated act, or lack of appropriate action, which causes harm or distress to an older person\u0026quot;. Abuse on all fronts\u0026mdash;physical, sexual, psychological, emotional, financial, and material\u0026mdash;as well as neglect and major loss of respect and dignity are all included in this category of violence [8]. Operationally, neglect is defined as \u0026ldquo;the refusal or failure of responsible caregivers to provide a care dependent older adult with assistance in daily living tasks or essential support such as food, clothing, shelter, health and medical care\u0026rdquo; [9]. According to data from the WHO [8], one in six older adults aged 60 years and over have experienced abuse at least once in their lives, and the prevalence of abuse among this demographic is rising. Older adults\u0026rsquo; abuse in communities is on the rise, according to a systematic review and meta-analysis of 52 studies from 28 different countries [10]. A review by Yon, Mikton, Gassoumis, and Wilber (2017) showed that the overall prevalence of abuse among community-dwelling older persons was 15.7%, and estimated the prevalence of neglect to be 4.2% based on 30 studies conducted in 20 different countries [11]. \u003c/p\u003e\n\u003cp\u003eDue to the world\u0026apos;s old population\u0026apos;s rapid growth and the societal changes, older adults\u0026rsquo; abuse and neglect are becoming a major social issue [12], and a matter of significant concern within the realm of public health, bearing serious implications for social, economic, and health domains [11]. Advanced age, female gender, higher educational status, lower economic status, dependency, loneliness, dementia, social isolation, and a violent family background are risk factors for older adults\u0026rsquo; abuse [13, 14]. Ageism against older people and specific cultural norms (e.g., normalization of violence) are community- and societal-level elements that have been connected to older adults\u0026rsquo; abuse instances [15]. Furthermore, a previous study showed significant correlations between abuse and the health and resilience of older adults [16]. This study suggested that a lower probability of exposure to abuse among older adults is associated with higher resiliency scores, indicating that as participants become more resilient, they are less likely to experience physical, anxiety, depression, and fatigue issues. Conversely, there is a negative moderate correlation between experience of abuse and health, meaning that as exposure to abuse decreases, the health of older adults improves.\u003c/p\u003e\n\u003cp\u003eThe adverse health outcomes resulting from the mistreatment of older individuals can be particularly serious. This form of abuse has the potential to diminish an individual\u0026apos;s functional capacity, increase their dependence, contribute to cognitive impairment, and elevate the risk of malnutrition, polypharmacy, morbidities, or premature death [15, 17]. It raises the likelihood of hospital admission and institutionalization, both of which have a major, detrimental financial impact on health, families, and society at large, encompassing healthcare expenses for medical care and recovery, along with the delivery of support and assistance by the judicial and societal framework [18, 19]. Despite its widespread prevalence and serious consequences on physical and mental health, older adults\u0026rsquo; abuse is inadequately reported, and its precise rate remains uncertain [20]. A report from the US Department of Justice asserts that a significantly larger proportion of harassment and inappropriate behavior is perpetrated against senior citizens than is officially documented. Only one out of every 23 incidents are reported to the relevant governing bodies [21]. Discrepancies in the statistical data related to this issue stem from a lack of consensus on the assessment of older adults\u0026rsquo; abuse [15].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasurement of abuse and neglect among older adults\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple methodologies are available for evaluating abuse and neglect in older individuals. Presently, there is no universally acknowledged standard for appraising older adults\u0026rsquo; abuse. There is an important diversity of legal definitions, a broad spectrum of clinical experiences and scenarios, and a significant overlap between indicators of abuse and disease markers, in addition to the variations in standards across different regions. Consequently, a compelling need exists for further validation testing of the existing assessment tools [22, 23].\u003c/p\u003e\n\u003cp\u003eOverall, the majority of published tools were predicated on inadequate construct descriptions (abuse-focused tools) and tests of validity with older adults [24, 25]. Many previously developed scales constituted components of generic older adults\u0026rsquo; abuse measurements [25-27]. For instance, the Conflict Tactics Scale was initially designed to assess abuse and neglect in the older population, but it was predominantly appraised with students [28, 29]. The Elder Abuse Instrument (EAI, [30]) and the Elderly Indicators of Abuse (E-IOA, [31]) have not been validated in a sample of community-dwelling older people. In addition, some measures may not encompass all types of abuse, such as the Older Adult Abuse Psychological Measure (OAPAM) [32] and the Older Adult Financial Exploitation Measure (OAFEM) [33]. Another measure recently developed in Japan, i.e. the 36-item Assessment Tool for Domestic Elder Abuse (ATDEA), encompasses different types of domestic abuse among older adults; however, it can be burdensome as a lengthy assessment [34]. Few were culturally and socially tailored instruments to specific older adults (such as the Family Members Mistreatment of Older Adults Screening Questionnaire, for Mexican older adults) [35]. Some tools can be utilized to appraise abuse among older adults either in nursing homes [36] or in acute care settings [37].\u003c/p\u003e\n\u003cp\u003eIt is notable that no antecedent measurement scales tailored to evaluate neglect and abuse within local communities have come to light, and an Arabic version of such a scale remains unidentified. In 2020, Asiamah et al. [38] developed the Neglect and Abuse Scale (NAS). The NAS represents the inaugural endeavor to quantitatively assess instances of neglect and abuse experienced by older adults within their respective communities. The scale is composed of 11 items, each accompanied by three descriptive anchors denoting \u0026quot;not at all\u0026quot; (1), \u0026quot;sometimes\u0026quot; (2), and \u0026quot;always\u0026quot; (3) [38]. The analytical process yielded a bifactorial solution labeling its extracted factors as \u0026quot;neglect and assault\u0026quot; (N\u0026amp;A) and \u0026quot;discrimination and exploitation\u0026quot; (D\u0026amp;E). Factor 1 (D\u0026amp;E) encompasses eight items, each emblematic of diverse forms of abusive behaviors, inclusive of age-based discrimination, cheating, deceit for personal gain, instilling fear and panic, sexual harassment, denial of rights or privileges, stealing or defrauding, and betrayal. Factor 2 (N\u0026amp;A) comprises three items, pertaining to neglect (i.e. the deficiency in ensuring an individual\u0026apos;s well-being), verbal abuse/disparaging remarks, and physical battery and assault, (i.e. acts causing bodily harm or injury to older adults). The scale has evinced commendable internal consistency and validity, thus endowing it with utility as a discerning instrument for appraising neglect and abuse experienced by older adults at the community level [38].The NAS has, therefore, a broad scope ensuring it captures the multifaceted nature of older adults\u0026rsquo; abuse. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRationale of the present study \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic landscape of Egypt is changing quickly. According to projections, the proportion of seniors (60 and over) in the population would more than double between 2020 and 2050, from 8.4 million, or 8% of the total, to 22 million, or 14% [39]. Despite the traditional collectivist nature of its culture, Egypt is currently witnessing a rise in the prevalence of older adults\u0026rsquo; abuse, impacting the perception of nursing care quality among older adults [40]. For instance, a cross-sectional survey found that 43.7% of Egyptian older adults reported experiencing abuse at the hands of family members, with neglect accounting for the majority of cases (42.4%) [41]. Because a high proportion of older adults\u0026rsquo; abuse cases remain undetected, it is imperative for healthcare providers and social workers providing at-home care services to have access to validated tools to identify elder abuse, given their apt positioning to recognize instances of abuse. This study addresses older adults\u0026rsquo; abuse and neglect within the context of a psychometric analysis of the Arabic version of the scale, directly contributing to the objectives of the UN Decade of Healthy Ageing [42]. The absence of linguistic and culturally equivalent measurement instruments that retain the same meaning and conceptual relevance through the examination of psychometric properties used to measure the prevalence of elder abuse in Arabic-speaking countries has been identified [22, 43, 44]. Validating this neglect and abuse scale for use with Arabic-speaking older adult populations is crucial to ensure its cultural appropriateness, linguistic equivalence, and contextual applicability across the diverse Arab world, where no such measure previously existed. This process can strengthen the scale\u0026apos;s utility and adoption for research and clinical practice in Arabic-speaking settings, and can assist researchers and practitioners in better detecting and addressing this important public health issue. In this context, the present study aimed to examine the psychometric properties of a new Arabic translation of the NAS in a sample of Arabic-speaking sample of community older adults from Egypt. It is expected that the two-factor solution will be supported, and that the Arabic NAS will show good reliability and concurrent validity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe investigation utilized a descriptive correlational design with a cross-sectional approach to examine a cohort of individuals aged 60 years or older, who possessed Egyptian citizenship and were proficient in the Arabic language. The study encompassed 539 participants, inclusive of individuals of both male and female genders. Prior to their participation, each individual provided informed consent and affirmed the absence of cognitive, communication, or neurodegenerative impairments. Exclusion criteria were applied to individuals with visual impairments such as severe retinopathy, glaucoma, or cataracts, as well as those demonstrating mental incapacity or acute illnesses necessitating inpatient care. Participants were recruited through face-to-face interviews at one-day clinics affiliated with General Alexandria Main University Hospital and via an online survey distributed through social media platforms such as Facebook, Messenger, and WhatsApp. Written permissions were obtained from official authorities and heads of the one-day clinics prior to participant enrollment. Participants were apprised of the study\u0026apos;s objectives, as well as the confidentiality and anonymity of their responses. Those meeting the inclusion criteria provided digital informed consent and completed the online form. The survey was conducted between August and October 2023, and participation was voluntary. Data were collected using a Google Form link.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe 11-item Neglect and abuse scale of older adults in the community\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe NAS, developed by Asiamah et al. in 2021, comprises 11 items divided into two factors (\u0026quot;neglect and assault\u0026quot;, N\u0026amp;A; and \u0026quot;discrimination and exploitation\u0026quot;, D\u0026amp;E), that constitute two potential indicators of neglect and abuse of older adults at the community level [38]. The translation of the NAS was carried out by two translators whose native language is Arabic and who were proficient in both English and Arabic. These translators were then validated by a committee consisting of a linguistics expert and healthcare professionals. The objective of this validation was to guarantee that the translated Arabic version of the NAS was free from any inconsistencies and ambiguities. To this end, the Arabic version of the scale was blindly back-translated into English by two independent translators who were proficient in both English and Arabic. The back-translated measure was then reviewed by the expert committee to reconcile any discrepancies between the translations. It is important to note that the translation of the RSOA was done in Standard Arabic, which is universally understood by all Arabic-speaking countries, regardless of the specific accent used. This translation followed a guideline in translation, adaptation, and validation as outlined by Sousa and Rojjanasrirat (2011). The research team intervened to resolve the inconsistency in case of disagreement between translators. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Older People\u0026apos;s Quality of Life-brief (OPQOL-brief) Questionnaire\u003c/strong\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis questionnaire is intended for the self-assessment of the quality of life (QOL) among the aging population [45]. It encompasses thirteen questions that evaluate various domains such as leisure activities, home and neighborhood environment, social interactions, autonomy, mental and emotional well-being, and overall health. Typically, participants rate their experiences and feelings over a specified period using a Likert scale with five points, ranging from \u0026quot;strongly agree\u0026quot; to \u0026quot;strongly disagree.\u0026quot; The total score on the OPQOL-brief is calculated by summing all the items, with higher scores indicating a higher quality of life, ranging from 13 to 65 [46, 47]. The OPQOL-brief is considered a valid and reliable tool for assessing QOL in older individuals [45]. The Arabic version of the scale was used in our study [48].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Resilience Scale of Older Adults (RSOA)- Arabic version. \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe RSOA is a versatile survey designed to evaluate older individuals\u0026apos; protective resilience characteristics from their own perspective. It comprises fifteen items, and respondents rate each item on a five-point Likert scale from one (never) to five (always). The RSOA has demonstrated strong reliability with a Cronbach\u0026rsquo;s alpha of 0.882. The item reliability of each subscale ranges from 0.25 to 0.83. Higher scores on all RSOA variables as well as the overall score indicate higher resilience levels in older individuals [49]. The Arabic version of the scale was used in our study [50].\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp skip=\"true\"\u003eThe factor structure of the NAS was explored using the EFA and CFA using RStudio (Version 4.2.2.). First, we checked the original 11-items unidimensional version, showing a very bad fit to the present data. Consequently, we decided to divide the sample into two subsamples of 33% (n=178) and 67% (n=361) randomly. EFA was performed on the first half sample (n=178) based on the principal component extraction approach and the orthogonal \u0026ldquo;Varimax\u0026rdquo; rotation. Factors were extracted for further analysis based on eigenvalues on the Scree plot (Factors with eigenvalues \u0026gt;1) (Figure 1). The data viability for factorability was evaluated through Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) measure of sample adequacy (Values \u0026gt;0.7) and Bartlett\u0026rsquo;s test of Sphericity (P\u0026lt;0.05) [51]. After that, we performed a CFA on the other subsample (n=361) to confirm the derived factor structure from EFA. A confirm[52]atory factor analysis was conducted using the \u0026ldquo;Lavaan\u0026rdquo; and \u0026ldquo;SemTools\u0026rdquo; package [52].\u003c/p\u003e\n\u003cp skip=\"true\"\u003eValues greater than 0.90 and 0.95 for the CFI and TLI, values closer to 1.00 for the GFI indicate good model fit. However, values for the RMSEA are expected to be at or below 0.08 to represent a good model fit, whereas values \u0026le;0.10 are indicative of an acceptable fit [53].\u003c/p\u003e\n\u003cp\u003eTo examine gender invariance of the NA scores, we conducted multi-group CFA assessed at the configural, metric, and scalar levels. Following the recommendations of (Chen, 2007), we accepted \u0026Delta;CFI\u0026thinsp;\u0026le;\u0026thinsp;0.010 and \u0026Delta;RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.015 or \u0026Delta;SRMR\u0026thinsp;\u0026le;\u0026thinsp;0.010 (0.030 for factorial invariance) as evidence of invariance. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eExploratory Factor Analysis (sample 1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, the original 11-items unidimensional version, revealed a bad fit: RMSEA of 0.12 [90% CI 0.11, 0.13], CFI of 0.86, TLI of 0.82 and a GFI of 0.84. EFA with Varimax rotation extracted two factors from the NAS measure. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e below shows the factor loadings of 11 items of the NA measure for two extracted factors from the EFA. The internal consistency was adequate for F1 (\u0026alpha;\u0026thinsp;=\u0026thinsp;.84 / \u0026omega;\u0026thinsp;=\u0026thinsp;.84) and F2 (\u0026alpha;\u0026thinsp;=\u0026thinsp;.84 / \u0026omega;\u0026thinsp;=\u0026thinsp;.85).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactor loadings of the Neglect and Abuse scale items following the Exploratory Factor Analysis.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eThe Neglect and Abuse scale (NAS)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExtracted factors*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeglect you though they have an obligation toward your welfare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsult you or say demeaning things about you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysically assault you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiscriminate you based on your age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCheat you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeceive you for personal interests\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInstill fear and panic in you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexually harass you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHave your rights or privileges denied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSteal from you or defraud you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetray you\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*Exploratory factor analysis with Varimax rotation; Factor loadings\u0026thinsp;\u0026lt;\u0026thinsp;0.4 are not shown for simplicity\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eConfirmatory Factor Analysis (sample 2)\u003c/h2\u003e\n \u003cp\u003eA CFA was conducted in using the \u0026ldquo;Lavaan\u0026rdquo; and \u0026ldquo;SemTools\u0026rdquo; package. The two-factor solution of the NAS showed a \u0026chi;2\u0026thinsp;=\u0026thinsp;157.537, df\u0026thinsp;=\u0026thinsp;42, CFI of 0.93, TLI of 0.91 and a GFI of 0.92, and a good RMSEA of 0.08 [90% CI 0.07, 0.10]. The second order CFA of the NAS showed good fit indices as follows: \u0026chi;2\u0026thinsp;=\u0026thinsp;157.537, df\u0026thinsp;=\u0026thinsp;39, CFI of 0.93, TLI of 0.90 and a GFI of 0.93, and a good RMSEA of 0.09 [90% CI 0.08, 0.11] (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The internal consistency was adequate for F1 (\u0026alpha;\u0026thinsp;=\u0026thinsp;.83 / \u0026omega;\u0026thinsp;=\u0026thinsp;.83), F2 (\u0026alpha;\u0026thinsp;=\u0026thinsp;.83 / \u0026omega;\u0026thinsp;=\u0026thinsp;.84) and the total score (\u0026alpha;\u0026thinsp;=\u0026thinsp;.88 / \u0026omega;\u0026thinsp;=\u0026thinsp;.89).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSex invariance (total sample)\u003c/h2\u003e\n \u003cp\u003eSex invariance for the two-dimensional NA scale was confirmed at the configural, metric and scalar models. Results were shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. No significant difference in terms of neglect and abuse scores was seen between males and females (16.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93 vs 15.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64, t(537)\u0026thinsp;=\u0026thinsp;1.49, p\u0026thinsp;=\u0026thinsp;.137).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eConcurrent validity (total sample)\u003c/h2\u003e\n \u003cp\u003eHigher neglect and abuse were significantly and moderately associated with lower resilience (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.28; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower quality of life (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.41; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMeasurement invariance across sexes.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModel Comparison\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;CFI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;RMSEA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;SRMR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta;df\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConfigural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e294.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfigural and metric\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e285.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetric and scalar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e9.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScalar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e294.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first foreign language adaptation study of the NAS, and represents the inaugural effort to address older adults\u0026rsquo; abuse and neglect through a psychometric analysis of the Arabic version of the scale. The objectives of the present study were to explore the factor structure, reliability, gender invariance, and concurrent validity of the NAS, which stands as the primary instrument developed to assess community-level abuse and neglect of older adults. Given its status as the inaugural tool designed to measure a significant obstacle to walkable neighborhoods, defined as communities that support neighborhood-level active behaviors such as walking, bicycling, skating, and other forms of active transportation [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], this scale has the potential to exert a substantial impact on gerontology, research, and public health policy. Findings showed that the Arabic-language version of the NAS is a valid, reliable and easily applicable scale for assessing abuse and neglect in older individuals within the community.\u003c/p\u003e \u003cp\u003eCFA yielded a two-factor structure, supporting the originally proposed factorial model. The reliability or internal consistency of the scales was estimated using two primary psychometric indicators, namely the Cronbach\u0026rsquo;s α coefficient and McDonald's omega (\u0026ge;\u0026thinsp;.7 and factor loading\u0026thinsp;\u0026ge;\u0026thinsp;0.5). Our reliability assessments of the validated scale indicated a commendable level of internal consistency for the overall score (α\u0026thinsp;=\u0026thinsp;.88 / ω\u0026thinsp;=\u0026thinsp;.89), as well as for F1 (α\u0026thinsp;=\u0026thinsp;.83 / ω\u0026thinsp;=\u0026thinsp;.83), F2 (α\u0026thinsp;=\u0026thinsp;.83 / ω\u0026thinsp;=\u0026thinsp;.84). Furthermore, every item of this scale [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] demonstrated a factor loading\u0026thinsp;\u0026ge;\u0026thinsp;0.5 (0.51\u0026ndash;0.81). In comparison, the English version of the scale displayed an overall Cronbach\u0026rsquo;s α of .9, with the \"N\u0026amp;A\" and \"D\u0026amp;E\" domains yielding alpha values of .74 and .92, respectively. Furthermore, every item of this scale exhibited a factor loading\u0026thinsp;\u0026ge;\u0026thinsp;0.5 (0.52\u0026ndash;0.84). Consequently, the scale demonstrated good structural validity and internal consistency, and can serve as a valuable instrument for measuring neglect and abuse among Arabic-speaking older individuals.\u003c/p\u003e \u003cp\u003eSex invariance tests indicated that male and female participants did not significantly differ in the measurement features, suggesting the scale's applicability and interpretability across sexes. Research findings suggest that the majority of older individuals are female, and more older adult females experience abuse than their male counterparts [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. According to meta-analyses of older adults\u0026rsquo; abuse, older females, particularly those residing in non-Western countries such as in Asia and the Eastern Mediterranean, are more likely to be abused, whereas the rate of older adults\u0026rsquo; abuse does not differ by sex in Western developed countries [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These sex differences can be due to several factors, including higher educational attainment and better self-rated health in males compared to females [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConcurrent validity analysis unveiled a moderate negative correlation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.28, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.41, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) between the NAS scores [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and resilience and quality of life scores, suggesting that neglect and abuse is closely related to lower resilience, poorer quality of life, and indicating its utility in evaluating crucial aspects of neglect and abuse among older Arabic-speaking individuals.In agreement with our findings, the work of Chokkanathan \u0026amp; Natarajan [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] indicated that mistreatment was associated with diminished quality of life. older individuals with a history of abuse tend to exhibit lower levels of resilience [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], even when confounding factors are adjusted [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. According to the World Report on Violence and Health [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], older adults become less resilient toward abuse because of their physical limitations. Other vulnerabilities related to old age can also lead to poor resilience in the face of abuse, including economic dependency, lower mental health well-being and social connectedness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eStrengths of this study lie in its cultural relevance, comprehensive evaluation, adequate sample size, and methodological rigor. However, several limitations, such as generalizability, language and translation issues, concurrent validity measures, lack of longitudinal assessment, and limited participant characteristics such as their health and mental status, presence of chronic illnesses, frailty, levels of dependency, and caregiver-level factors, should be acknowledged. These factors may influence NA and could have implications for the interpretation of the scale's results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eClinical implications and future research\u003c/h2\u003e \u003cp\u003eThe Arabic translation of the NAShas several clinical implications, including its usefulness as an assessment tool, its potential for cross-cultural comparisons, and its application in intervention and prevention planning. Additionally, researchers can utilize the scale in studies examining the factors influencing abuse and neglect in Arabic-speaking older adults, which can lead to evidence-based interventions and policies, guide the allocation of resources, and develop targeted programs. Future studies should focus on further validation, cultural adaptation, and longitudinal studies. Comparative studies, predictive validity, and intervention development can enhance our understanding of and preventing abuse and neglect in older Arabic-speaking individuals. This should include examining its sensitivity and responsiveness in diverse Arabic-speaking populations and different settings, such as acute care settings and nursing home residents.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this research contributes to addressing the absence of valid and well-suited models for analyzing abuse and neglect in community-dwelling older Arabic-speaking individuals. The present results demonstrated the scale's reliability and robustness as a tool for assessing abuse and neglect among the Arabic-speaking older people in the community settings. The results derived from CFA provided evidence for a consistent factorial structure, indicating that the scale can accurately measure the phenomena of elder abuse and neglect in this population. Furthermore, reliability analyses supported the internal consistency of the scale's subscales and total score, indicating its reliability and usefulness in measuring the abuse and neglect constructs. Sex invariance analysis indicated that the scale operates similarly across both sexes, making it applicable and interpretable for both males and females. The concurrent validity analysis demonstrated a strong relationship between the Arabic NAS and associated metrics, confirming its ability to capture important aspects of NAS among Arabic-speaking older individuals. In sum, the study's conclusions support the validity and reliability of the Arabic NAS as a method for accurately evaluating abuse and neglect of the older Arabic-speaking population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e: Ethical permission was acquired with the IRB code 00013620 (AU-20-5-239) from the Research Ethics Committee of the Faculty of Nursing, Alexandria University, Egypt. Written informed permission was given by all subjects, and submitting a soft copy online was regarded as providing written informed consent as well. The study\u0026apos;s methodology complied with all applicable rules and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll of the data created or examined for this work are not publicly available, however they can be obtained from the corresponding author upon justifiable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have nothing to reveal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003enonexistent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eThe study was conceptualized by FFR, MIMK, and SH. MIMK, EFSM, and RSS formulated the initial draft of the text. RSS and EFSM were responsible for data collection. ZB and SH conducted the analysis and provided their interpretation. MIMK, EFSM, RSS, ME, RFMM, FFR, and SH made substantial contributions to the final draft through their writing. All authors granted their final approval of the work subsequent to an evaluation of its intellectual merit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors extend their heartfelt gratitude to every older adult participant who graciously assisted with the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCamargo-Casas S, Suarez-Monsalve S, Zepeda MUP, Garc\u0026iacute;a-Pe\u0026ntilde;a C, Cano-Gutierrez CA: \u003cstrong\u003eMultimorbidity, Depressive Symptoms, and Self-Reported Health in Older Adults: a Secondary Analysis of the Sabe Bogota Study\u003c/strong\u003e. \u003cem\u003eRevista de investigacion clinica \u003c/em\u003e2018, \u003cstrong\u003e70\u003c/strong\u003e(4):192-197.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO): \u003cstrong\u003eDecade of healthy ageing 2020\u0026ndash;2030\u003c/strong\u003e: WHO; 2020.\u003c/li\u003e\n\u003cli\u003eCutchin MP: \u003cstrong\u003eThe process of mediated aging-in-place: a theoretically and empirically based model\u003c/strong\u003e. \u003cem\u003eSocial science \u0026amp; medicine (1982) \u003c/em\u003e2003, \u003cstrong\u003e57\u003c/strong\u003e(6):1077-1090.\u003c/li\u003e\n\u003cli\u003eAnker-Hansen C, Skovdahl K, McCormack B, T\u0026oslash;nnessen S: \u003cstrong\u003eThe third person in the room: The needs of care partners of older people in home care services-A systematic review from a person-centred perspective\u003c/strong\u003e. \u003cem\u003eJournal of clinical nursing \u003c/em\u003e2018, \u003cstrong\u003e27\u003c/strong\u003e(7-8):e1309-e1326.\u003c/li\u003e\n\u003cli\u003eGenet N, Boerma W, Kroneman M, Hutchinson A, Saltman R: \u003cstrong\u003eHome Care Across Europe Current Structure and Future Challenges\u003c/strong\u003e: WHO; 2012.\u003c/li\u003e\n\u003cli\u003eKarimoei M, Reje N, Foroughan M, Montazeri A: \u003cstrong\u003eElderly Abuse Rates Within Family Among Members of Senior Social Clubs in Tehran\u003c/strong\u003e. \u003cem\u003eYektaweb Journals \u003c/em\u003e2012, \u003cstrong\u003e6\u003c/strong\u003e(4):37-50.\u003c/li\u003e\n\u003cli\u003eZawisza K, Galas A, Tobiasz-Adamczyk B, Grodzicki T: \u003cstrong\u003eValidity of a Self-Reported Neglect Scale Among Older Adults in Poland\u003c/strong\u003e. \u003cem\u003eThe Gerontologist \u003c/em\u003e2020, \u003cstrong\u003e60\u003c/strong\u003e(3):e117-e126.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO): \u003cstrong\u003eAbuse of older people\u003c/strong\u003e: WHO; 2022.\u003c/li\u003e\n\u003cli\u003eUnited Nations, Department of Economic and Social Affairs (DESA): \u003cstrong\u003eNeglect, abuse and violence against older women (ST/ESA/351)\u003c/strong\u003e. 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The psychometric properties of instruments measuring elder neglect and abuse in Arabic have not been previously examined. Validating these instruments can enhance the consistency of elder neglect and abuse (NA) prevalence estimates and contribute to a more comprehensive understanding of the issue at national, regional, and global levels. This study represents the first attempt to validate the Arabic version of the 11-item Neglect and Abuse Scale (NAS) and establish its psychometric soundness in a sample of Arabic-speaking Older Adults in the Community.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA cross-sectional study encompassed 539 Arabic-speaking older Egyptians, with 50.3% being female and 60.7% aged between 65 and 75. Participants completed an anonymous Google form-based questionnaire that included the NAS, the Older People's Quality of Life-brief (OPQOL-brief) Questionnaire, 15-item Resilience Scale of Older Adults (RSOA), and sociodemographic inquiries. The forward-backward translation method was employed to ensure accurate translation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eExploratory Factor analysis with Varimax rotation unveiled two factors from the NAS, reflecting the multidimensional nature of the scale. Confirmatory factor analysis validated the two-factor solution, demonstrating a good fit to the data. Reliability assessments showed a satisfactory level of internal consistency for the overall score and the two factors (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;.83 \u0026minus;\u0026thinsp;.88 / McDonald\u0026rsquo;s ω\u0026thinsp;=\u0026thinsp;.83 \u0026minus;\u0026thinsp;.89). Sex invariance tests indicated that male and female participants did not significantly differ in the measurement features, suggesting the scale's applicability and interpretability across sexes. Concurrent validity analysis revealed a moderate negative correlation between the Arabic NAS scores, RSOA (r =-.28, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and OPQOL-brief (r =-.41, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides a valid and reliable tool to identify and evaluate older adults\u0026rsquo; abuse and neglect in Arabic-speaking communities, supporting effective intervention and prevention efforts. It also facilitates cross-cultural comparisons of abuse and neglect rates, risk factors, and outcomes between Arabic-speaking community-dwelling older adults and other language groups, advancing the global understanding of this issue.\u003c/p\u003e","manuscriptTitle":"Translation, validity, and reliability of the Arabic-language version of the 11- item Neglect and Abuse Scale (NAS) in Community Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 18:36:55","doi":"10.21203/rs.3.rs-4565016/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e006af4a-4651-48be-92b3-f1f6e1660d47","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-03T07:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 18:36:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4565016","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4565016","identity":"rs-4565016","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}