An elderly patient arrives with bruises. A daughter and a son (who is the legally registered guardian) accompany the patient. The patient seems reluctant to speak. What is the most appropriate first step?

When elder abuse is suspected, the first clinical step is to interview the patient privately and alone — away from any accompanying family members or caregivers — to allow the patient to speak freely without fear of retaliation. Abusers often accompany victims to medical appointments to monitor their communications. After assessing the patient's history, physical findings, and any disclosures, mandatory reporting to Adult Protective Services (APS) is required in most jurisdictions if abuse is reasonably suspected. Speaking with the alleged abuser first could compromise patient safety and the investigation.