Hospitalization and discharge against medical advice underpinned by elder mistreatment

This clinical vignette is that of an 82-year-old woman who was admitted into a geriatrics unit in Nigeria, with acute heart failure and multiple decubitus ulcers. She was subsequently discharged against medical advice after 27 days on account of financial constraints and her children's inability to achieve a unified front for her care provision. The clinical scenario illustrates that medical presentation of disease may be a manifestation of elder mistreatment. It also highlights how discharge against medical advice may be the culmination of mistreatment of hospitalized older adults. We review the literature on types and important features of elder mistreatment and how it may be diagnosed in clinical settings. We also discuss challenges that clinicians in Nigeria may face in diagnosing and managing elder mistreatment as a result of a dearth of training in geriatrics and the absence of a national framework to tackle elder mistreatment.