Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach

Elder abuse and neglect are defined as action or negligence against a vulnerable older adult that causes harm or risk of harm, either committed by a person in a relationship with an expectation of trust or when an older person is targeted based on age or disability. This mistreatment may include physical abuse, sexual abuse, neglect, psychological abuse, or financial exploitation; many victims experience multiple types of abuse. Elder abuse is both common and costly. It has an estimated prevalence of 5% to 10% and has been linked to major adverse health outcomes, including dementia, depression, and mortality. Although not easily quantified, elder abuse is estimated to cost many billions of dollars annually. In addition to community-dwelling older adults, residents of skilled nursing facilities may also be victims of mistreatment by staff members or other residents

Management of salicylate poisoning

Salicylates are weak acids that work as neurotoxins. The goal of management is to keep salicylates out of the brain and enhance elimination. Acute salicylate toxicity manifests as tinnitus, nausea, vomiting, and hyperventilation in a patient who takes a single large ingestion. Chronic salicylate toxicity is associated with long-term use, has a more insidious onset, and symptoms tend to be less severe, resulting in delayed diagnosis. It is more commonly seen in elderly patients. Therapeutic interventions for toxicity include gastrointestinal decontamination, serum and urine alkalinization, and haemodialysis. Mechanical ventilation may lead to clinical deterioration and death in a salicylate-poisoned patient due to worsening acidosis from respiratory failure. This results in severe acidosis, cerebral oedema, pulmonary oedema, and cardiac arrest.</p

Teaching the recognition of odors

Odor recognition is a valuable skill for the emergency services provider, particularly when dealing with the poisoned patient. A simple “ten test-tube sniffing bar” emphasizing sensory recognition of common toxins in association with representative case histories is an effective emergency services teaching tool. The odor, toxin, case history, and appropriate references are described for each component of the sniffing bar