What would be specific questions to screen for older adult abuse?

Mr. W. is brought to the emergency department by his neighbor, Mr. C., who lives across the hall from him in a high-rise apartment building for low-income senior citizens. Mr. C. proceeds to explain that Mr. W. has become increasingly confused, paranoid, and secretive. He has stopped participating in social activities where he lives, no longer has a telephone, and won’t allow anyone into his apartment. It has been 4 months since Mr. C. last saw Mr. W. and says, “he looks bad. He’s lost weight and is too thin. He wouldn’t talk to me when I tried to start a conversation and he only opened his door a couple of inches. The smell coming from his apartment was awful. I can sometimes hear people yelling in the apartment, and I only ever see his older son stop by occasionally to check on him. And, today, I find him like this. I had to do something because I can’t just stand by and let this happen to him!” Mr. C. points to Mr. W. who has a black eye, swollen upper lip, and dried blood on his beard and clothing.

Mr. W. is sitting in a chair and avoids eye contact. He is wearing thread-bare clothing, which is dirty, and his body odor is unhygienic.

Question 1
How should you proceed to interview Mr. W.?
Question 2
What would be specific questions to screen for older adult abuse?
Question 3
What are possible indications of neglect in Mr. W.?
Question 4
What are possible reasons for Mr. W. failure to seek assistance?
Question 5
How will you document Mr. W.’s case of suspected older adult mistreatment?
Question 6
In a case of suspected older adult abuse, what baseline laboratory tests should be ordered?

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