The size, shape, color, and location of injuries should be carefully documented using either body maps or photographs. Many electronic health records allow for photographs to be uploaded directly into a patient’s chart. Each department should have a policy regarding photographing patients and storage of images.

Figure 1. Injury on a 75-year-old female patient with lethargy and altered mental status.

If there is a suspicion of elder mistreatment, the emergency provider must take appropriate steps to ensure the patient’s safety. In some cases, the involvement of other family members may be adequate. In others, hospital admission may be required.

Reporting requirements vary among jurisdictions. In most states, the Agency on Aging or Adult Protective Services receives and investigates reports of elder abuse and neglect. It is important to know the reporting requirements and procedures for the jurisdictions in which you practice.

Case Conclusion

The patient remains lethargic during her emergency department course. Urine drug screen is negative. Head CT shows an acute on chronic subdural hematoma. When told of these results, the patient’s daughter becomes tearful and admits that she had been taking her mother’s pain medication. When the patient would not provide her daughter with the patient’s most recent prescription for pain medication, the patient’s daughter struck her in the head, knocking her to the ground.

Emergency department personnel contact the police and Adult Protective Services. The patient is admitted to the hospital for medical care pending the police investigation. With the assistance of Adult Protective Services, the patient is placed in an extended care facility following discharge from the hospital.

Dr. Rozzi is an emergency physician; director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania; and vice chair of the Forensic Section of ACEP.

References

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