What is the most appropriate action when an 82-year-old woman presents with signs of elder neglect and abuse but does not wish to report her son?

In cases where there are signs of elder neglect and abuse, it is crucial to take action that prioritizes the safety and well-being of the vulnerable individual, regardless of the individual's wishes. Notifying adult protective services is the most appropriate action in this scenario because these agencies are specifically trained to handle situations involving elder abuse and neglect. They have the resources and authority to investigate the allegations, ensure the safety of the elderly woman, and provide appropriate interventions.

Even if the woman does not wish to report her son, it is important to recognize that her ability to make decisions about her safety may be compromised due to the circumstances of neglect or abuse. By involving adult protective services, professionals can assess the situation more thoroughly and provide support that she may not be able or willing to seek on her own.

Other options, such as contacting the son directly or discharging the patient home without any intervention, would potentially place the woman at further risk. A psychiatry consultation for capacity determination, while it can be helpful in assessing her ability to make informed decisions, does not directly address the immediate need to protect her and ensure her safety from potential ongoing harm. Therefore, the most responsible course of action is to report the situation to adult protective services.