PUID: 56 || PLAB 2 Mock :: Medical Ethics: Elderly Multiple Bruises
- examiner mla
- Aug 10
- 2 min read
Summary
An elderly woman, brought to hospital by her daughter after a fall, is found to have bruises of varying ages. The candidate’s role is to sensitively gather history from the daughter, explore possible abuse, assess risk factors, and plan appropriate management while adhering to safeguarding protocols.
Key Points
Incident History & Data Gathering
Confirm patient identity and relationship with caregiver.
Establish a clear and detailed account of the incident:
Exact sequence of events before, during, and after the fall.
Witnesses present at the time.
Any inconsistencies in the account — address them tactfully.
Explore pre-fall history:
Medical conditions: dementia, stroke, hypertension, osteoporosis.
Mobility status, use of aids (zimmer frame), vision issues, dizziness, confusion.
Previous falls or fractures.
Medication Review
List current medications and confirm usage (e.g., amlodipine, paracetamol).
Elder Abuse Red Flags
Multiple bruises at different healing stages.
Hesitant or inconsistent responses from caregiver.
Social isolation or limited support.
Social & Environmental Factors
Household composition — who else lives with patient.
Caregiver’s work commitments and availability.
Social network, access to other family members/friends.
Financial pressures or conflicts.
Important Considerations
Safeguarding Duty: GMC guidance mandates prompt action if abuse is suspected.
Patient Safety First: Rule out medical causes for falls before concluding abuse.
Involve Seniors: Always escalate suspected abuse to senior colleagues.
Documentation: Record all findings and conversations accurately.
Diagnostic Approach
History Taking
Focused incident and background history.
Compare caregiver’s account with objective findings.
Physical Examination
Document injury sites, sizes, colours, and stages of healing.
Investigations
X-ray results (pending in scenario).
Consider CT head if head trauma suspected.
Full skeletal survey/bone scan for other injuries.
Routine blood tests.
Management
Immediate
Provide analgesia as required.
Ensure patient is safe and away from potential abuser if needed.
Safeguarding
Refer to social services (normalise process to caregiver).
Involve safeguarding team and senior doctors.
Further Care
Treat identified injuries.
Consider physiotherapy and mobility support.
Discuss long-term care options — increased home visits or nursing home.
Follow-Up
Arrange review appointment.
Provide written information on elder abuse resources and respite care.
Communication Skills
Use clear, non-judgemental language.
Show empathy to both patient and caregiver.
Stress the importance of understanding the injuries for better care, not to assign blame.
Gently highlight inconsistencies without confrontation.
Normalise safeguarding referrals as a standard supportive process.
Ethical Considerations
Confidentiality: Share details only with appropriate safeguarding authorities.
Consent & Capacity: Presume capacity unless evidence otherwise.
Non-Discrimination: Avoid assumptions about abuse based on demographics.
Duty of Candour: Be open about concerns and actions being taken.
Additional Resources
GMC Guidance on Safeguarding Adults at Risk
NICE Guidelines: Suspected or confirmed abuse in adults.
NHS Safeguarding policies.
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