Clinical Case Study: A 74 year old woman was admitted to a long-term care facili

Question

Clinical Case Study:

A 74 year old woman was admitted to a long-term care facility. Her son reported that, over the past year he has noticed his mother progressively having problems with her mental capacity. The changes have developed gradually but have gotten worse. He reports that at times she is alert and other times she has been disoriented, depressed, and tearful.   She has been forgetting thins and doing things out of the ordinary. His neighbor found her down the street looking for his father who passed 2 years ago. Because her behavior has gotten worse and she has become more agitated she is no longer able to live alone. She has medical diagnoses of dementia, a history of transient ischemic attacks, congestive heart failure, status post–myocardial infarction, hypercholesterolemia, and a history of urinary tract infections (UTIs), and urinary incontinence. Two weeks after her admission, she is observed by the nursing staff to be more confused and agitated over the past few days. She falls asleep during meals, and upon awakening, she is disoriented to place and time, thinking she is only visiting at the nursing home. She frequently calls out for her son and becomes combative and is always trying to leave the nursing home. These are new behaviors for this patient. The night staff report she is confused, and they have overheard her talking to her son during the night. Before this week, she was slightly confused, extremely courteous older women. The CNA reports the resident’s urine is foul smelling and dark in color.

1.What are some cognitive changes seen in a number of elderly?

2.Based on the information provided by the nursing staff do you believe the patient is experiencing delirium or dementia?

Explanation / Answer

1.cognitive changes is the normal process in aging,some of the cognitive abilities observed in them are vocabulary,brain aging,memory,conceptual reasoning,and processing speed decline gradually over time.Most of the factors for affecting cognitive aging are medications that may produce side effects drowsiness and mental dullness,changes in mood such as depression,anxiety which can alter one's motivation ,sensory changes which can interfere with the processing of information.

2.Delirium and dementia may be particularly difficult to distinguish and a person may have both.In fact frequently delirium occurs in people with dementia.But in this case it is clearly distinguished by the onset of symptoms ,as the old woman is in long term care as it happens only in dementia ,because the minor symptoms gradually worsen over time.So the patient is suffering from dementia.

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