0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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TREATMENT

■ Assess immediate risk (victims are at highest risk when they attempt to

leave the relationship).

■ Document patient’s description of the event and current and past injuries.

■ Refer to social work while in the ED.

Elder Abuse and Neglect

Elder abuse is increasing but continues to be underreported and under

recognized.

RISKFACTORS

Caregiver overwhelmed, frustrated, or resentful; elder is disabled or has wors-

ening cognitive impairment

SYMPTOMS/EXAM

■ Sudden onset of behavior symptoms(depression, confusion, anxiety)

■ Caregiver refuses to leave patient alone with physician.

■ Unexplained delay in seeking treatment or previous unexplained

injuries(bruises, burns, fractures)

■ Lack of physical care (poor personal hygiene, malnutrition, soiled bed-

dings or clothing, decubiti)

■ Patient appears fearful of caregiver, and caregiver has an attitude of indif-

ference or anger toward him/her.

■ Caregiver is overly concerned with cost of treatment.

DIAGNOSIS

■ Look for injuries, bruises.

■ Check for STDs.

■ Directly question patient regarding abuse (alone).

TREATMENT

Treat illness and injuries. Notify adult protective services immediately!

Sexual Assault

Male sexual assault is now 10% of all sexual assault.

SYMPTOMS/EXAM/DIAGNOSIS

■ Obtain data about assault tactfully (victims should not have to relive every

detail).

■ Do a thorough and compassionate physical exam, with a rape kit if available.

■ Toluidine blue detects small vulvar tears, and Wood’s lamp detects

semen stains.

■ Chances of finding forensic evidence >72 hours are slim to none.

TREATMENT

■ Treat all injuries.

■ Pregnancy prophylaxis

■ STD/HIV prophylaxis

■ Counseling in the ED, arrange for close follow-up

Elder abuse is associated

more with personality

problems of caregivers

(substance or alcohol

dependence, mental illness)

than with situational stress.