Review Question - QID 105638

All patients, regardless of age, ought to be given a chance to speak with their physician alone.

Elderly patients often visit the physician with a spouse, child, or other care-giver. It is important to preserve the relationship with both the patient and their loved one, while ensuring that the patient is the provider's priority. To strengthen the physician-patient relationship and to explore issues that may be sensitive, the physician should spend time with a patient in private.

Swagerty et al. discuss the widespread problem of elder mistreatment and abuse. The authors note that recognizing mistreatment can often be difficult as older adults may be unable to provide information because of cognitive impairment. Abuse and neglect are most often discovered during routine visits at the physician's office. The authors emphasize that generally, the patient should be interviewed without the caregiver present.

Lachs et al., in an 11-year longitudinal study of a cohort of 2812 community-dwelling adults older than 65 years, found caregiver burnout and frustration to contribute to elder mistreatment. The authors caution that as the population ages, the number of older adults at risk for abuse will increase and physicians must become familiar with referral pathways and mandatory reporting laws in their states.

Illustration A shows the breakdown of the types of elder abuse.
Illustration B shows the breakdown of those found to be responsible for elder abuse.

Incorrect Answers:
Answers 1 and 2: At this time we do not know if this patient has dementia. She should be assessed for this, perhaps with a mini-mental exam, but not prior to the physician speaking with her alone.
Answer 3: The patient should definitely be assessed for depression as this can commonly cause personality changes and pseudo-dementia in the elderly, but this should be done privately.
Answer 4: At this time there is no specific reason to suspect intracranial pathology.