Innovations In Clinical Neuroscience

MAR-APR 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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R I S K M A N A G E M E N T Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 3 – 4 , M A R C H – A P R I L 2 0 1 7 ] 43 appointment (or sooner if necessary). • As always, thoroughly document the clinical basis for prescribing medications. Understand your state's statutes and/or regulations regarding the reporting of elder abuse or neglect. While most healthcare providers are keenly aware of their obligation to report child abuse, many do not appreciate their concurrent obligation to report suspected abuse of adults, particularly the elderly or incapacitated. Although the laws vary, in most states physicians are required to make a reporting when they suspect elder abuse, which is defined by the United States Centers for Disease Control and Prevention (CDC) as "an intentional act, or failure to act, by a caregiver or another person involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older)." 5 Patients may be reluctant to report abuse, fearing that they will not be believed or that they will be sent away from their families and be placed in a potentially worse situation. In other instances, "actions that constitute abuse may not be recognized as such by the abused party." 6 For example, a victim may ignore or not be aware of the abuser's ulterior motives when shown attention and/or romantic affection by the abuser. In other instances, the victim may feel too humiliated to report economic losses. Be alert to the following signs of abuse and neglect: • Physical abuse—Fractures, cuts, suspicious burns, bruises on arms consistent with having been grabbed or shaken, other bruises not readily explained, bite marks, depression, or delirium. • Sexual abuse—Reports of new instances of venereal disease or urinary tract infections (UTIs) • Psychological or verbal—Confusion, dramatic changes in sleep patterns, unusual or excessive fear, loss of interest in self and surroundings, unexplained weight changes, deprivation of personal property, seclusion • Financial exploitation—Significant disparity between assets/income and lifestyle, sudden failure to pay bills, failure to renew prescriptions or keep appointments, malnutrition or weight loss, lack of knowledge of personal finances, anxiety regarding finances, sudden appearance of caretaker upon whom the patient seems abnormally dependent • Neglect—Poor general hygiene; poor oral hygiene; unexplained weight loss; dehydration; malnutrition; decubitus ulcers; unkempt appearance; inadequate clothing; absence of eyeglasses, dentures, or hearing aids; signs of overdrugging or indications that the patient is not being given prescribed medications Sadly, studies have shown that the abuser is often a family member. According to the 1998 National Elder Abuse Incidence Study (NEAIC) conducted by the National Center on Elder Abuse at the American Public Human Services Association and Westat, in almost 90 percent of the cases with a known perpetrator, that individual is a member of the victim's family. Two- thirds of these are either the victim's spouse or an adult child. Watch for the following signs of potential mistreatment by caregivers: • A show of anger or frustration toward the patient • A lack of knowledge or indifference regarding the patient's condition • A history of doctor-hopping at the caregiver's direction • Implausible explanations of the patient's injuries/condition • Attempts to monopolize conversation or preclude patient from speaking directly to you • Failure to visit the patient in the hospital • Inappropriate display of affection between the caregiver and the patient • Apparent financial dependence of caregiver upon the patient • Excessive concern over the cost of treatment • Evidence of substance abuse or mental health problems on the part of the caregiver. 6 Communication with family members and other caregivers may be needed. When treating elderly patients, (to the extent allowed by the patient), it may be beneficial to involve family members and/or other caregivers in order to achieve optimal care. And, because family members are often the impetus to litigation following a less than desired outcome, effective communication is also an important step in minimizing liability risk. Consider implementing the following protocols: • Provide caregivers with written information about the patient's condition that can be reviewed in a more relaxed setting and be used later as a reference. The APA has patient education brochures on various psychiatric disorders and their treatments that may be accessed at health/lets-talk-facts-brochures. • At the beginning of treatment, ascertain from the patient his or her desires as to family involvement. Suggest that one person be the one with whom you will primarily communicate, particularly if the patient has a large family. Ideally this will be the person most directly responsible for the patient's day-to- day care. • Make certain that caregivers understand the patient's medication regimen and what potential side-

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