Sally Donovan, 92 years old, is in the gerontology clinic today. She currently lives with her 65-year-old son. You notice that she has lost 30 pounds since her last visit 2 months ago. Her demeanor is submissive and she looks to her son to answer any direct questions from the medical assistant and the provider. At checkout, her son opens her checkbook and writes the check for her co-payment, including signing her name on the signature line.
1. What are the alarm signs for potential elder abuse with Ms. Donovan?
2. What are your next steps in reporting suspected elder abuse?

1. The alarm signs for potential elder abuse in this situation include the submissive behavior and the patient's reliance on her son to answer direct questions. In addition, the fact that the son has the patient's checkbook and forges the signature is troubling and suggests financial abuse. 2. The next steps in reporting suspected elder abuse should include speaking with the patient alone...let the patient know that you simply want to help. If the patient is reluctant, it may signal abuse. If the situation is not urgent, notify adult protective services in the home state.