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Case 1. A.J. 94 year old lady in residential home. Dementia Aortic stenosis Chronic Kidney Disease, stage 3 OA knees Hypertension Glaucoma. A.J. contd. P.M.H. September 2011 Transient Ischaemic Attack May 2002 Right cataract extraction and implant Medication Clopidogrel 75mg daily

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a j 94 year old lady in residential home
A.J. 94 year old lady in residential home
  • Dementia
  • Aortic stenosis
  • Chronic Kidney Disease, stage 3
  • OA knees
  • Hypertension
  • Glaucoma
a j contd
A.J. contd.

P.M.H.

  • September 2011 Transient Ischaemic Attack
  • May 2002 Right cataract extraction and implant

Medication

  • Clopidogrel 75mg daily
  • Maxidex eye drops 0.1% daily to R eye
  • Laxido orange
  • Zeroderm ointment
a j contd1
A.J. contd.

Hospital admissions:

  • 2008 admitted from home after a fall
  • Anterior dislocation of shoulder
  • CKD diagnosed
  • Aortic stenosis confirmed on echo
  • Discharged to residential home
a j contd2
A.J. contd.
  • 2010 admitted after further fall
  • Displaced fracture R distal humerus –fixed internally
  • CT scan head – no bleed
  • 2011 admitted after an episode of weakness and slurred speech with no evidence of infarct or bleed on CT scan- diagnosed as TIA
  • Echo confirmed aortic stenosis and 24 hour tape and blood tests normal other than known CKD.
a j contd3
A.J. contd.
  • Discharged back to residential home but became more aggressive and transferred to different home April 2013

ISSUES:

  • New G.P. with no prior knowledge of person
  • No formal diagnosis of dementia in records
  • DNACPR was in place( G.P. had done after T.I.A.)
  • Elderly, more frail , no plans in place for future care
  • Settled in home, mobilises with help, eats and drinks well
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