Yves Rolland, MD, PhD
January 28, 2015

Your patient, Mr. X, is 88 years old. He consults you regularly every three months for monitoring of a moderate hypertension and for hypercholesterolemia. He calls you because he feels too tired to move and he prefers that you see him directly at his home. You visit Mr. X eight days later. He opens the door and leads you slowly to the dining room where you meet his wife who lives with him.

His blood pressure is 15/8.5 mmHg and he says his cholesterol has not been checked over the last 3 years. He points out that he pays attention to his diet to avoid high fat and hyper caloric foods. His health seems to be as usual and his physical examination is normal. For no particular reasons, he seems to have lost weight and his wife indicates that he never leaves the house.

1. What is your most likely diagnosis?
2. On what grounds?

His wife informs you that Mr. X has fallen several times over the past two months. In two weeks, he fell more than four times, with no real apparent trauma. All these “problems” seem to have occurred since his hospitalization, when he underwent surgery for a prostatic adenoma.

3. What would it be worth setting out to avoid the patient from becoming dependent?
4. What kind of interventions can be considered in this particular case?

A few months later, his wife reports that recently Mr. X has become occasionally incontinent and that he finds it difficult to wash himself.

5. What should be quickly implemented? Give practical indications

The patient has become dependent and needs assistance to get around and to be fed. His wife, aged 86 years, says that she can no longer take care of him at home.

6. What are your suggestions and what can be discussed with the patient and his family?