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A PMHNP conducts a home visit for a 78-year-old woman with major depressive disorder and early vascular dementia. The patient's adult son, who is her primary caregiver, is present. The PMHNP notices the patient has lost 20 pounds since the last visit, has an unkempt appearance, a stage II pressure ulcer on her sacrum, and an unexplained bruise on her left forearm. When asked about meals, the patient whispers, 'He forgets to feed me sometimes, but don't say anything, he's all I have.' The son becomes defensive and states, 'She's exaggerating. I do my best.' The PMHNP must determine her legal obligation while navigating the patient's explicit request not to report.
Explanation
The critical principle in elder abuse reporting is that mandatory reporting overrides patient preferences, and that reasonable suspicion, not confirmed abuse, triggers the obligation. When a patient requests that the clinician not report, the legal duty to report still takes priority over the patient's wish for privacy, especially when cognitive impairment may limit the patient's ability to self-protect.
Key Takeaway
Mandatory reporting of suspected elder abuse to Adult Protective Services is required based on reasonable suspicion regardless of the patient's request not to report. Document objective findings, file the report, and never confront the alleged abuser before reporting.