Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms to improve the health of people nationwide.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

The USPSTF is committed to mitigating the health inequities that prevent many people from fully benefiting from preventive services. Systemic or structural racism results in policies and practices, including healthcare delivery, that can lead to inequities in health. The USPSTF recognizes that race, ethnicity, and gender are all social rather than biological constructs. However, they are also often important predictors of health risk. The USPSTF is committed to helping reverse the negative impacts of systemic and structural racism, gender-based discrimination, bias, and other sources of health inequities, and their effects on health, throughout its work.

Intimate partner violence (IPV) affects millions of Americans across the lifespan but is often unrecognized.^1-3 Nearly half of U.S. adult women (47%) and men (44%) report experiencing sexual violence, physical violence, or stalking in their lifetime.^1,3 Approximately half of U.S. adult women (49%) and men (45%) report experiencing psychological aggression by an intimate partner in their lifetime.^1,3 Women experience higher rates of sexual violence (20%), stalking (13.5%), severe physical violence (32.5%), and adverse health and social consequences associated with experiencing IPV (87%) compared with men (8%, 5.2%, 24.6%, and 60%, respectively).^1,3 Some evidence suggests that incidence, severity, and frequency of IPV increases and protective factors decrease during public health emergencies such as the COVID-19 pandemic.^1,4

Abuse of older and vulnerable adults by a caregiver or someone else they may trust is common and can result in significant injury, death, and long-term adverse health consequences.^1,5,6 More than 1 in 10 (11%) adults age 60 years or older report experiencing at least one type of abuse or neglect in the past year.^1,5 Vulnerable adults, persons who require care due to a physical or mental disability, are more likely to experience violent victimization and maltreatment regardless of age compared with adults without vulnerabilities.^1,7

The U.S. Preventive Services Task Force (USPSTF) concludes with moderate certainty that screening for IPV in pregnant or postpartum persons and women of reproductive age and providing or referring those who screen positive to multicomponent interventions has a moderate net benefit.

The USPSTF concludes that the evidence is insufficient on screening for caregiver abuse and neglect in older and vulnerable adults and the balance of benefits and harms cannot be determined.

Go to Table 1 for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.⁸

Patient Population Under Consideration

The recommendation on screening for IPV applies to pregnant and postpartum persons and women of reproductive age without recognized signs and symptoms of IPV. The recommendation on screening in older and vulnerable adults applies to persons without recognized signs and symptoms of abuse or neglect.

Definitions

IPV refers to physical violence, sexual violence, psychological aggression (including coercive tactics, such as limiting access to financial resources), or stalking by a current or former spouse or dating partner.^1,9 Based on evidence in the systematic review, multicomponent, higher-intensity interventions demonstrated a benefit in pregnant and postpartum persons. Women of reproductive age refers to pregnant and postpartum persons and nonpregnant women who are similar to populations enrolled in studies of effective interventions who could be eligible for similar services.

Abuse of older adults refers to acts whereby a trusted person (e.g., a caregiver) causes or creates risk of harm to an older adult.^1,10 For this definition, the Centers for Disease Control and Protection (CDC) considers older adults to be age 60 years or older.^1,10 This recommendation statement uses age-inclusive language such as “older” rather than “elderly.” The term caregiver broadly refers to relationships with a provision of assistance with daily activities and an expectation of trust. Abuse of vulnerable adults refers to acts (e.g., neglect) by persons in a caregiving role for persons age 18 years or older who rely on a caregiver due to physical or mental disability, or both, and are unable to protect themselves.¹ The legal definition of vulnerable adults varies by state. Abuse of older adults and vulnerable adults includes physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, and financial or material exploitation.¹ The populations addressed in this recommendation are not mutually exclusive. For example, older adults may have disabilities that could categorize them as “vulnerable,” and older or vulnerable adults may experience IPV.

Assessment of Risk of IPV

IPV affects persons of all ages and racial, ethnic, and socioeconomic backgrounds.¹ Based on the evidence, all pregnant and postpartum women of reproductive age should be screened. In a recent systematic review, individual factors that consistently increased risk of IPV included experiencing other forms of violence within the relationship, alcohol misuse, and mental health factors (posttraumatic stress disorder, depression, fear, threats of self-harm, borderline personality disorder, and anger).^1,11 Another systematic review reported unplanned pregnancy, having parents with a low level of education (e.g., less than a high school diploma), and being young and unmarried as specific risk factors for IPV perpetrated against women.^1,12 Evidence suggests that pregnancy may increase risk of initiation of IPV and worsen severity of IPV.^1,13

Based on recent survey data, women identifying as non-Hispanic multiracial were most likely to report experiencing IPV in their lifetime (64%), followed by Native American women, Alaska Native women (58%), Black women (54), White women (48%), Hispanic women (42%), and Asian or Pacific Islander women (27%).³ IPV exposure can begin at an early age, with 27% of women reporting first contact of sexual violence, physical violence, or stalking at 17 years of age or younger.³ In a 2019 Youth Risk Behavioral Surveillance System survey, adolescent girls and boys reported experiencing physical dating violence (9% and 7% respectively) and sexual dating violence (13% and 4% respectively).^1,14

Risk factors for IPV in couples of the same sex and couples in heterosexual relationships overlap.^1,15 Prevalence of IPV varies by sexual orientation, with women identifying as “bisexual” reporting the highest rates of lifetime prevalence of rape, physical violence, or stalking by an intimate partner (61%) compared with women who identify as “lesbian” (44%) or “heterosexual” (35%).¹

In a recent systematic review, transgender persons were more likely to experience IPV compared with cisgender persons (74 studies; N=1,273,989 participants, including n=49,966 transgender participants; relative risk [RR], 1.7 [95% CI, 1.4 to 2.0]).^1,16 Risk did not differ based on sex assigned at birth.^1,16

Screening Tests for IPV

Screening for IPV often refers to use of a brief questionnaire to assess current or recent abuse.¹ Several screening instruments can be used to detect IPV in the primary care setting, including but not limited to the Humiliation, Afraid, Rape, Kick (HARK);¹⁷ Hurt, Insult, Threaten, Scream (HITS);¹⁸ and Woman Abuse Screening Tool (WAST).¹⁹

Due to fear, intimidation, and lack of support, persons may not disclose abuse unless directly questioned and when questioned still may not disclose it.¹ Barriers to disclosure of IPV for persons experiencing abuse include concern about negative clinician attitudes, perception of safety, and concern about the consequences of disclosing abuse.^1,20 Facilitators to disclosure of IPV include a positive relationship with a clinician and clinicians directly asking persons experiencing abuse about IPV in private and safe settings.^1,20 Evidence suggests that factors such as institutional racism, language barriers, and unfamiliarity with laws, rights, and services may contribute to barriers to seeking help for specific groups of women, including Black, Asian, “minority ethnic,” and immigrant women.^1,21 State and local reporting requirements vary from one jurisdiction to another, with differences in definitions, who and what should be reported, who should report, and to whom. Some states require clinicians (including primary care providers) to report abuse to legal authorities, and most require reporting of injuries resulting from guns, knives, or other weapons.²²

Screening Intervals for IPV

The USPSTF found no evidence on appropriate intervals for screening. In reviewed evidence, trials often screened for current IPV or IPV in the past year.

Interventions for IPV

Based on the evidence, effective interventions generally address multiple factors related to IPV (such as depression rather than IPV alone), involved ongoing support services and multiple visits, and provided a range of emotional support and behavioral and social services.¹ In trials, these interventions were conducted in pregnant or postpartum women. Effective multicomponent interventions were delivered over multiple sessions and combined components specific to IPV with components addressing health, family, or social needs that may be barriers or facilitators to ending abuse (e.g., counseling for depression, postpartum and parenting support, training related to conflict resolution, and linkage to community services). Studies of interventions that provide brief counseling specific to IPV and the provision of information about referral options in the absence of multicomponent interventions generally did not demonstrate benefit.

Additional Tools and Resources 

Intimate Partner Violence

The CDC’s report “Intimate Partner Violence Prevention: Resource for Action” highlights strategies based on the best available evidence to help states and communities prevent IPV, support survivors, and lessen the harms of IPV (https://www.cdc.gov/violence-prevention/media/pdf/resources-for-action/IPV-Prevention-Resource_508.pdf).

The National Academies of Sciences, Engineering, and Medicine’s report “Essential Health Care Services Addressing Intimate Partner Violence” presents findings from research and deliberations and recommendations for leaders of healthcare systems, federal agencies, healthcare providers, emergency planners, and those involved in IPV research (https://nap.nationalacademies.org/catalog/27425/essential-health-care-services-addressing-intimate-partner-violence).

The U.S. Department of Veterans Affairs’ Intimate Partner Violence Assistance Program is committed to helping veterans, their partners, and Veterans Affairs staff who are affected by IPV (https://www.socialwork.va.gov/IPV/Index.asp).

Abuse of Older or Vulnerable Adults

The Administration for Community Living (ACL) features resources for older adults and adults with vulnerabilities. ACL is focused on developing systems and programs that prevent abuse from happening, protecting persons from abusive situations, and supporting persons who have experienced abuse to help them recover (https://acl.gov/programs/protecting-rights-and-preventing-abuse). ACL’s National Family Caregiver Support Program highlights services to provide state and community-based coordinated support for caregivers (https://acl.gov/programs/support-caregivers/national-family-caregiver-support-program).

The CDC highlights information on abuse in older persons, including resources on strengthening prevention strategies (https://www.cdc.gov/elder-abuse/about/index.html).

The National Institutes of Health’s National Institute on Aging features several resources that could assist primary care clinicians who care for older adults, including information on healthy aging (https://www.nia.nih.gov/health/caregiving/healthy-aging-tips-older-adults-your-life) and spotting signs of abuse in older adults (https://www.nia.nih.gov/health/elder-abuse/spotting-signs-elder-abuse). 

Suggestions for Practice Regarding the I Statement and Other Populations 

Potential Preventable Burden

Caregiver abuse of older adults. Prevalence estimates of abuse in older adults varies, but abuse is common.¹ Risk factors for experiencing abuse include isolation, lack of social support, functional impairment, poor physical health, cognitive impairment, low socioeconomic status, and history of being in an abusive relationship.^1,23-25 Based on nationwide data from a recent study in older adults, more than 1 in 10 (12%) older adults experienced a single form of abuse and 2% experienced multiple forms of abuse over their lifetimes.^1,26 Financial exploitation (35%) and neglect (34%) were the most commonly reported types of abuse.^1,26 Older adults are more likely to experience abuse by nonintimate partners (56%), but also experience IPV (23%) and abuse by nonintimate and intimate partners (21%).²⁷ Older adults experiencing abuse suffer serious negative physical health effects and adverse psychological consequences, including distress, anxiety, and depression.^1,6,28

Abuse of vulnerable adults. Based on estimates from a recent survey in noninstitutional settings, persons with disabilities were more likely to experience violence (violent crime, rape or sexual assault, robbery, aggravated assault, and simple assault) compared with persons without disabilities (approximately 46 per 1,000 persons with a disability vs. 12 per 1,000 persons without a disability). In this survey, adults with cognitive disabilities were most likely to experience abuse (83 per 1,000 persons).^1,7 Women with disabilities are more likely to experience lifetime IPV compared with men with disabilities, men without disabilities, and women without disabilities.^1,29 More than half (59%) of all violent acts experienced by vulnerable adults were committed by intimate partners, other relatives, or well-known acquaintances.^1,7

IPV in other populations. Evidence suggests that IPV may be most common during adolescence and young adulthood;² however, women of all ages report IPV. Approximately 2% of women age 45 years or older experienced first contact of sexual violence, physical violence, or stalking by an intimate partner in the past 12 months.³

IPV in men. More than 44% of men report sexual violence, physical violence, or stalking by an intimate partner in their lifetime.³ Among men who experience sexual violence, physical violence, or stalking, the most common IPV-related adverse effects include posttraumatic stress disorder symptoms, feeling fearful, feeling concerned for safety, injury, missing days of work or school, and needing medical care.³

Potential Harms

Potential harms of screening for abuse in older or vulnerable adults and for IPV in men and other populations include shame, guilt, self-blame, retaliation or abandonment by perpetrators, and the repercussions of false-positive results (e.g., labeling and stigma).¹ Studies of harms were primarily conducted in person. Virtual visits may expand access to screening but may increase potential for harm (due to partner or caregiver overhearing responses to screening questions).¹

Current Practice

Caregiver abuse of older or vulnerable adults. For abuse of older adults, mandatory reporting laws and regulations vary by state; however, most states require reporting.¹ The review found limited evidence on screening instruments to accurately detect caregiver abuse or neglect. Further, the review did not find recent estimates of screening in clinical practice for abuse in older and vulnerable adults in the United States.¹

Other Related USPSTF Recommendations

The USPSTF found insufficient evidence to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment in children and adolescents younger than age 18 years without signs and symptoms of or known exposure to maltreatment.³⁰ The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons and older adults.³¹

This recommendation updates the 2018 USPSTF recommendation statement on screening for IPV and screening for abuse in older or vulnerable adults. In 2018, the USPSTF recommended that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services.³² The USPSTF also concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults.³² The current draft recommendation statement is consistent with the 2018 recommendation. To highlight that the evidence base focused on pregnant and postpartum persons, the USPSTF emphasized this population in this draft recommendation statement. For abuse of older or vulnerable adults, the term “caregiver” was added before abuse or neglect when appropriate to clarify when the focus was on screening for abuse or neglect perpetrated by a caregiver or someone they trust.

Scope of Review

The USPSTF commissioned a systematic review¹ to evaluate the benefits and harms of screening for IPV, abuse of older adults, and abuse of vulnerable adults. The review also evaluated the evidence on the accuracy of screening tests for IPV and abuse of older or vulnerable adults, and the benefits and harms of interventions for IPV and abuse of older or vulnerable adults. The scope of this review is similar to that of the prior systematic review.

Accuracy of Screening Tests

IPV

Accuracy varied across 17 studies evaluating screening tools to identify IPV.¹ The assessment tools were administered in emergency departments, primary care practices, urgent care, and antenatal clinics and by telephone or mail.¹ Most screening tools were designed to identify exposure to IPV within the past year. The remaining tools assessed current or ongoing IPV, lifetime abuse, or the ability to predict future IPV.¹ The majority of studies recruited adult women age 18 years or older. One study included women as young as 16 years and one study recruited men.¹ Studies assessed 14 different screening tools; most screening tools were assessed by a single study and used the longer structured 39-item Conflict Tactics Scale-2 (CTS-2) as the reference standard.¹

The nine studies to detect exposure to IPV within the past year used nine different screening tools: Abuse Assessment Screen (AAS), Afraid, Controlled, Threatened, Slapped or physically hurt screen (ACTS), HARK, HITS, Electronic HITS (E-HITS), Partner Violence Tool (PVS), Parent Screening Questionnaire, and WAST and WAST-Short. Sensitivity ranged from 26% to 87% and specificity ranged from 80% to 97%.¹ Generally available screening tools may reasonably identify women experiencing IPV in the past year.¹ The review estimated that use of the HARK screening tool (80% sensitivity and 95% specificity) would result in 81,000 true-positive test results and 5,000 false-positive test results (positive predictive value, 83%) in a population of 100,000 women with a 15% prevalence of IPV (similar to prevalence rate of IPV reported in studies in U.S. primary care settings).¹

In a single study in men (n=53) on the accuracy of the PVS screening tool in the emergency department to detect past year IPV, sensitivity was low on both the PVS and HITS tools compared with CTS-2 scores for psychological abuse (30% and 35%, respectively) and for detecting physical abuse (46% for both tools).^1,33 In six studies of tools to detect current or ongoing IPV, sensitivity ranged from 12% to 94% and specificity ranged from 38% to 100%.^1,34-39 In a single study focused on the Slapped, Things, Threaten (STaT) tool’s accuracy in detecting lifetime IPV, sensitivity was 96% and specificity was 75% compared with the reference tool (Index of Spouse Abuse).^1,40 In a single study (n=409) of a three-item tool to predict future abuse, sensitivity was 20% (95% CI, 13% to 30%) and specificity was 96% (95% CI, 93% to 98%).^1,41

Abuse of Older Adults

The USPSTF reviewed two cross-sectional studies (n=1,055) on the accuracy of tools to detect abuse and neglect among adults age 65 years or older.¹ In a study assessing the Hwalek-Sengstock Elder Abuse Screening Test (n=139), accuracy was low (sensitivity, 46% [95% CI, 32% to 59%] and specificity, 73% [95% CI, 62% to 82%]) for detecting physical or verbal abuse in generally healthy older adults presenting for routine dental care.^1,42 In the other study using the Emergency Department Senior Abuse Identification (ED Senior AID) screening tool to detect abuse, sensitivity was 94% (95% CI, 71% to 99%) and specificity was 84% (95% CI, 76% to 91%).^1,43 Both studies assessed two different tools in two different settings. Whether these results are applicable to routine primary care settings is uncertain.¹

Abuse of Vulnerable Adults

The review identified no studies on screening tools to detect abuse and neglect of vulnerable adults.¹

Benefits of Early Detection and Interventions

IPV

Generally, intervention benefit varied by intervention characteristics and recruited population.¹ Effective interventions involved ongoing support services, which included multiple visits with patients, addressed multiple risk factors (not just IPV), and provided a range of emotional support and behavioral and social services.¹ Studies delivering these multicomponent, higher- intensity interventions were conducted in pregnant and postpartum populations and did not focus on nonpregnant women or men.¹ Brief interventions generally did not demonstrate effectiveness, regardless of population (including pregnant or postpartum women or women who were not pregnant or recently delivered).¹

Pregnant and postpartum populations. Thirteen studies (n=7,425) assessed the effectiveness of interventions in persons with screen-detected IPV (or at risk for IPV). Of these, seven studies (n=2,644) assessed effectiveness of interventions during pregnancy and the postpartum period.¹ In the three studies that assessed intensive services, interventions were delivered in home visits or outpatient settings to pregnant and postpartum women.¹ Two home-visit intervention studies^44,45 (n=882) that included multiple visits over 1 to 2 years found lower rates of IPV in women assigned to the intervention group compared with the control group.¹ In one study, IPV victimization was lower in the intervention group (7.50 events per person-year) compared with the control group (9.55 events per person-year) at 3 years, but the difference was not statistically significant (incident rate ratio of average IPV events per person-year, 0.86 [95% CI, 0.73 to 1.01]).⁴⁴ The other home-visit study found statistically significant lower mean CTS-2 scores from baseline in the intervention group compared with the control group at 2 years (-40.82 vs. -35.87; mean difference in change from baseline scores, -4.95; p<0.001).⁴⁵ The third trial (N=913) enrolled women who screened positive for one of several risk factors for adverse perinatal outcomes (cigarette smoking, environmental tobacco smoke exposure, depression, and IPV); those randomized to the intervention received counseling specific to each identified risk factor.¹ In the subgroup of women who screened positive for IPV at baseline (n=306), those receiving the intervention had significantly fewer recurrent episodes of IPV during pregnancy and postpartum (odds ratio, 0.48 [95% CI, 0.29 to 0.80]) and fewer very preterm neonates (≤33 weeks’ gestation) (2 vs. 9 women; p=0.03).^1,46 Interventions were delivered over a mean of 4.7 sessions (range, 4 to 10 sessions) over 5 months.^1,46

In four studies assessing brief clinic-based interventions in pregnant and postpartum women, three focused on counseling specific to IPV.¹ Of those three studies, two found no group differences in rates of IPV,^47,48 and one found mixed results for subtypes of IPV⁴⁹ (the benefit was significant for psychological and minor physical abuse and not for severe physical and sexual abuse).¹

Nonpregnant women. Three studies (n=3,759) compared screening with no screening for IPV and found no benefit when screening was followed by brief interventions.^1,50-52 In these trials of adult women (mean age, 34 to 40 years), one study reported including 5% pregnant women, the other two studies did not report including any pregnant or postpartum women, and none included adolescents or men.¹ Studies assessed screening followed by brief education and referral options for women who screened positive.¹ Trials did not provide ongoing support services and did not report the proportion of women receiving intensive services after referral.¹ None of the three studies reported improvements in screened groups compared with groups that were not screened on health outcomes, including IPV, quality of life, or mental health outcomes.¹

Six trials enrolling nonpregnant women measured changes in overall IPV incidence. Five trials reported on specific categories of IPV.¹ Generally, compared with studies enrolling pregnant and postpartum populations, studies in nonpregnant women provided fewer visits with less contact time and did not provide education or support specific to child development, parenting, or risk factors related to adverse perinatal outcomes (other than IPV, such as depression and smoking).¹ Four studies reported no group differences in rates of overall IPV or combined physical and sexual violence.^1,53-56 One study reported mixed results on IPV subtypes.^1,57 Interventions in nonpregnant women primarily included brief counseling, provision of information, and referrals.¹

Other populations. A study assessing interventions for new parent couples (n=368 couples, described as male and female partners) found no significant group differences in IPV victimization at 15 or 24 months.^1,58 The review identified no eligible screening or intervention studies for IPV in men.

Abuse of Older Adults

There were no identified studies on benefits of screening or early interventions in older adults.

Abuse of Vulnerable Adults

There were no identified studies on benefits of screening or early interventions in vulnerable adults.

Harms of Screening or Treatment

IPV

Two trials in adult women reported on harms of screening for IPV and identified no adverse effects of screening.¹ One RCT (n=591) developed a specific tool, the Consequences of Screening Tool (COST), to measure the consequences of IPV screening, such as “Because the questions on partner violence were asked, I feel my home life has become (less difficult… more difficult).”^1,52 Results indicated that being asked IPV screening questions was not harmful to women immediately after screening.¹ Another trial (n=399) reported no adverse events; however, it was unclear whether events were prespecified or how they were monitored.^1,51

Five trials reported on harms of interventions and identified no significant harms associated with the interventions.¹ One trial assessing a brief counseling intervention surveyed women at 6, 12, and 24 months about survey participation (including potential harms) and found no group differences in the percentage of women who reported harms. The authors concluded no harms were associated with the intervention.^1,55,59 Among women who reported that their abusive partner was aware of their participation in the trial, the number of negative partner behaviors (e.g., got angry, made her more afraid for herself or her children, or restricted her freedom) was not significantly different between groups.¹ In another trial that asked by telephone whether violence frequency increased after taking part in an antenatal clinic study, the authors reported no adverse events related to study participation by women.^1,49 Other trials also reported no harms associated with interventions; however, it was unclear how harms were measured or assessed.^1,45,56,57

There were no identified studies that reported on harms of screening or interventions in men.

Abuse of Older Adults

There were no identified studies on harms of screening or interventions in older adults.

Abuse of Vulnerable Adults

There were no identified studies on harms of screening or interventions in vulnerable adults.

Go to Table 2 for research needs and gaps related to screening for IPV and caregiver abuse of older or vulnerable adults.

IPV Screening Recommendations

The American Academy of Family Physicians supports the 2018 USPSTF recommendation to screen for IPV in all women of reproductive age and provide interventions for women who screen positive.⁶⁰ The American Medical Association recommends that physicians routinely inquire about physical, sexual, and psychological abuse.⁶¹ For persons experiencing abuse, it recommends that physicians and patients work together to develop exit plans for emergencies and consider referrals to appropriate care and resources.⁶¹ The American Academy of Neurology recommends routine screening in all patients for past and ongoing violence.^1,62 The American Academy of Pediatrics recommends that pediatricians be alert to signs and symptoms of exposure to IPV in caregivers and children.^1,63 The American College of Obstetricians and Gynecologists recommends screening for IPV in all pregnant women over the course of pregnancy and offering educational materials on IPV even if no abuse is acknowledged.⁶⁴ According to the Canadian Task Force on Preventive Health Care, available evidence does not justify universal screening in Canadian citizens.^1,65 The Women’s Preventive Services Institute recommends that adolescents and women be screened for interpersonal and domestic violence at least annually.⁶⁶

Abuse of Older and Vulnerable Adults Screening Recommendations

The American Academy of Family Physicians supports the 2018 USPSTF recommendation.⁶⁰ The American Medical Association and the American Academy of Neurology recommend routinely screening all patients for abuse and neglect.^61,62 The American College of Obstetricians and Gynecologists recommends screening persons age 60 years or older for signs and symptoms of mistreatment, following appropriate state guidelines, and referring persons who screen positive to appropriate care.⁶⁷ According to the Canadian Task Force on Preventive Health Care, available evidence does not justify universal screening for abuse of elderly and vulnerable persons among Canadian citizens.^1,65

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To fulfill its mission to improve health by making evidence-based recommendations for preventive services, the USPSTF routinely highlights the most critical evidence gaps for making actionable preventive services recommendations. We often need additional evidence to create the strongest recommendations for everyone and especially for people with the greatest burden of disease.

In this table, we summarize key bodies of evidence needed for the USPSTF to make recommendations for Screening for Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults.