Development and Validation of the Care Risk Perception Scale (CRPS) for Caregivers of Older Adults With Dementia in Long-Term Care Facilities

Abstract

Objectives: Global aging has increased the demand for long-term care facilities (LTCFs) for older adults with dementia. This challenge is further exacerbated by systemic barriers such as insufficient infrastructure and a shortage of trained caregivers within LTCFs. These limitations heighten care risks for vulnerable populations and underscore the urgent need for tools to evaluate caregivers' risk perceptions-a critical determinant of safety practices. This study developed and validated the Care Risk Perception Scale (CRPS), a specialized instrument designed to assess caregivers' perceived risk associated with dementia care and inform targeted interventions in LTCFs.

Design: A mixed-method design was used, including literature review, 2 rounds of Delphi expert consultation (n = 22), and psychometric validation with 501 caregivers in LTCFs.

Setting and participants: Participants were caregivers of older adults with dementia in LTCFs in Sichuan Province, China. Inclusion criteria required at least 3 months of caregiving experience and cognitive competence, March-September 2024.

Methods: A mixed-method design was used: (1) literature review and 2 Delphi rounds (22 experts) generated a preliminary scale; (2) psychometric validation involved 501 caregivers from 150 Chinese LTCFs, including item analysis, exploratory factor analysis (n = 200), and confirmatory factor analysis (n = 301).

Results: The final CRPS contains 23 items across 4 dimensions: institutional, environmental, psychological support, and competency risks. The scale demonstrated strong reliability (Cronbach's α = 0.882 overall; 0.753-0.905 for subscales) and validity (content validity = 0.928). Exploratory factor analysis extracted 4 factors explaining 69.78% variance (Kaiser-Meyer-Olkin = 0.888, Bartlett's χ² = 3753.073, P < .001). Confirmatory factor analysis confirmed model fit (χ²/df = 2.725, Comparative Fit Index = 0.928, Root Mean Square Error of Approximation = 0.075). Split-half reliability was 0.457 (P < .001), and test-retest reliability was 0.714 (P < .001).

Conclusions and implications: The CRPS is a scientifically robust tool to assess care risk perceptions in LTCFs. By identifying caregivers' risk awareness gaps, it supports targeted interventions and policy reforms for standardized safety audits to enhance dementia care quality and safety.

Keywords: Older adults with dementia; caregivers; long-term care facilities; risk perception; scale construction.