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Perform lumbar puncture
1%
1/98
Question the patient regarding abuse or neglect
8%
8/98
Question the patient's son regarding the home situation
Ask the patient's son to leave the room
77%
75/98
Call Adult Protective Services to report the patient's son
Select Answer to see Preferred Response
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. Peterson et al. sought to estimate the prevalence of elder exploitation and factors associated with this. First, they note that exploitation is the most common form of abuse, although no strong data exists regarding its characteristics. They found African-American race to be associated with exploitation as well as poverty and impairment in performing an ADL. Cohabitation with a spouse or partner was associated with a lower relative risk for exploitation. Incorrect Answers: Answer 1: The patient exhibits nonspecific findings, and there is no mention of a recent fall or focal deficits to warrant a CT scan at this point. Answers 2 and 3: The patient's son should be asked to leave the room to allow the patient to discuss in private any abuse or neglect that might be occurring. Answer 5: Although Adult Protective Services (APS) might eventually become involved, the next step at this time would be further interview with the patient.
2.8
(4)
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