- Updated USPSTF recommendations say intimate partner violence (IPV) screening has moderate benefit but there isn't enough research on elder abuse screening.
- These recommendations do not reflect a change from the last USPSTF recommendations in 2018.
- One new aspect, though, is that older and vulnerable adult abuse screening recommendations are now framed around caregiver abuse and neglect.
The U.S. Preventive Services Task Force (USPSTF) renewed its recommendation for intimate partner violence (IPV) screening and its call for more evidence on screening for abuse of older or vulnerable adults.
In line with 2018 guidanceopens in a new tab or window, the task force recommended that adolescents and adults who are pregnant or postpartum and all women of reproductive age should be screened for intimate partner or domestic abuse.
"The USPSTF concludes with moderate certainty that screening for IPV in women of reproductive age, including those who are pregnant and postpartum, and providing or referring those who screen positive to multicomponent interventions with ongoing support has a moderate net benefit," the group led by Michael Silverstein, MD, MPH, of Brown University in Providence, Rhode Island, wrote in JAMAopens in a new tab or window.
The task force also reviewed evidence on screening for abuse of older or vulnerable adults with a physical or mental disability who haven't displayed recognized signs and symptoms of abuse or neglect.
In an evolution from 2018, the task force specified caregiver abuse, meaning when a trusted person or caregiver "causes or creates risk of harm to an older adult." This term was added "to clarify when the focus was on screening for abuse or neglect perpetrated by a caregiver or someone they trust," Silverstein wrote. Caregiver abuse includes physical, sexual, emotional, and psychological abuse, as well as neglect, abandonment, or financial exploitation. In fact, financial exploitation and neglect were found to be most common, the task force noted.
For this area, USPSTF reiterated its 2018 decision that current evidence is insufficient to assess the balance of benefits and harms.
None of the 35 studies included in the evidence review, also published in JAMAopens in a new tab or window, for the update evaluated screening or interventions for caregiver abuse among older or vulnerable adults; just two assessed the accuracy of caregiver abuse screening tools for this population, with mixed results.
Nearly half of adults report experiencing sexual or physical violence or stalking at some point in their lifetime, Silverstein and team noted. Women and people who report a gender different than sex experience higher levels of IPV than men. Additionally, 1 in 10 adults older than 60 report experiencing some form of abuse or neglect in the past year. Authors noted that these groups are not mutually exclusive.
Beyond screening checklists, something all clinicians should do as "an essential part of good healthcare" is to create safe environments for patients to disclose abuse, according to Eve Rittenberg, MD, MA, of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues, writing in a linked editorial in JAMA Internal Medicineopens in a new tab or window.
One tactic is to meet with the patient alone without a caregiver, partner, or family member present so the patient can speak candidly. Physicians can ask if the patient feels safe in their environment and respond "with nonjudgmental empathy, validation, and support if they report concerns." Rittenberg's group also recommended connecting caregivers with resources and respite care to help combat stress.
"Clinicians and health systems should have protocols in place to respond to disclosures and connect the patient to appropriate resources for shared decision-making, safety planning, and follow-up," she concluded.
In another editorialopens in a new tab or window in JAMA, Melissa Simon, MD, MBA, MPH, of Northwestern University Feinberg School of Medicine in Chicago, wrote that the "IPV and elder abuse dual epidemics deserve more attention," calling them "public health emergencies, with survivors also facing profound consequences."
Simon called them "hidden epidemics" because of major data gaps, partially due to lack of standard definitions and measurements, and disciplinary silos.
"This stagnation in the development of more evidence-based interventions for IPV and elder abuse is troubling, especially in the setting of the current reductions in federal support for public health, healthcare delivery, and research," she wrote, adding that many organizations, including CDC, have had to pause or scale back support for IPV and elder abuse programs.
Simon also noted that federal bans on words like "diversity," "gender," and "women" may discourage researchers from studying these vital topics. Plus, abortion restrictions increase risk of reproductive coercion and "create a climate of fear that discourages both disclosure and data collection."
Ultimately, the revised USPSTF recommendation "is a stark reminder of how fragmented and incomplete current knowledge and ability to prevent IPV and elder abuse are," Simon wrote. "Defunding federal research agencies, eliminating independent review bodies, and eroding reproductive rights only deepen these gaps, leaving millions of U.S. residents vulnerable to preventable harm."
The evidence review spanned studies found in PubMed/MEDLINE, Embase, and the Cochrane Library from 2017 through Dec. 14, 2023, along with studies used in the prior USPSTF review. Eligible studies on screening test accuracy, randomized trials of screening or interventions, and cohort studies on potential harms were conducted in English, recruited in primary care and emergency department settings, and were conducted in countries marked "very high" on the Human Development Index.
For IPV, two randomized trials showed no harms of IPV screening compared to no screening, while one found no significant reduction in IPV nor benefit for other outcomes 3 to 18 months after screening. Among nine studies focused on the accuracy of detecting past-year or current IPV, sensitivity ranged from 26% to 87%, and specificity ranged from 80% to 97%.
Thirteen trials evaluated various interventions for women with screen-detected IPV. One found a significant reduction in IPV with multiple perinatal home visits (standardized mean difference −0.34, 95% CI −0.59 to −0.08). Another found significantly fewer recurrent episodes of IPV with behavioral counseling for multiple risks, including IPV, smoking, depression, and tobacco (standardized mean difference −0.40, 95% CI −0.68 to −0.12). Studies looking at brief counseling or advocacy interventions specific to IPV found no difference in overall IPV rates.
In terms of limitations of the new evidence, the review focused on populations without signs or symptoms of abuse and didn't evaluate clinician or patient preferences for screening implementation preferences. Studies relating to the accuracy of screening included some from emergency department settings, limiting applicability to primary care.
Disclosures
All authors followed the USPSTF policy regarding conflicts of interest, and all USPSTF members receive travel reimbursement and an honorarium for participation.
One author reported receiving grants from the National Institute on Aging.
Simon noted being a former member of USPSTF and participating in the 2018 recommendation statement for intimate partner violence and elder abuse.
Rittenberg reported receiving honoraria from Harvard Medical School and CME Outfitters for continuing medical education talks on intimate partner violence and trauma-informed care.
Other editorialists had no disclosures.
Primary Source
JAMA
Source Reference: opens in a new tab or windowSilverstein M, et al "Screening for intimate partner violence and caregiver abuse of older or vulnerable adults: U.S. Preventive Services Task Force Recommendation Statement" JAMA 2025; DOI: 10.1001/jama.2025.9009.
Secondary Source
JAMA
Source Reference: opens in a new tab or windowFeltner C, et al "Screening for intimate partner violence and for caregiver abuse of older or vulnerable adults: An evidence report and systematic review for the U.S. Preventive Services Task Force" JAMA 2025; DOI: 10.1001/jama.2025.2449.
