Disposition

Safety is a key issue. Patients must not be returned to their living situations if there is any doubt about their safety. A formal safety assessment may dictate consultation with domestic violence experts, such as a hospital-based social worker or an on-call community-based elder abuse professional. It is important to remember that abuse or neglect may occur when a caregiver is overwhelmed, frustrated, or resentful of the responsibilities involved in taking care of the patient. If indicated, caregivers should be provided with intervention options, such as arranging for home care, respite, or counseling, or should be given advice as to the appropriate care for their family member.

The serious problem of drug and alcohol abuse among the elderly must be recognized by emergency department staff and addressed through appropriate referrals. Communities with geriatric treatment centers provide a valuable resource for patients identified through emergency department visits. Identification of such centers and the referral opportunities they represent should be readily available to emergency department staff.

When discharge is safe and appropriate, aftercare instructions should include appropriate treatment and referral for identified injuries and illness. Referrals should include specific available services, such as "Meals on Wheels," home health aides, visiting nurses, transportation, emergency shelter, legal aid, and medical and mental health services.

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