Mr. D is a 76-year-old Chinese older adult who resides in rural Tennessee. His 45-year-old niece has been living with him in exchange for his care. In a recent visit, Mr. D persistently complains about the increasing intensity and frequency of pain. You are puzzled by the complaints because the methadone that was prescribed for him should be controlling the pain. You ask another family member to bring in all of Mr. D’s medications so that you can check for drug/drug interactions.

When you examine the methadone tablets it reveals that the methadone tablets have all been switched by someone for OTC potassium tablets. You find out after questioning the relative that Mr. D’s niece was previously addicted to drugs and that she is the one that is responsible for administering his medications daily. The other family members suspect that she has been abusing drugs again, but they are reluctant to probe too deeply because there is no one else to care for Mr. D.

Please answer the following questions based on the information in the narrative and the readings in the textbook and any other resources:

1. What signs might you look for during visits that might lead you to suspect the possibility of elder neglect or mistreatment?

2. What other risk factors might you consider important and which of these risk factors do you think would apply in these circumstances with Mr. D?

3. What issues would you discuss with a) Mr. D b) the niece c) the rest of the family d) and then with all of them present?

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