A patient, aged 77 years, has Alzheimer's disease and lives wither daughter. While checking her blood pressure at the clinic, the nurse noticed fresh bruises on the patient's palms and buttocks. The patient could not explain these bruises

Question

The nurse discussed her observations with the daughter, who became defensive and said that her mother was very difficult to manage. She stated, "My mother is getting worse every week. She is not my mother anymore. She can't recognize me, and she wanders all night. We take turns because she has to be watched constantly. Last night I fell asleep, and she fell down the stairs while wandering.". Which statement is most accurate? a. Reporting the injuries in this case is not indicated by available data.
b. The nurse should report the injuries as suggestive of elder abuse.
c. The nurse is only required to report the injury if the patient is incompetent.
d. The nurse is legally required to report the injuries as possible abuse.

Answer 1

A
Based on available information, it appears the patient is unable to care for herself and is therefore a vulnerable adult, one of the criteria in most locales for mandatory reporting of suspected abuse. The requirement for legal adjudication of incompetence varies from locale to locale, but it appears that the patient would at least meet the criteria for such adjudication, so the case could be reported IF the nurse suspected the injuries were due to abuse. However, in this case, the injuries are consistent with the daughter's report of the patient's fall, which could cause bruises in the locations noted. There is no data suggestive of abuse or neglect, such as bruises of various ages or in locations unexplained by falls, or signs of malnutrition or impaired hygiene. Therefore, there is no suspicion of abuse or neglect and thus no obligation to report. Also, reporting the case when there are no valid data supporting a diagnosis of abuse would result in an investigation that would likely increase family distress and impair the working relationship with the clinic, making it harder to monitor for signs of abuse or neglect in the future.