Screening For Intimate Partner Violence Elder Abuse And Abuse Of Vulnerable Adults

PURPOSE: To systematically review the evidence on screening for intimate partner violence (IPV), elder abuse, and abuse of vulnerable adults for populations and settings relevant to primary care in the United States. DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, Embase, and trial registries through October 4, 2017; reference lists of retrieved articles; outside experts; reviewers; and active surveillance of literature since August 2018. STUDY SELECTION: Two investigators independently selected English-language studies using a priori criteria. Eligible studies included randomized, controlled trials (RCTs) of screening or treatment for abuse victimization, studies evaluating accuracy of screening tests to detect abuse, and cohort studies with a concurrent control group assessing the harms of screening or treatment for abuse. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. DATA SYNTHESIS: Thirty studies (14,959 participants) were included. Three RCTs (3,759 participants) compared IPV screening (with brief intervention and information about referral options for screen positive women) with no screening; none found significant improvements in any outcome over 3 to 18 months (e.g., IPV, quality of life, or depression) and two RCTs (1,051 participants) reported no harms associated with screening. Fifteen studies assessed the accuracy of one or more abuse screening tools (1,051 participants); studies reported on different measures (e.g., current, past-year, or lifetime IPV). Nine studies assessed tools to detect any past-year or current IPV in women; for past-year IPV (5 studies; n=6,331), sensitivity of five tools ranged from 65 to 87 percent, and specificity ranged from 80 to 95 percent. The accuracy of five tools (4 studies; n=1,795) for detecting current abuse varied widely; sensitivity ranged from 46 to 94 percent, and specificity ranged from 38 to 95 percent. Eleven RCTs (6,740 participants) evaluated interventions for adult women with screen-detected IPV or who were considered at risk for IPV. Eight reported on the incidence of any category of IPV; two of these (575 participants) found a statistically significant benefit in favor of the intervention, one home visiting intervention (standardized mean difference -0.34; 95% CI, -0.59 to -0.08) and one behavioral counseling intervention addressing multiple risk factors (SMD -0.40; 95% CI, -0.68 to -0.12). Of the six other RCTs reporting on measures of any IPV exposure, one home visiting intervention (N=643) found an association with reduced IPV, but differences were not statistically significant (SMD -0.04; 95% CI, -0.23 to 0.14), and five RCTs (7,283 participants) found similar rates of IPV in both groups with no statistically significant differences between groups. Two RCTs (210 participants) reported on subtypes of violence only and found mixed results. One RCT assessing a behavioral counseling intervention targeted at multiple risk factors (IPV, smoking, depression, tobacco exposure) reported on birth outcomes among the subgroup of women who screened positive for IPV at baseline (306 of 1,044 enrolled participants) and found no significant difference between groups in rates of low birth weight neonates (

This review is an update for the U.S. Preventive Services Task Force (USPSTF) recommendation on screening women for intimate partner violence (IPV) and elderly and vulnerable adults for abuse and neglect. The USPSTF defines screening as obtaining information about abuse from individuals in health care settings who do not have complaints or obvious signs of abuse, such as physical injuries. In 2004, based on results of a previous review, the USPSTF found insufficient evidence to recommend for or against routine screening of women for IPV or of older adults or their caregivers for elder abuse. The USPSTF could not determine the balance between the benefits and harms of screening because of the lack of critical evidence, particularly the lack of trials of the effectiveness of screening in health care settings and the effectiveness of interventions to reduce harm from abuse. The USPSTF reviewed several existing screening instruments that demonstrated adequate internal consistency and were validated with longer instruments. However, none were evaluated against measurable violence or health outcomes. Also, despite reviewing an extensive literature on IPV, few studies provided data on screening and management to guide clinicians in practice, and there was little to no evidence from studies of elder abuse or neglect. The Centers for Disease Control and Prevention recognizes four categories of IPV, including physical violence, sexual violence, threat of physical or sexual violence, and psychological or emotional abuse. For this review, abuse and neglect of vulnerable adults is also considered with elder abuse. A vulnerable adult is a person age 18 years or older whose ability to perform the normal activities of daily living or to provide for his or her own care or protection is impaired due to a mental, emotional, long-term physical, or developmental disability or dysfunction, or brain damage. Definitions vary by State, and sometimes included in the definition is the receipt of personal care services from others. Types of elder abuse that also apply to vulnerable adults include physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation, and self neglect. Based on evidence gaps identified from the previous review and using the methods of the USPSTF, the USPSTF and Agency for Healthcare Research and Quality determined Key Questions for this review. Key Questions for IPV include: 1. Does screening asymptomatic women in health care settings for current, past, or increased risk for IPV reduce exposure to IPV, physical or mental harms, or mortality? 2. How effective are screening techniques in identifying asymptomatic women with current, past, or increased risk for IPV? 3. What are the adverse effects of screening for IPV? 4. For screen-detected women with current, past, or increased risk for IPV, how well do interventions reduce exposure to IPV, physical or mental harms, or mortality? 5. What are the adverse effects of interventions to reduce harm from IPV? Key Questions for elder and vulnerable adult abuse and neglect include: 1. Does screening asymptomatic elderly and vulnerable adults in health care settings for current, past, or increased risk for abuse and neglect reduce exposure to abuse and neglect, physical or mental harms, or mortality? 2. How effective are screening techniques in identifying asymptomatic elderly and vulnerable adults with current, past, or increased risk for abuse and neglect? 3. What are the adverse effects of screening for abuse and neglect of elderly and vulnerable adults? 4. For screen-detected elderly and vulnerable adults with current, past, or increased risk for abuse and neglect, how well do interventions reduce exposure to abuse and neglect, physical or mental harms, or mortality? 5. What are the adverse effects of interventions to reduce harm from abuse and neglect?

Learn the causes of—and consequences from—elder abuse of men For the most part, often only women are considered the victims of elder abuse. However, men are also subject to this disturbing social problem. Abuse of Older Men examines the diverse aspects of this surprisingly widespread issue that includes sexual abuse, abuse by intimates, and benign neglect in the health care field, as well as effective treatment strategies. This unique resource provides the latest research and crucial discussions of why the problem is often invisible, under-studied, and under-treated. Detailed explorations include risk assessment, differential detection of abuse of one gender over the other, the risk of abandonment, economic exploitation, and the issues of older men who had been abused in childhood. In the past, elder abuse literature has—quite correctly—mainly focused on the abuse of women, who represent the majority of older persons. Abuse of Older Men expands the discussion of this distressing social challenge to include the other gender, reviewing the different types of abuse and the reasons why it is not readily apparent in today’s society. This compelling text examines in detail the causes and consequences of elder abuse of men. The under-reporting of abuse is addressed, along with suggestions on ways to better approach various problems. This insightful resource is extensively referenced and provides tables to clearly present data. Issues discussed in Abuse of Older Men include: intimate partner abuse perpetrated against older men sexual abuse of older men in nursing homes the impact of gender on the reporting of elder abuse neglectful aspects of osteoporosis in older men past relationships that increase the risk of the neglect of older fathers news accounts that repost the frequency and types of abuse against men identifying and treating victims societal forces that affect older men’s risk of mistreatment recommendations for structuring services to better meet victim’s needs the social construction of manhood as an important factor in understanding the abuse of older men Abuse of Older Men provides crucial information practitioners, educators, researchers, and students in social work, nursing, medicine, law, gerontology, adult protective services, criminal justice, sociology, psychology, domestic violence, counseling, ethics, public policy, and aging networks.

This book provides a global comprehensive and systematic state-of-the review of this field that fills the gaps between research, practice, and policy. The book addresses the epidemiology of the issue and the global prevalence of elder abuse in both developed and developing countries, which synthesizes the most up-to-date data about risk factors and protective factors associated with elder abuse and consequences of elder abuse; clinical assessment and management of elder abuse, including screening, detection, management of elder abuse, and the role of decision making capacity and forensic approaches; practice and services that describe adult protective services, legal justice, elder court systems, and guardianship system; elder abuse and culture, which provides more in-depth anthropological and ethnographic experiences; policy issues, which highlights the elder justice movement, GAO reports, elder justice act, older American act and elder justice coordinating council; and future directions, which explores translational research, practice, education/training and policy issues surrounding elder abuse. Elder Abuse: Research, Practice and Policy is a useful resource for aging researchers, social services, general internists, family medicine physicians, social workers, nurses, and legal professionals interested in the issues of elder abuse.

Since the late 1970s when Congressman Claude Pepper held widely publicized hearings on the mistreatment of the elderly, policy makers and practitioners have sought ways to protect older Americans from physical, psychological, and financial abuse. Yet, during the last 20 years fewer than 50 articles have addressed the shameful problem that abusersâ€"and sometimes the abused themselvesâ€"want to conceal. Elder Mistreatment in an Aging America takes a giant step toward broadening our understanding of the mistreatment of the elderly and recommends specific research and funding strategies that can be used to deepen it. The book includes a discussion of the conceptual, methodological, and logistical issues needed to create a solid research base as well as the ethical concerns that must be considered when working with older subjects. It also looks at problems in determination of a report's reliability and the role of physicians, EMTs, and others who are among the first to recognize situations of mistreatment. Elder Mistreatment in an Aging America will be of interest to anyone concerned about the elderly and ways to intervene when abuse is suspected, including family members, caregivers, and advocates for the elderly. It will also be of interest to researchers, research sponsors, and policy makers who need to know how to advance our knowledge of this problem.

PRESERVING A LIFE OF PEACE AND DIGNITY FOR THE AGING This ground-breaking volume offers a new, collaborative approach geared to enhance case review, improve victim safety, raise abuser accountability, and promote system change. Sharing the common goal of promoting elder victim safety, experts in adult protective services, law enforcement, prosecution, health care, advocacy, and civil justice have formed a unique, multidisciplinary team approach to tackle the following critical topics: Establishing a collaborative description of elder abuse history Identifying the criteria for the reporting of cases Accessing the intervention systems involved Highlighting benefits and obstacles to success Reviewing policy, legislation, research, and social change As the aging population continues to grow, so does the potential for increasing cases of elder abuse. Replete with case examples that allow the experiences of victims to speak for themselves, this book provides the framework to begin, and to build on, collaborative approaches at the local, state, and national levels toward ending elder abuse.

Evidence pertaining to continual violence throughout the life cycle coupled with the experience of growing old in a life permeated by intimate violence is scarce. And the focus is usually on the victims ─ usually, the older, battered women ─ and seldom on their aging partners or adult children who were part and parcel of the violent dynamics in the family system. With the increase in longevity and the older population’s subsequent growth in size, the number of elderly couples living and aging in long-lasting conflictive relationships is on the rise. The relatively intense preoccupation with elder abuse in the gerontological literature in recent years has not specifically addressed long-term intimate violence among the old adults and its lasting consequences. Similarly, the literature on intimate intergenerational relationships in old age has usually focused on normative exchanges between partners and their extended family, including their adult children. Therefore, conflictive relationships, and particularly violent ones, have also fallen outside the scope of this body of research. This volume describes and analyzes the various perspectives of family members concerning life, and particularly old age, in the shadow of long-term intimate violence. It explores how people make sense out of living and aging in violence, how interpersonal, familial and cross-generational relationships are perceived and reconstructed and how “we-ness” is achieved, if at all, in such families.

CONTEXT: Family and intimate partner violence occurs commonly in the U.S. and causes important health problems. Although the clinician's role in identification and intervention is considered a professional and legal responsibility, the effectiveness of these efforts is unclear. OBJECTIVE: To examine evidence on the performance of screening procedures and interventions in the primary care setting in reducing harm from family and intimate partner violence for children, women, and elderly adults. DATA SOURCES: MEDLINE(r), PsycINFO, CINAHL, Health & Psychosocial Instruments, ERIC, AARP Ageline, and the Cochrane Controlled Trials Register, reference lists of systematic reviews, and experts. STUDY SELECTION: Included studies had English-language abstracts, were applicable to U.S. clinical practice, described abuse and neglect in women, children, or elderly adults, were conducted in or linked to primary care, obstetrics/gynecology, or emergency department settings, and included a clinician in the process of assessment or intervention. DATA EXTRACTION: We extracted selected information about study design, patient samples and settings, methods of assessment or intervention, and clinical endpointsand applied a set of criteria to evaluate study quality. DATA SYNTHESIS: No studies directly addressed the effectiveness of screening in a healthcare setting in reducing harm, or described the adverse effects of screening and interventions. All instruments designed to screen for child abuse and neglect were directed to parents, particularly pregnant women. These had fairly high sensitivity but low specificity. Several brief instruments designed to identify women with intimate partner violence compared well to longer previously validated instruments. We found few studies of screening for elder abuse and neglect. A randomized controlled trial with 15-years follow-up indicated that nurse home visits during pregnancy and for 2-years postpartum for low-income women improved abuse and neglect outcomes for children. Studies of interventions for children of other ages, women who are not pregnant, and elderly adults are lacking. CONCLUSIONS: Screening and interventions for child abuse are directed to parents during prenatal and postpartum periods. Several brief screening instruments have been tested for women, but interventions are lacking. Few instruments and no interventions were identified for elderly adults.

Product Description: Addresses key issues facing older people and our entire society. Topics include care pathway model, guidelines for health care professionals, understanding elder abuse in minority populations, moral and ethical implications of elder abuse, sexual violence against elderly women, helping victims, and more. For public health personnel.

In this second edition of their classic volume, the authors present their elder abuse diagnosis and intervention model. This comprehensive model of detection, assessment, and intervention enables the practitioner first to identify the type of elder mistreatment, including physical, sexual, psychological, and financial. It then provides systematic and realistic interventions. This updated edition also includes information on legal interventions with suggestions on how the practitioner should act in the courtroom, give testimony, document findings, and prepare for legal involvement with the criminal justice system. Actual legal tools are included in the appendix. This is a classic resource for all health professionals who work with the elderly.