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Case Study - Mrs. Doris’s Decline
Mrs. Doris, an 85 year old woman, was admitted to hospital two weeks ago after a serious fall and hip fracture. You are asked to see Mrs. Doris as she is having difficulty participating actively in her therapy program due to confusion.
Prior to this admission Mrs. Doris had been living alone in her own home. Her husband passed away less than a year ago and her two children live out of province. Mrs. Doris has maintained an active lifestyle and has always been very close to her friends and neighbours. Until recently she has continued to drive her car and enjoy her involvement with the ladies bridge club at her church.
History
After meeting with Mrs. Doris and reviewing her chart you obtain permission to talk to her neighbours and close friends. You become aware of the following:
slow decline over the last 6 months
forgetting where she put her purse and keys
increased difficulty with cleaning and cooking
mixing up several appointments
no longer attending weekly bridge games at the church
not seen out of home or driving her car
Examination
A full physical, including mental status examination, reveals :
no physical or neurological deficits
difficulty following multi-step commands
poor short term memory
difficulty naming common objects
appears detached and disinterested
CAT scan: generalized cerebral atrophy, increased ventricular size and presence of mild microvessel disease
