Elder abuse

An 88-year-old female is transferred late in the day with a report of falling the previous night and striking her eye on the bedside table. She was initially evaluated at an outside emergency room, and then was seen by the local ophthalmologist with a diagnosis of an open globe injury. She was subsequently referred to the university hospital for further evaluation and treatment. She is agitated, abusive, and quite unhappy at having multiple exams by both the resident on service and the faculty. She threatens to leave without allowing further evaluation or surgical correction. The emergency room nurse checks the patient's blood pressure, which is elevated and has been climbing throughout her visit. The clinician sits and speaks quietly with the patient and family, eventually gaining her trust and cooperation.