USPSTF Updates Stance on Screening Women, Elderly for Violence

In its new draft recommendations on screening for intimate partner violence (IPV) and abuse of elderly and vulnerable adults, the U.S. Preventive Services Task Force (USPSTF) recommends clinicians screen women of childbearing age for IPV and either provide or refer women who screen positive to intervention services. However, the task force is less sure about the benefits of screening elderly or vulnerable adults.

The task force changed its 2004 stance on IPV after an evidence review indicated that currently available screening instruments "accurately identify women experiencing IPV" and that the benefits of screening outweigh the harms.

"For IPV, there is adequate evidence that available screening instruments can identify current and past abuse or increased risk for abuse," the USPSTF said in its statement. "Several instruments used in more than one study were highly sensitive and specific. The USPSTF concludes with moderate certainty that screening women of childbearing age for IPV has a moderate net benefit."

The B recommendation on IPV from the task force applies to asymptomatic adult women ranging from 14 to 46 years of age.

The AAFP, which has not yet updated its own 2004 recommendations, recognizes that all family physicians should be "alert to physical and behavioral signs and symptoms associated with abuse or neglect," but in 2004, the Academy had concluded that the evidence was insufficient to recommend for or against screening adults or adolescents of either sex for intimate partner violence. The Academy plans to update its recommendations after the USPSTF publishes its final conclusions later this year.

The task force's new draft recommendation statement is available for comment until July 10, 2012, at 5 pm EDT.

With regard to screening elderly or vulnerable adults (i.e., physically or mentally dysfunctional adults) for abuse and neglect, the task force and the Academy remain on the same page, concluding that the evidence is insufficient to assess the balance of the benefits and harms of screening.

"Little information is available on the prevalence of abuse among noninstitutionalized elderly or vulnerable adults, although reported rates range from 2 to 25 percent," the USPSTF said in its statement.

The task force also said evidence was insufficient to affirm the accuracy of screening or early detection or that screening or early detection reduces exposure.

According to the USPSTF statement, child abuse and neglect will be addressed in a separate draft recommendation that is being developed.