JAMA addresses issues with elder abuse screening

In editorials in this week’s issue of JAMA, authors discussed the need for more research in developing better screening tools for discovering instances of elder abuse.

The authors were responding to a statement issued Tuesday by the U.S. Preventive Services Task Force (USPSTF) that it “found no evidence about whether screening can successfully identify elderly or vulnerable adults who are being abused,” nor did it find evidence that screening can prevent elder abuse.

The editorial argues that the research done to indicate that screening is not supported by evidence was lacking and only assessed one tool. Researchers noted:

The field should clearly define each abuse subtype and develop brief, practical screener tools with input from multiple stakeholders for primary care and other health care professionals. These tools need to be tested in methodologically rigorous studies using confirmed abuse cases and appropriate controls. The findings of such studies should be disseminated to broad clinical audiences for evaluation and to encourage adoption. Only then can we expect the next USPSTF update to conclude something other than “insufficient evidence.”

Authors also noted that research is particularly limited when it comes to homebound individuals. Challenges to this include clinician underrecognition and underreporting and concerns regarding the accuracy of patient reports because of aging or dementia, patient reluctance, recanting, and fear of institutionalization, according to the editorial, which also noted that “elderly patients who have experienced abuse may also be difficult to enroll in studies because consent can be difficult to obtain, particularly if abuse is being perpetrated by the patient’s proxy or guardian.”

Authors concluded that more research is needed, but noted that self-screening tools through patient portals might be promising and more effective.

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