An elderly man presents to the ED after falling down a flight of stairs at home. He has mild but worsening dementia and his wife called EMS when he couldn’t stand up from the fall. Your patient still does his own ADLs but is progressively forgetting things, like where he put his keys and to turn the stovetop off. His wife provides the history but the offered mechanism does not match the injuries sustained. When you talk to your patient alone, he tells you that sometimes his wife gets angry when he forgets things and today she hit, then pushed him. He lost his balance and tumbled down the stairs. He knows his wife is just frustrated and loves him, he doesn’t want to get her into trouble. What to do?
This is a case of possible elder abuse. You are a mandated reporter. It is complicated by the fact that the suspected abuser is your patient’s wife, which may be confused for intimate partner violence. But the abuse of an elder falls under the “elder abuse” category, meaning you should call social work and 1.800.342.3009 (press option 6). Remember, as with child abuse, you do not need to confirm abuse, you only need to suspect.
The law: http://www.rainn.org/files/reportingdatabase/NewYork/NewYorkElderlyMandatoryReporting.pdf
More info about elder abuse (epidemiology, possible scenarios, etc): http://www2.monroecounty.gov/aging-pride.php