A 77-year-old woman is brought to the Emergency Department by ambulance because she has severe...

When elder neglect is suspected—especially in cases of self-neglect or unclear caregiver dynamics—the most important immediate step is to assess the patient’s decision-making capacity. If she lacks capacity, protective intervention is warranted.

Toronto Notes 2023 – Geriatrics, “Elder Abuse and Capacity Assessment”:

“Decision-making capacity must be assessed when a patient is refusing care despite evidence of harm or risk.”

MCCQE1 Objectives (ELOM > 90-1: Capacity and Consent):

“Candidates must assess capacity in elderly patients before attributing decisions to autonomy, particularly in complex care situations.”

Evaluating criminal records (B) or clutter (C) may be relevant later but do not take precedence over capacity assessment. Alcohol/substance use (D) and financial abuse (E) are differential concerns, not the critical first step.