An 80-year-old woman is brought to the office for follow-up of hypertension. The patient is prescribed lisinopril but has not taken any in the past 2 weeks because she ran out of medication. She has tried to contact her son to pick up a refill but has been unable to reach him. The patient moved in with her son 2 months ago after he arranged for her house to be sold. She says he stays at his girlfriend's house during the week, so she must find neighbors who are able to drive her places. Medical history includes a cerebrovascular accident with mild residual weakness on the left side. Temperature is 37 C (98.6 F), blood pressure is 156/88 mm Hg, and pulse is 80/min. The patient is fully oriented. Cardiopulmonary examination shows no abnormalities. Gait and voluntary movements are normal. On mental status examination, she appears tired and is wearing tattered clothing. Which of the following is the most appropriate next step in management of this patient?

Question

An 80-year-old woman is brought to the office for follow-up of hypertension.  The patient is prescribed lisinopril but has not taken any in the past 2 weeks because she ran out of medication.  She has tried to contact her son to pick up a refill but has been unable to reach him.  The patient moved in with her son 2 months ago after he arranged for her house to be sold.  She says he stays at his girlfriend's house during the week, so she must find neighbors who are able to drive her places.  Medical history includes a cerebrovascular accident with mild residual weakness on the left side.  Temperature is 37 C (98.6 F), blood pressure is 156/88 mm Hg, and pulse is 80/min.  The patient is fully oriented.  Cardiopulmonary examination shows no abnormalities.  Gait and voluntary movements are normal.  On mental status examination, she appears tired and is wearing tattered clothing.  Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

11ec160b_365b_311f_9249_5b0408ba9e52_MD0001_00 This patient's medical history and examination indicate several signs concerning for elder neglect and possible exploitation. The patient's son sold her house, is not at home most days, and is difficult to contact. He has neglected to assist the patient in picking up her prescriptions or drive her places, forcing her to rely on neighbors for help. Her physical examination is remarkable for elevated blood pressure (likely due to not taking lisinopril) and her tattered clothing may also be an indication of neglect. Healthcare professionals who care for the elderly have a legal and ethical obligation to intervene when elder abuse, neglect, or exploitation (collectively, elder mistreatment) are suspected. Physicians should be alert for signs of elder mistreatment, including evidence of neglect, deterioration in medical conditions and malnutrition, atypical injuries, and behavioral changes (eg, depression, anxiety). The next step in management is to report suspected mistreatment to Adult Protective Services, which can investigate the situation with home visits, initiate review of financial records to identify victims of financial exploitation, and assist in mobilizing resources (eg, assistance with prescriptions and transportation to appointments, home care services). (Choices A and D) Although home healthcare services and an in-home social work assessment may be helpful for this patient, investigation for elder mistreatment takes priority. It is mandatory to report suspected elder mistreatment to Adult Protective Services without delay. (Choice B) It would be inappropriate to contact the son to review treatment recommendations when there are signs of neglect and possible financial exploitation. (Choice E) It is premature to suggest an assisted living facility without first conducting an appropriate investigation into elder mistreatment and assessing the patient's specific needs. Educational objective: Physicians should be alert for signs of elder mistreatment, including evidence of neglect, deterioration in medical conditions and malnutrition, atypical injuries, and behavioral changes. It is mandatory to report suspected elder mistreatment to Adult Protective Services. __________ References: Elder abuse: systematic review and implications for practice. (http://www.ncbi.nlm.nih.gov/pubmed/26096395)

An 80-Year-Old Woman Is Brought to the Office for Follow-Up