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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

Comments

Anonymous said…
Elder abuse is a serious and growing concern in both long-term care facilities as well as private homes. We would greatly encourage readers to check out this review by Hollie Caldwell, PhD, Elder Abuse Screening Instruments in Primary Care: An Integrative Review, 2004 to 2011 [http://www.clinicalgeriatrics.com/articles/Elder-Abuse-Screening-Instruments-Primary-Care-Integrative-Review-2004-2011.] We also recommend this tip sheet, which provides advice for preventing abuse and neglect in older adults. [http://www.clinicalgeriatrics.com/files/elder_abuse_tips.pdf.]
Richard said…
Most older people are not experiencing abuse. But, unfortunately, there are ways in which an older person can be harmed or abused by others. An older person may also experience more than one form of abuse at any given time. Government and NGO's should work hand-in-hand to overcome this problem. Don't forget that every person will become old at one stage. So respect your elder people.
helen zoya said…
Today elder abuse is continually increasing and has become one of serious problems in our society. In the survey it has been found that the majority of elder abuse victims are female. It is seriously a big shame on our society. People don’t want to live with their old parents and their why they have to take aid of old age homes.
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