Clinical Dilemma Activity: Elder abuse

Clinical Dilemma Activity: Elder abuse I. History of Present Problem: John Peterson is an 82-year old male who is brought to the emergency department (ED) by his son because of concerns of caregiver neglect. John lives in his apartment and requires help with ADLs during the day. When the son visited his dad, he found him soaked in urine, surrounded by spoiled food, with dried vomit on his clothing. The trash cans outside the home were overflowing, and inside, there was debris and old food left on the bedroom and kitchen floors. John is complaining of pain in his feet, which he attributes to his diabetes. The son reports that his current caregiver is a family friend who has a history of drug addiction and may have relapsed. The patient is alert and oriented and admits to feeling sickly. He does not remember when he last had a glass of water. There is a distinct smell of feces and urine. Upon closer assessment, there are dried feces in his perirectal area with a large red swollen scrotum and redness in his groin folds. There is also evidence of skin tears/bleeding on the left lateral thigh that appeared to be of a friction/shear type mechanism. Mr. Peterson states that he has not had a bath in three weeks. He also reports being unable to get up from the chair by his bed without assistance for the last three days because of increasing weakness and fatigue. Personal/Social History: Mr. Peterson’s son, Frank, reports that the patient was relatively healthy and self-sufficient up until the age of about 77. His first wife, Frank’s mother, died 20 years ago. He remarried two years after his first wife died. Frank and his father’s second wife, Janet, did not get along well, which resulted in a more distant relationship between father and son. Frank lives about four hours away, is an only child, and visits 2-3 times a year. When Janet died a year ago, it first became apparent that John needed help with day to day functioning. John was resistive to leaving his home or having “strangers” come into his house but finally agreed to let a family friend help out. During a previous visit, Frank noticed that his father had a frailer appearance and was more forgetful. It has been about three months since his last visit. Frank reports that his father does not have many visitors or close friends that are still alive.