Any visit to the doctor is a precious opportunity to detect abuse, collect evidence and protect the elderly, experts say, but abuse screening by health-care professionals is spotty.

Screening is a challenge because abuse injuries may resemble those that are part of the aging process, like slow-healing bruises or breaks from bumps or falls, experts said. But they agree that as a whole, the industry needs to raise awareness about elder abuse and improve screenings.

Screening is weakest during routine appointments with health-care providers at clinics, said Kathleen Ziemba, social work supervisor for patient and family services at Meriter Hospital. But "it's beginning to happen," she said.

If abuse is detected, at least 32 states require health-care professionals to report it, according to the American Bar Association.

In Wisconsin, doctors are supposed to offer elderly patients options that help victims take control of their lives, such as how to get help or create an emergency safety plan. But doctors here must also respect a patient's right not to disclose domestic abuse. They're required to report only in cases of diminished mental capacity, gunshot wounds or life-threatening injuries, or if the patient is at risk of such injuries.

The rules leave a gray area for health-care professionals.

"We do see (abuse)," Ziemba said. "The challenge for us is that it's not a mandatory reporting system."

Until last year, Wisconsin had no mandatory reporting law at all.

Nationally, the politics of mandatory reporting of elder abuse are complex. The health-care and finance industries oppose it, citing patient and customer confidentiality. The National District Attorneys Association supports it.

Elder advocates differ. Some say reporting laws don't make much difference and violate seniors' independence. Others argue mandatory reporting means help for more victims.

Gov. Jim Doyle is willing to hear proposals to extend the state's mandatory requirements, spokesman Matt Canter said.

Regardless, many health screenings aren't even catching it in the first place, experts say.

A recent study of elderly women who live in two Northwest states showed that one in four had been a victim of physical, psychological or sexual violence by a spouse or intimate partner, but only 3 percent had been asked by health-care providers about intimate violence.

The author, Amy Bonomi, an associate professor at Ohio State University, said the questions just aren't being asked enough. "The health-care setting is a crucial focus for victims because it provides a safe, confidential place for ongoing interactions between abused women and their health-care providers," she said.