Exam 5: Substance Use Assessment and Domestic Violence Assessment

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If a woman answers yes to any of the AAS questions, then a careful assessment is needed to discover how recently and how serious the abuse was. Sometimes more violence is uncovered as the assessment continues. The health care provider should convey a sense of concern and even distress about the violence and that the abuse is not the woman's fault. The message that help is available should also be conveyed. The American Medical Association has developed a nine-question screen that can be used with elderly persons who are cognitively intact. Assessment of physical abuse or neglect in the person with cognitive challenges is more complicated. Red flags of possible abuse are physical findings that are not consistent with the history provided by the patient, family members, or caregiver.
It is also important to assess and document prior abuse, including IPV, childhood physical and sexual abuse, and prior rapes of all kinds (stranger, date, intimate partner). Cumulative trauma can be associated with more severe mental and physical health problems.

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Many investigations have demonstrated that abused women have significantly more chronic health problems, whether the abuse is physical or mental. These health problems go beyond the obvious health care problem, which is injury. The health effects of elder abuse are not nearly as well studied. Elder neglect, which can be intentional or unintentional, is also discussed.

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In some cases, a woman may deny abuse by answering "no" to the AAS questions, but other indicators lead the health care professional to suspect abuse. In these cases, the health care professional must be persistent and thorough in the repeated assessment for domestic violence. Other tools may be helpful.