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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