Elder abuse and vulnerability — structured clinical viva

This is physical, psychological, and financial abuse within an intimate partnership (IPV grown into later life), plus vulnerability from depression and mild cognitive impairment.^[1]

Capacity. Assess separately: (a) decision to return home tonight; (b) financial management; (c) contact with partner; (d) medical/psychiatric treatment. Use Appelbaum/Grisso abilities after clear risk disclosure. He may have capacity to refuse police yet still accept a safety plan, bank protections, or temporary alternative accommodation. Coercion and fear can undermine voluntariness — document process carefully.^[2][5]

Safety. Take disclosure seriously; mortality associations with mistreatment argue against minimisation.^[3] Explore lethality (escalating violence, weapons, isolation). If he has capacity and insists on going home, offer maximum voluntary protections (crisis numbers, code-word plan, packed bag, medical alert, scheduled check-ins, legal advice on protection orders) and document risks discussed. If capacity for the return-home decision is absent or risk is imminent and severe, use emergency protective and substitute-decision principles under local law — without inventing section numbers.^[1][4]

Multi-agency. Social work, elder abuse services/helplines, safeguarding/APS equivalent, bank fraud teams, legal aid; police if duty or imminent serious harm requires. Reporting rules are jurisdiction-specific.^[4]

Psychiatry. Optimise depression treatment, suicide risk assessment, trauma-informed therapy access, cognition review, follow-up intensity. Do not force antipsychotics for fear of a real abuser.^[1]