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Elder Abuse

Matthew DeLaney, MD, Neda Frayha, MD, and Jeff Holmes, MD
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Elder abuse is likely underdiagnosed and may occur in a broad variety of settings. Providers should have a high clinical suspicion for possible elder abuse when evaluating geriatric patients.

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Anna A., MD -

Thanks for offering this discussion. It was very helpful. I wish that there could have been more focused discussion on means for determining capacity—this question was posed near the end of the discussion, but was not answered directly. I had 2 patients last evening who were brought in with these concerns— one was a disheveled paralyzed patient with dementia by ambulance from a primary care office without a family member, and one by a very caring daughter where the patient was being abusive to the family. If a patient is referred from primary care with concern for physical or financial exploitation and the patient does not want to be evaluated, what is the next step? Getting social services involved is important, but does a psychiatrist need to evaluate these patients to determine their capacity to make decisions for their own health care? The first patient finally agreed to stay, but the abusive alcoholic father would not. These are always challenging situations in the midst of a busy emergency department. Any thoughts or suggestions?

Mike W., MD -

Hi Anna,
Thx for the question - yes, certainly the demented pt does not have capacity, but the alcoholic? Even if intoxicated, he may still have capacity and this would b established with a discussion w the patient establishing that he is A&OX3 and understands implications of his actions. If he is abusive, social services would certainly b a consideration, but this would not preclude the pt having capacity and being able to leave AMA, if he chose to do so

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Hacking Up A Lung Full episode audio for MD edition 176:04 min - 83 MB - M4AHippo Urgent Care RAP - April 2018 Written Summary 365 KB - PDF

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