Screening
Should apparently asymptomatic patients be tested for elder abuse? There have been no randomised trials of elder abuse screening in asymptomatic populations, although the 1992 American Medical Association guidelines on elder abuse suggested that all outpatients be screened for family violence.31 By contrast, the US Preventive Medicine Task Force concluded that there was insufficient evidence for or against screening for family violence in outpatients of any age,32 and a Canadian Task force had a similar opinion.33 How should the clinician reconcile these two competing stances? Arguments against screening for family violence essentially are based on two major themes: (1) no effective screening techniques have been developed for elder abuse, and (2) even if there were an effective screening strategy, no study has shown that intervention in those identified actually improves clinical outcomes (and might, paradoxically, worsen matters in a contentious family violence situation in which the abuser of a vulnerable victim is brought to the attention of the health-care system or official agencies). The first criticism is addressed in this section; the second is addressed in the subsequent section about intervention