Case Scenario

My 81-year-old patient, E.P., has a history of hypertension, hypothyroidism, and mild chronic obstructive pulmonary disease, but I have not seen them since the initial COVID-19 shutdown. The county Adult Protective Services agency has requested a medical assessment because of concerns for E.P.’s safety and possible self-neglect following reports of E.P. appearing confused and wandering in the neighborhood. As a family physician, what are my responsibilities to the patient and to Adult Protective Services in this situation? What is the best clinical approach to addressing the concerns for E.P.’s welfare?

Commentary

Elder abuse (in this Curbside Consultation, “elder” refers to a person 60 years or older) affects at least one in 10 older adults but is often undetected and underreported, even compared with any other form of abuse.¹ Elder abuse can take several forms, including neglect and physical, emotional, financial, or sexual maltreatment. Adult self-neglect is the most common form of elder abuse² (Table 1^2–4). Most of these adults live in private residences; approximately 10% of reports to Adult Protective Services involve older adults who are living in residential care facilities.² Many states use a centralized or combined local and state hotline model to report allegations of maltreatment. Nationally, the Eldercare Locator (1-800-677-1116) can direct people to individual state resources. Approximately 60% of reports come from professionals such as police, social services, or visiting nurses or aides; other reporters include relatives, nonprofessionals (e.g., neighbors), caregivers, and the individual involved (self-report).² Physicians and medical personnel are mandated reporters.²