A 79-year-old woman is brought to the emergency ward by her son for lethargy and generalized weakness


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A 79-year-old woman is brought to the emergency ward by her son for lethargy and generalized weakness. The patient speaks in short utterances and does not make eye contact with the provider or her son throughout the interview and examination. You elicit that the patient lives with her son and daughter-in-law, and she reports vague weakness for the last couple days. The emergency room provider notices 3-4 healing bruises on the patient’s upper extremities; otherwise, examination is not revealing. Routine chemistries and blood counts are unremarkable; non-contrast head CT demonstrates normal age-related changes. Which of the following is the most appropriate next step in management?

[poll type=multiple min=1 max=5 public=true]

    1. Perform lumbar puncture
    1. Question the patient regarding abuse or neglect
    1. Question the patient’s son regarding the home situation
    1. Ask the patient’s son to leave the room
    1. Call Adult Protective Services to report the patient’s so
      [/poll]n

ans:The patient is brought to the emergency room by her son; the history and initial examination are concerning for elder abuse or neglect. It is prudent to allow the patient to speak alone with the provider.

Elder abuse is an unfortunately common problem encountered in medical practice. Neglect or exploitation, besides frank physical abuse, are also seen. In such encounters, providers should have some clinical suspicion with a patient that has vague complaints, lack of specific findings on examination, and a home situation that could create this situation. Patients should be given the opportunity to speak privately with their providers if suspicion or concern exists.

Hoover and Polson review the topic of elder abuse and neglect. Notably, one out of every 10 elderly persons experiences abuse of some kind, and it can occur in a home or institutional setting. They propose a clinical algorithm in instances where a provider suspects the possibility of elder abuse or neglect: first, evaluate for cognitive deficits with the Mini-Cog test, if impairment is suspected. If this is negative or not suspected, the next step would be the Elder Abuse Suspicion Index (EASI), a validated short questionnaire metric for assessing elder abuse.