You are seeing Mr. Sampson, a 71 year old man, for the first time in 3 years. He says he hasn’t had his blood pressure checked recently and would like you to assess it today. He wanted to come sooner but says he couldn’t. Please take a focused history.
History
- Inquires about patient’s well being since last visit
- Establishes social context – patient lives alone with son
- Establishes sons’ social context (has recently lost his job, divorced)
- Inquires about independence regarding finance, health, transportation
- Inquires about aggression from son
- Establishes past history of injuries and abusive behavior by son
- Extent of medical attention sought/needed for past injuries
- Inquires if son was verbally abusive
- If son has used weapons to harm patient, or has access to weapons
- Substance abuse by the son and quantity (abuses alcohol weekly)
- Assesses patient’s access to health care/medication
- Asks if patient feels safe at home
- Whether friends/family are aware of the abuse
- Emergency plans to escape in the event of further abuse
- Asks if he has access to financial resources
- Asks if he would like help from a counselor
- Asks if he would like support from community resources
- Asks if he would like legal counseling
- Addresses patient’s concern about loss of independence and lack of power
Case 2 – Uncontrolled Blood Pressure and Elder Abuse