Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department (Domestic Violence CME and Geriatrics CME)

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Delivery Method:	Online
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Publication Date: September 2024 (Volume 26, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 09/01/2027.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 2 Domestic Violence CME credits and 4 Geriatrics CME credits, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

The prevalence of elder abuse and neglect is trending upward among American seniors, but physician reports of suspected maltreatment are not keeping pace. The most important step in management of elder abuse and neglect is making the diagnosis and reporting the suspicions to Adult Protective Services. This review presents a systematic approach for emergency department diagnosis of elder abuse and neglect, including a thorough history and physical examination combined with the use of standardized validated screening tools. To better assess and treat victims of suspected abuse, physicians can also employ a multidisciplinary team or recruit available resources in the hospital and the community, such as case managers, social workers, and primary care providers to create safety plans for at-risk elders.

Case Presentations

An 80-year-old man is brought in by EMS for high blood sugar, and you note that this is his third time presenting to the ED with this chief complaint…

• As you examine the patient, you ask him why he isn’t taking his medications, and he states that he hasn't been able to get to the pharmacy.
• On examination, the patient is ill-kempt, with poor skin turgor, long toenails, and a small wound on his left foot.
• At first, you think he’s being difficult, but then you begin to wonder whether something else could be going on...

An 84-year-old woman is brought to the ED by her adult son after a fall at home…

• The patient is taking the anticoagulant, apixaban, for atrial fibrillation. Her evaluation is significant for a laceration on her neck and bruising over her medial forearms.
• The patient has a history of cognitive impairment and cannot provide a reliable history, so her adult son provides most of the history. The nurse looks confused, because the description of the fall reported by paramedics is different from the history provided by the patient’s son.
• You consider asking the patient directly what happened and whether she was physically injured by her son, but you aren’t sure whether this is the right approach. You suspect elder abuse and wonder what other findings might help direct her care…

A 79-year-old woman is brought to the ED for vaginal itching…

• An aide at the bedside reports that the patient has a history of dementia and lives in a long-term care facility.
• A nurse helps you with a chaperoned examination, which reveals a thick, yellow-green cervical discharge that is concerning for a sexually transmitted infection.
• You wonder how best to proceed to ensure this patient’s safety…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.