Elder abuse disclosure — CASC communication station · Psych CASC / OSCE

Prompt

An older outpatient with depression discloses controlling and physically abusive behaviour by an adult child carer; you must respond with empathy, private exploration, capacity-sensitive safety planning, and clear multi-agency next steps without coercion or invented legal sections.

Station brief

Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar in an old-age clinic. The adult child is in the waiting room. [1]

Candidate instructions. Respond to disclosure of elder abuse. Ensure privacy. Assess immediate safety and the person’s wishes. Explore nature of abuse (physical, psychological, financial, neglect). Check mood and suicidal ideas. Outline options (safety planning, social work/safeguarding, police, alternative accommodation, financial protections) without inventing statute numbers. Agree next steps and follow-up. Do not force decisions or collude with minimisation. [1][3]

Candidate scenario

Your patient is 81, treated for late-life depression. Mid-session they say quietly: "My daughter takes my pension card. If I argue she hits my arm. I am frightened but she is all I have." No acute medical emergency is apparent. English is fluent. [1]

Marking domains

Warmth, non-judgemental stance, belief of disclosure
Confirms privacy; does not bring daughter in without consent
Explores subtypes, frequency, escalation, weapons, isolation
Suicide/self-harm risk and mood briefly assessed
Safety options explained in plain language; choice respected if capacious
Multi-agency help described in principle (social work, elder abuse services, police, financial protections)
Clear agreed plan and follow-up; documentation mentioned
Avoids invented legal sections and coercive ultimatums [1][2][3]

Reveal assessor key

Open. Thank them for trusting you; state you take this seriously; confirm the daughter is not in the room; check if they feel safe talking now. [1]

Explore. What happens, how often, injuries, control of money/visitors, threats, whether anyone else knows. Ask about suicidal thoughts given depression and fear. [1]

Safety and options. "We can make a plan that fits what you want as much as possible." Options: urgent social work/safeguarding involvement; temporary safe place; medical review of bruises; bank/card protections; legal advice on protection orders; police if they wish or if severe imminent danger/local duty requires. Explain you may need to share limited information with the team to keep them safe — be honest. [1][3][4]

Capacity-sensitive stance. Check understanding of risks of returning home unchanged; if understanding is limited by fear, cognition, or depression, gently note you may need senior/safeguarding input and more support to decide safely — without humiliation. [2]

Close. Summarise agreed steps (e.g. social work today, crisis numbers, follow-up call, whether daughter is told anything); thank them; avoid forcing an immediate police report solely to "pass" the station if they refuse and no clear mandatory trigger is established — still do not abandon safety planning. [1][3]

References

[1]Lachs MS, Pillemer KA Elder Abuse N Engl J Med, 2015.PMID 26559573
[2]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
[3]Cooper C, Selwood A, Livingston G Knowledge, detection, and reporting of abuse by health and social care professionals: a systematic review Am J Geriatr Psychiatry, 2009.PMID 19916205
[4]Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach Ann Emerg Med, 2016.PMID 27005448

Station brief

Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar in an old-age clinic. The adult child is in the waiting room. [1]

Marking domains

Warmth, non-judgemental stance, belief of disclosure

Confirms privacy; does not bring daughter in without consent

Explores subtypes, frequency, escalation, weapons, isolation

Suicide/self-harm risk and mood briefly assessed

Safety options explained in plain language; choice respected if capacious

Multi-agency help described in principle (social work, elder abuse services, police, financial protections)

Clear agreed plan and follow-up; documentation mentioned

Avoids invented legal sections and coercive ultimatums [1][2][3]

Reveal assessor key

Open. Thank them for trusting you; state you take this seriously; confirm the daughter is not in the room; check if they feel safe talking now. [1]

Explore. What happens, how often, injuries, control of money/visitors, threats, whether anyone else knows. Ask about suicidal thoughts given depression and fear. [1]

References

[1]Lachs MS, Pillemer KA Elder Abuse N Engl J Med, 2015.PMID 26559573
[2]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
[3]Cooper C, Selwood A, Livingston G Knowledge, detection, and reporting of abuse by health and social care professionals: a systematic review Am J Geriatr Psychiatry, 2009.PMID 19916205
[4]Rosen T, Hargarten S, Flomenbaum NE, Platts-Mills TF Identifying Elder Abuse in the Emergency Department: Toward a Multidisciplinary Team-Based Approach Ann Emerg Med, 2016.PMID 27005448