Bruno Vellas, MD, PhD
September 9, 2013
Objectives
1. Explain the concepts of pathological ageing, polypathologies, and vulnerability
2. Describe the principles related to prevention
3. Discuss how to evaluate autonomy and dependency, and examine assistance and preventive measures
Presentation
The patient is an 88-year-old man who comes to see you every three months for follow-up of his hypertension and high cholesterol. He calls because he feels too tired to come to your office and prefers that you come and see him at his home. You go to his home one week later and he and his wife receives you.
Consultation
His blood pressure is 150/85 mmHg and he comments that his cholesterol levels have not been checked for more than three years. On the other hand, he is very careful with his diet, avoiding fatty and high-calorie foods. His overall health status seems in general to be the same as usual.
Question 1: What would you do, and what follow-up do you suggest in the medium and long term?
His wife calls you a few months later as her husband has fallen several times lately (more than 4 falls in 2 weeks) without any apparent damage.
Question 2: What should you do?
His wife tells you that recently her husband has developed urinary incontinence.
Question 3: What should you check for?
The patient was catheterized by the Urology department because of urinary retention caused by a benign prostatic hyperplasia with overflow incontinence. He continues to have falls, and is becoming more and more dependent. Given the family’s concerns and at their request, you decide to hospitalize him.
Question 4: What tests do you think are necessary?
Question 5: What steps need to be taken rapidly?
CT scan revealed a large subdural hematoma. The patient has fever (39°C) since yesterday.
Question 6: What would you do?
The patient has become dependent and needs help to get around and to eat. His wife, who is 86 years old, tells you that she cannot take him back in their home.
Question 7: What do you suggest to the family?
Question 8: What assessments should be performed when the patient first enters the nursing home?
Question 9: What follow-up do you recommend?
Question 10: What could we have suggested for this patient when he called for the first time saying that he did not feel able to come and see you?
Question 11: Please describe the three main categories of elderly patients
Question 12: What are the main geriatric evaluation tools?
Question 13: What action and follow-up could we have offered this patient?