case study: assessments

Ms. R presented with injuries after a “fall.” The history of this fall is provided almost exclusively by Ms. R’s daughter, who interrupts Ms. R’s attempts to contribute to the story. When interviewed alone, Ms. R initially says she fell but then admits to frequent verbal and infrequent physical abuse by her daughter. Her new story is that her daughter was insisting that she sign papers to allow her to control all of her banking and finances.  They argued, as they do frequently, and her daughter struck her twice in the face with Ms. R’s cane.

On physical exam, Ms. R is mildly cachectic-appearing. She has ecchymoses/ bruising in the peri-orbital areas bilaterally, with the left eye nearly swollen shut. She has tenderness in both maxillary sinuses. She also has bruising on her left cheek and on the external aspects of both upper arms. From the imaging results, Ms. R is noted to have an acute left zygoma fracture, an acute displaced nasal bone fracture, and an age-indeterminate right zygoma fracture. On laboratory tests, she’s found to be anemic and to have low albumin, suggesting
poor nutrition.

...elder abuse cases happen in the absence of risk factors or suspicious behaviors.

Research has indicated that many elder abuse cases happen in the absence of risk factors or suspicious behaviors.
Elder mistreatment is often subtle and presents non-specifically. When assessing older adult patients, emergency providers need to maintain a high index of suspicion.

How to Assess


Observe the patient
and caregiver interaction. 


Take diagnostic scans
and involve radiologists.


Obtain a complete and
accurate medical history.


Determines a diagnosis
and plan of treatment.


Conduct a head-to-toe
physical exam, if possible.