PERIODIC HEALTH EXAMINATION, 1994 UPDATE .4. SECONDARY PREVENTION OF ELDER ABUSE AND MISTREATMENT

Objective: To provide recommendations for family physicians on the det ection, assessment and management of abuse or mistreatment in patients over 65 years of age. Options: Detection of elder abuse by history an d examination or by specific protocols; intervention through mandatory reporting, removing the victim from the situation or acting as an adv ocate for the patient. Outcomes: Termination of abusive situation and prevention of further abuse. Evidence: A MEDLINE search was conducted with the use of medical subject headings ''elder abuse'' and ''epidemi ology'' for articles published from January 1980 to October 1992 and h eadings ''elder abuse'' and ''clinical trials'' for articles published from January 1980 to February 1994. Standard references and review ar ticles and their bibliographies were scrutinized, and experts were con sulted. Values: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. Since senior citizens are among the most disadvantaged people in Canadian society, prevention of abuse and promotion of their autonomy were the highest v alues selected. Benefits, harms and costs: The principal benefits are cessation and prevention of abuse. Potential harms include the loss of a personal residence, the erosion of an established family structure and the loss of autonomy for the victim.Recommendations: There is poor evidence to include case finding for elder abuse in or exclude it fro m the periodic health examination. However, it is prudent for physicia ns to be alert for indications of elder abuse and, if such abuse is di scovered, to take measures to prevent further abuse.