New medical task force guidance says ‘no’ to screening older adults for caregiver abuse

by Donna Shryer

The U.S. Preventive Services Task Force has concluded there is insufficient evidence to recommend screening older adults for caregiver abuse and neglect, even as new data reveals the widespread nature of elder mistreatment.

In updated recommendations published in JAMA, the independent panel of medical experts found that more than 1 in 10 adults aged 60 and older experienced at least one type of caregiver abuse or neglect in the past year. Among abused seniors, financial exploitation affects 35%, while neglect impacts 34%, making these the most common forms of elder mistreatment.

Despite this high prevalence, the task force concluded that current evidence is insufficient to assess whether the benefits of elder abuse screening outweigh potential harms. This contrasts sharply with its strong recommendation for screening women of reproductive age for intimate partner violence, where evidence shows moderate benefit.

The evidence gap stems from limited research on screening effectiveness in older populations. Researchers reviewed only two studies examining screening tools for adults 65 and older, with mixed results on accuracy. One tool showed 46% sensitivity and 73% specificity for detecting abuse in dental care settings, while another demonstrated 94% sensitivity and 84% specificity in emergency departments.

The task force emphasized that vulnerable adults, including those requiring care due to physical or mental disabilities, face higher rates of violent victimization regardless of age. However, no studies examined screening tools specifically designed for this population.

Researchers identified critical gaps requiring additional study, including the development of accurate screening instruments for primary care settings and evidence on intervention effectiveness. The task force noted that screening could potentially cause harm through shame, retaliation, or false-positive results, but acknowledged the serious health consequences of undetected abuse. 

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New medical task force guidance says ‘no’ to screening older adults for caregiver abuse