A 72-year-old man with dementia and back pain has ecchymotic stripes on his back; his daughter says the marks are shingles. What is the most appropriate action?

• A. Report to the hospital staff that his daughter has physically abused him.
• B. Ask his daughter how long ago he was exposed to the shingles virus.
• C. Report to the hospital staff that he has a shingles outbreak.
• D. Ask him about the bruise while alone en route to the hospital.

Answer: (D)

The key idea is to obtain an honest account directly from the patient by interviewing him privately, away from the daughter. In elder patients, especially with dementia, caregivers can influence or limit what the patient feels safe saying. By asking him about the bruise in a private setting, such as during transport to the hospital, you allow him to describe how the injuries happened without pressure or fear of repercussion. This helps determine whether the marks are due to an injury or a misinterpretation, and it guides any necessary safety or reporting actions. The other options rely on the daughter’s account, prematurely label abuse, or repeat a non–patient-centered question, which could miss signs of abuse or fail to protect the patient. If the patient cannot provide information, or if abuse is suspected based on the response and exam, involve appropriate authorities and support services.