An 86-year-old female complains of pain in her sacral area. You observe a four-centimeter decubitus ulcer in the area. Her son tells you that she is bedridden and that he cares for her. Her bedding is wet and smells like urine. You should suspect:

• A. Physical neglect.
• B. Psychological abuse.
• C. Physical abuse.
• D. Psychological neglect.

Answer: (A)

When evaluating an elderly patient who is bedridden, signs that care is not meeting basic needs point to neglect. A four-centimeter pressure ulcer indicates prolonged pressure without adequate turning, skin care, or wound management. Wet, urine-smelling bedding shows poor incontinence management and hygiene. Together, these reveal a failure to provide essential care and protection, which is the hallmark of physical neglect.

Physical neglect is defined as withholding basic necessities like hygiene, skin care, moisture control, and medical attention. The signs here are not about intentional harm or emotional deprivation. Psychological neglect would involve failing to address emotional and social needs, while physical abuse would involve deliberate violent harm. The combination of a pressure injury and inadequate hygiene cleanly fits physical neglect, making it the best explanation for the scenario.