Elder Abuse and Neglect: Recognition, Reporting, and Documentation Practice Questions

25 multiple-choice questions on Elder abuse and neglect: recognition, reporting, and documentation for paramedic and EMT students, from Chapter 45 (Geriatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Elder abuse is most often committed by:

   1. A. Strangers who target older adults at home
   2. B. Paid caregivers in hospitals
   3. C. Family members, often adult children
   4. D. Other residents of nursing homes
   Show answer

   Answer: C. Family members, often adult children

   Most elder abuse is committed by family members, most often adult children and spouses, who frequently live with the victim. Abuse in facilities occurs too, but strangers are not the usual perpetrators.

2. The most common type of report that adult protective services (APS) receives about older adults is:

   1. A. Sexual abuse
   2. B. Abandonment
   3. C. Physical abuse
   4. D. Self-neglect
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   Answer: D. Self-neglect

   Self-neglect, in which an older adult cannot meet his or her own basic needs for food, hygiene, medication, or safety, is the most common allegation in APS reports nationally (NAMRS data). Physical abuse is common and serious but is reported less often than self-neglect. Abandonment is among the least common allegations. Sexual abuse is the least often reported form.

3. An 82-year-old woman has bruises in a grip pattern on both upper arms. Her son says she 'bumped into a door.' This finding:

   1. A. Is suspicious for physical abuse
   2. B. Is typical of an accidental fall
   3. C. Is caused by normal fragile skin
   4. D. Proves she has a bleeding disorder
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   Answer: A. Is suspicious for physical abuse

   Bilateral bruises on the upper arms suggest grabbing and do not fit a single bump into a door. Fragile skin bruises easily, but it does not produce a symmetrical grip pattern.

4. Which finding in a bedbound older adult most strongly suggests caregiver neglect?

   1. A. A clean room with a hospital-style bed
   2. B. Medications organized in a weekly box
   3. C. Untreated pressure ulcers and soiled linens
   4. D. A home health nurse visit earlier this week
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   Answer: C. Untreated pressure ulcers and soiled linens

   Advanced pressure ulcers, poor hygiene, dehydration, and malnutrition in a dependent patient suggest failure to provide basic care. An organized pill box and home nurse visits are signs of attentive care.

5. Which finding suggests financial exploitation of an older adult?

   1. A. Bruises in various stages of healing
   2. B. Unpaid bills despite enough income
   3. C. Soiled bedding and a sacral ulcer
   4. D. Fear and silence near her caregiver
   Show answer

   Answer: B. Unpaid bills despite enough income

   Unpaid bills, missing belongings, sudden changes to wills or bank accounts, and a caregiver controlling the money suggest financial exploitation. Bruises in different stages of healing suggest physical abuse, soiled bedding with an ulcer suggests neglect, and fearful silence near a caregiver suggests emotional abuse; each needs reporting, but none is a specific sign of financial exploitation.

6. An older man becomes quiet and fearful and looks at his daughter before answering every question. This behavior may indicate:

   1. A. Normal shyness in older adults
   2. B. Hearing loss in both ears
   3. C. Hypoglycemia
   4. D. Emotional abuse or intimidation
   Show answer

   Answer: D. Emotional abuse or intimidation

   Fearfulness, withdrawal, and deferring to a caregiver before speaking can signal intimidation or emotional abuse. Hearing loss causes trouble understanding, not fearful glances at a family member.

7. When you suspect elder abuse, the best way to obtain the patient's history is to:

   1. A. Interview the patient together with the caregiver
   2. B. Ask the suspected abuser to explain first
   3. C. Rely on the caregiver because of dementia
   4. D. Interview the patient apart from the caregiver
   Show answer

   Answer: D. Interview the patient apart from the caregiver

   A private interview lets the patient speak freely without fear of retaliation; a reason such as a medical exam can be used to separate them. A joint interview lets the abuser control the answers.

8. A capable 81-year-old with signs of financial exploitation by her nephew asks you not to tell anyone. In most states, a paramedic who is a mandated reporter should:

   1. A. Report it; her consent is not required
   2. B. Honor her wish and make no report
   3. C. Report it once she signs a consent form
   4. D. Ask the nephew to repay the money first
   Show answer

   Answer: A. Report it; her consent is not required

   In most states health care providers, including EMS, are mandated reporters of suspected elder abuse, neglect, or exploitation, and the duty does not depend on the adult's consent; the report goes to APS or law enforcement as state law directs. A capable adult keeps the right to refuse APS services after the report. Laws vary (New York, for example, has no general mandatory reporting outside facilities), so know your state's rules. Staying silent can violate the law and leave her at risk. Confronting the nephew can escalate danger and is not your role.

9. Making a report of suspected elder abuse in good faith:

   1. A. Exposes the paramedic to a lawsuit
   2. B. Requires certainty that abuse occurred
   3. C. Is protected even if abuse is not proven
   4. D. Breaks federal HIPAA privacy regulations
   Show answer

   Answer: C. Is protected even if abuse is not proven

   State laws protect good-faith reporters from liability, and HIPAA permits disclosures required by abuse-reporting laws. Reasonable suspicion, not certainty, triggers the duty to report.

10. Which chart entry best documents a suspected neglect call?

    1. A. "Patient clearly neglected by her son"
    2. B. "Sacral ulcer 5 cm wide; refrigerator empty"
    3. C. "Home is disgusting and unfit to live in"
    4. D. "Caregiver seems like a bad person"
    Show answer

    Answer: B. "Sacral ulcer 5 cm wide; refrigerator empty"

    Objective, measurable descriptions of injuries and the environment support investigators, while labels and judgments such as 'neglected' or 'disgusting' read as opinion and can be challenged. Leave conclusions about who is responsible to APS and law enforcement.

11. The son of an older woman with suspicious injuries becomes angry when you suggest transport. The best action is to:

    1. A. Tell him you are reporting him for abuse
    2. B. Leave her at home to avoid conflict
    3. C. Ask him to explain each injury in detail
    4. D. Avoid accusations and focus on her care
    Show answer

    Answer: D. Avoid accusations and focus on her care

    Confronting a suspected abuser can escalate the danger to you and the patient; stay calm, get her to care, request police if needed, and report afterward. Leaving her at home leaves her in danger.

12. Which finding in a nursing home resident with dementia should raise concern for sexual abuse?

    1. A. Dry, flaking skin on the legs
    2. B. Occasional bladder leakage
    3. C. Unexplained genital bruising
    4. D. A small sacral pressure injury
    Show answer

    Answer: C. Unexplained genital bruising

    Genital or perineal bruising or bleeding, a new sexually transmitted infection, or fear during personal care suggests sexual abuse, and patients with dementia are especially vulnerable. Incontinence is common and is not itself a sign of abuse.

13. A caregiver says her mother 'sleeps all day' since she started giving extra doses of her sleeping pills 'to keep her calm.' This is an example of:

    1. A. Appropriate dementia care
    2. B. Abuse by chemical restraint
    3. C. Self-neglect by the patient
    4. D. Financial exploitation
    Show answer

    Answer: B. Abuse by chemical restraint

    Deliberately overmedicating to control behavior is chemical restraint, a form of abuse, and withholding needed drugs is also mistreatment. It is not self-neglect because the caregiver, not the patient, is responsible.

14. Which history should raise suspicion of elder abuse?

    1. A. A delay of days before seeking care for an injury
    2. B. An injury that matches the caregiver's account
    3. C. Prompt calls to 911 after each fall
    4. D. A caregiver who brings an updated drug list
    Show answer

    Answer: A. A delay of days before seeking care for an injury

    Unexplained delays, inconsistent or changing explanations, and injuries that do not fit the story are red flags. An injury that matches the reported mechanism and prompt care-seeking are reassuring.

15. An 87-year-old has circular bruises and abrasions around both wrists. This pattern suggests:

    1. A. Physical restraint
    2. B. Normal aging skin
    3. C. A wristwatch rash
    4. D. Peripheral edema
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    Answer: A. Physical restraint

    Circumferential marks on the wrists or ankles suggest tying or improper restraint, which is abuse unless medically ordered and monitored. Fragile skin bruises easily, but not in a ring around both wrists.

16. Which factor most increases an older adult's risk of being abused?

    1. A. Living in a well-staffed, inspected facility
    2. B. Having regular home health visits
    3. C. Dependence on a stressed caregiver
    4. D. Having a recently updated advance directive
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    Answer: C. Dependence on a stressed caregiver

    Cognitive impairment, physical dependence, social isolation, and a caregiver with stress, substance use, or financial dependence all raise abuse risk. Regular home health visits bring outside eyes into the home and do not raise risk, and an updated advance directive has no link to abuse risk. A well-staffed, inspected facility lowers rather than raises risk.

17. Approximately what share of older adults living in the community experience some form of abuse each year?

    1. A. About 1 in 100
    2. B. About 1 in 1,000
    3. C. About half
    4. D. About 1 in 10
    Show answer

    Answer: D. About 1 in 10

    Studies estimate that about 10% of community-dwelling older adults experience abuse each year, and only a small fraction of cases are reported. That underreporting is why EMS recognition matters.

18. When documenting bruises on a suspected abuse victim, you should avoid:

    1. A. Describing the size, shape, and location of each bruise
    2. B. Estimating the age of each bruise from its color
    3. C. Noting whether bruises are on both sides
    4. D. Recording the patient's own explanation
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    Answer: B. Estimating the age of each bruise from its color

    Bruise color is an unreliable guide to age, especially in older adults, so describe size, location, color, and pattern without dating them. Noting bilateral bruising is useful because it suggests a non-accidental pattern.

19. You find an 89-year-old woman with dementia alone at home, soiled, dehydrated, and with no food. Her live-in caregiver left 3 days ago. This represents:

    1. A. Self-neglect
    2. B. Neglect and abandonment
    3. C. Financial exploitation
    4. D. Normal dementia progression
    Show answer

    Answer: B. Neglect and abandonment

    A caregiver who has taken on responsibility and then leaves a dependent person without care commits neglect and abandonment. Because her dementia makes her dependent on that caregiver, this is not self-neglect.

20. A 78-year-old man who lives alone with no caregiver refuses to bathe, has a hoarded, unsanitary home, and is losing weight. This most likely represents:

    1. A. Self-neglect
    2. B. Caregiver neglect
    3. C. Financial abuse
    4. D. Emotional abuse
    Show answer

    Answer: A. Self-neglect

    Self-neglect is an older adult's failure to provide his own food, hygiene, or safe living conditions, and it is reportable in many states. With no caregiver involved, caregiver neglect does not apply.

21. On a call where you suspect elder abuse, your first priority is:

    1. A. Collecting evidence for police
    2. B. Identifying the abuser
    3. C. Scene and patient safety
    4. D. Notifying the family
    Show answer

    Answer: C. Scene and patient safety

    As on any call, ensure scene safety, then protect and treat the patient; investigation is the job of law enforcement and protective services. Collecting evidence must never delay care or put the crew at risk.

22. At a nursing home, you notice a resident has an unexplained fracture and staff give conflicting stories. You should:

    1. A. Accept the charge nurse's explanation
    2. B. Discuss your concerns with other residents
    3. C. Say nothing, since the facility will investigate it
    4. D. Treat, document, and report per your state's rules
    Show answer

    Answer: D. Treat, document, and report per your state's rules

    Abuse in facilities must also be reported, usually to APS or the state agency that oversees long-term care; conflicting stories and unexplained fractures are red flags. Relying on the facility to investigate itself is not enough.

23. A daughter caring for her father with advanced dementia seems exhausted and overwhelmed. Besides caring for the patient, an appropriate action is to:

    1. A. Tell her that her father needs a nursing home
    2. B. Share local respite and support resources
    3. C. Report her to APS for caregiver neglect
    4. D. Transport him so she can get some rest
    Show answer

    Answer: B. Share local respite and support resources

    Caregiver burnout is a risk factor for abuse and neglect, and connecting families with respite care and support groups can help prevent it. Fatigue alone is not neglect and is not grounds for an APS report when he is clean and cared for. Transporting a patient who does not need hospital care just to give the caregiver rest does not solve the problem. Deciding on nursing home placement is not the crew's role.

24. Which burn pattern in an older adult is most suggestive of abuse?

    1. A. Immersion burns on both feet
    2. B. A splash burn on one forearm
    3. C. A small burn on one finger
    4. D. Sunburn on the face and arms
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    Answer: A. Immersion burns on both feet

    Symmetrical stocking or glove immersion burns with sharp lines suggest forced immersion, whereas accidental splashes cause irregular patterns. A burn on one finger fits a kitchen or smoking accident.

25. A caregiver refuses to let you speak with the patient alone and answers every question for her. This should:

    1. A. Reassure you that she is well cared for
    2. B. Be documented as normal family support
    3. C. Raise your concern for possible abuse
    4. D. Prompt you to leave without assessing
    Show answer

    Answer: C. Raise your concern for possible abuse

    A caregiver who will not allow a private conversation or insists on answering may be controlling the victim, so find a way to talk with the patient alone. Attentive family support does not require keeping the patient from speaking.