Elder Abuse: The Daily PANCE Blueprint
An 82-year-old woman with moderate Alzheimer dementia is brought to clinic by her son, who lives with her and is her caregiver. He answers every question for her and refuses to leave the room. She has bruises of different colors on both upper arms, a stage 2 sacral pressure injury, and a 4-kg weight loss since her visit 3 months ago. When you examine her alone for a few minutes, she is tearful and says, "He gets angry with me." She lacks capacity for complex decisions. Which is the most appropriate next step?
A. Document the findings and reassess at her next routine visit
B. Confront the son about the injuries before they leave
C. Ask the patient's permission before taking any further action
D. Report the suspected abuse to Adult Protective Services
E. Refer the son to a caregiver support group
Answer and topic summary
The answer is D. Report the suspected abuse to Adult Protective Services
Bruises of different ages on the upper arms (a grab pattern), an untreated pressure injury, weight loss, a controlling caregiver, and her own words add up to suspected elder abuse and neglect. The PA’s duty is to report a reasonable suspicion to Adult Protective Services. Most states make clinicians mandated reporters of elder abuse, and proof is not required, only reasonable suspicion; HIPAA permits the disclosure. Her consent is not needed, especially since she lacks capacity, and asking a frightened patient to approve a report can put her at more risk. Waiting until the next visit leaves her in danger, and confronting the suspected abuser can escalate the harm or lead him to keep her away from care. Best practice is to interview the patient alone, document each injury in detail (location, size, color, and photographs), and treat her medical needs. If she is in immediate danger, call law enforcement or arrange a safe admission. Caregiver support can be part of the plan later, but it never replaces the report.
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