In April 2006, a 92-year-old Caucasian widow, May C., fell in her kitchen 10 miles west of Yakima, Washington, resulting in a compound fracture of her right femur. May called her LifeLine service for help and was transported to Providence Yakima Medical Center. Surgical repair of her leg was delayed for 3 ½ days due to a doctor shortage in the area. While in surgical recovery May suffered Delirium (DSM-IV-TR 293.0) and had to be restrained for her own safety for several hours, but returned to baseline mental status within 24 hours (A. Stultz, personal communication, 4/18/2006). On release from the hospital May was placed in a nursing home for physical rehabilitation. In 2000, May broke her left femur and hip, returning home with normal cognition after three months, but this time she has exhibited psychotic symptoms and signs of dementia in addition to pre-existing physical and mental health issues and is not expected to return home. May was offered an adult family home placement in 7/2006, as both family and nursing home staff agreed she would benefit from a more home-like environment, but May refused believing it was a plan to trick her out of her remaining money.
[...] She reports a love affair with a 31-year old male nurse's aid and is “broken hearted” when he rebuffs her advances. May believes her daughter and her roommate have “broken us As it did while still in her home, May's cognition continues to fluctuate. Her psychotic symptoms also fluctuate but are increasingly more prominent despite anti-psychotic medication. Because of her high initial level of intellectual functioning, her dementia is not always obvious to persons who do not know her well. [...]
[...] syndrome, urinary incontinence, rheumatoid arthritis of knees, feet and hands with replacement of both knee joints, migraine headache, Primary Insomnia (DSM- IV-TR 307.42 Generalized Anxiety Disorder ( 300.02 ) and Major Depressive Disorder ( Recurrent, Moderate, With Melancholic Features, With Full Inter-episode Recovery). Each of these diagnoses date back to the 1960's. In the last five years May has also been diagnosed with hypertension and Type II diabetes. May is believed to have had at least two transient ischemic attacks (TIA or “mini-stroke”) after reporting that she “floated” around the house prior to two falls (A. [...]
[...] Ohadinia, Noroozian, Shahsavand and Saghafi (2004) found that certain types of insomnia and especially daytime napping are correlated with Alzheimer disease. The worse the dementia, the higher the amount of daytime napping in the Iranian Alzheimer patients studied. A significant correlation was also found between paranoid symptoms and increased daytime napping. May has a long history of insomnia but has only begun napping during the day in the last 10 years or so. The amount of time she spends napping has increased dramatically in the last year, possibly supporting Dementia of the Alzheimer's Type as a diagnosis. [...]
[...] On several occasions, her granddaughter-in- law Doris Stultz (personal communication, 2/15/2006) stopped by to help with housework to find May unable to remember how to turn off the stove or confused as to what room she was in. May's increasing deafness and declining vision due to cataracts contribute to her difficulties but she does not want either treated. Her daughter, who spent part of each day with May, minimized May's symptoms and was unwilling to suggest a move to a more supportive living situation. [...]
[...] Utilization of Self-Identity Roles for Designing Interventions for Persons With Dementia [Electronic version]. The Journals of Gerontology: Series B Psychological sciences and social sciences, 61B(4), P202-P212. Seroquel®: Achieving Balance Brings Strength. Retrived 11/18/2006 from http://www.seroquel.com/ Ohadinia, S., Noroozian, M., Shahsavand, S. & Saghafi, S. (2004). Evaluation of Insomnia and Daytime Napping in Iranian Alzheimer Disease Patients: Relationship With Severity of Dementia and Comparison With Normal Adults [Electronic version]. The American Journal of Geriatric Psychiatry, 517-522. Rayner, A., O'Brien, J. & Shoenbachler, B. [...]
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