Screening for Elder Abuse and Neglect – the USPSTF Report

The United States Preventive Services Task Force (USPSTF) released its updated standards for screening older or physically or mentally dysfunctional adults for abuse and neglect. The conclusion? “Recommendation I – current evidence is insufficient to assess the balance of benefits and harms of the service.”

What does this mean? There are varying interpretations – but the wrong interpretation is that we should forego screening for abuse and neglect in vulnerable older patients. As the CDC report notes, few studies have evaluated the accuracy and outcomes of specific screening strategies in older adults. Yet elder abuse in its various forms affects in the range of 2% to well above 10% of older adults. This can include physical, psychological, or sexual abuse, financial exploitation, and neglect. One study found that 1 in 10 older adults may have been abused, yet only 1 in 5 of these cases were reported.

No doubt there are potential harms of screening for elder abuse, such as shame, guilt, retaliation, and the unnecessary turmoil caused by false-positive results. Yet while strong evidence on this topic is limited, existing reports suggest that the risk of such harms might be small.

Where to next? My own practice is (or at least aspires) to follow the recommendations in an excellent recent review by Mosqueda and Dong. They recommend identifying risk factors for abuse or neglect such as cognitive or physical impairment, low degrees of social support, and aggressive behaviors. They recommend carefully observing for signs of abuse or neglect, include indications that the patient is fearful of the caregiver, injuries in unusual locations or with inadequate explanations, and changes in behavior such as missing appointments or decreasing standards of hygiene. Finally, they recommend asking the patient (and caregiver, where appropriate) simple, direct questions:

•  Has anybody hurt you? 
• Are you afraid of anybody?
• Are your mom’s needs more than you are able to handle?
• Are you worried that you might hit your mom?” 

 by: Mike Steinman