RT Book, Section
A1 Harrison, Krista L.
A1 Smith, Alexander K.
A2 Walter, Louise C.
A2 Chang, Anna
A2 Chen, Pei
A2 Harper, G. Michael
A2 Rivera, Josette
A2 Conant, Rebecca
A2 Lo, Daphne
A2 Yukawa, Michi
SR Print(0)
ID 1180014993
T1 Ethics & Informed Decision Making
T2 Current Diagnosis & Treatment Geriatrics, 3e
YR 2021
FD 2021
PB McGraw-Hill Education
PP New York, NY
SN 9781260457087
LK accessmedicine.mhmedical.com/content.aspx?aid=1180014993
RD 2024/04/24
AB Case  Vignette  Part  1:  Introduction  and  Ethical  TensionsYou  are  in  clinic  seeing  a  longstanding  patient,  an  87-year-old  woman  with  diabetes,  congestive  heart  failure,  hypertension,  and  mild  cognitive  impairment.  She  ambulates  using  a  cane.  The  patient’s  adult  daughter  accompanies  her  on  this  visit.  The  daughter  lives  several  towns  away,  and  prior  to  today  had  not  visited  for  several  months.  The  daughter  reports  being  shocked  at  the  deteriorating  condition  of  her  mother’s  home.  She  describes  a  cluttered  house,  with  trip  hazards  everywhere  and  stinking  piles  of  garbage  in  the  kitchen.  The  patient  herself  says  she  has  some  recent  difficulty  with  her  vision,  but  other  than  that  believes  she  is  doing  fine.  On  examination,  her  blood  pressure  is  180/82  mm  Hg,  and  her  score  on  the  Montreal  Cognitive  Assessment  (MoCA)  is  23/30.  Laboratory  tests  show  a  HbA1c  (glycosylated  hemoglobin)  of  12.5.  A  visit  by  a  home  nurse  confirms  the  daughter’s  concerns  about  the  living  situation,  also  noting  that  the  patient’s  medications  have  been  removed  from  their  bottles  and  placed  together  in  a  jar  on  the  dresser.  When  you  meet  the  patient  next,  you  explain  your  concerns  about  her  living  situation  and  ability  to  care  for  herself.  She  responds  that  she’s  doing  “just  fine,”  and,  “I  won’t  move  into  a  nursing  home!”