There is no consensus that asymptomatic patients should be screened for elder abuse. The American Medical Association (AMA, 1992) suggests that all outpatients be screened for family violence, but the U.S. Preventive Services Task

Table 4-5 Elder Abuse: Definitions

Table 4-6 Screening Questions for Elder Abuse

Physical abuse: Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elderly person, or depriving the person of a basic need. Emotional abuse: Inflicting mental pain, anguish, or distress on an elderly person through verbal or nonverbal acts. Sexual abuse: Nonconsensual sexual contact of any kind. Exploitation: Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.

Neglect: Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.

Abandonment: The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person. Self-neglect: Characterized as the behavior of an elderly person that threatens his or her own health or safety.

Are you afraid of anyone at home?

Are you alone a lot?

Has anyone at home ever hurt you?

Has anyone taken anything that was yours without asking?

Does anyone at home make you uncomfortable or afraid?

Has anyone ever forced you to sign a document that you did not understand?

Are you kept isolated from friends or relatives?

Table 4-7 Physical Signs of Elder Abuse

Modified from National Center on Elder Abuse. October 2009.

Force (2009) concluded that there was insufficient evidence for or against screening for older adults or their caregivers for elder abuse. Patients should be screened if there is a suspicion of elder abuse. The questions should be open-ended, nonthreatening, and asked in a variety of ways to assess for the different forms of elder abuse (Table 4-6). A positive response should be followed by more direct questions as to the nature of the abuse. Direct questioning by physicians has been shown to increase reporting (Oswald et al., 2004).

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