Case 18 - The aged brain: when the pieces don't fit  pp. 132-138

The aged brain: when the pieces don't fit

By Bruno Franchi

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Clinical history

Mary presented from her home to our Tertiary Hospital in early June of 2003 (age 96) having “stumbled to the ground” being unable to get up. It is unclear how she obtained help; however the Ambulance crew noted she was failing to complete her Activities of Daily Living (ADLs) at home. The house condition was very poor, being dirty with evidence she was not cooking or eating well. She was walking with a frame and receiving assistance from domiciliary care on a monthly basis. She was noted to have significant visual and hearing impairment.

She was admitted to the General Medical Unit and requested residential care placement. A social work review was obtained to get her approved for placement. On signing the paperwork, she was noted to be “lucid and adamant she does not want to live at home.” Despite waiting for placement, she tired of waiting and discharged herself in early July. She was discharged with community supports (“GP Homelink”). No cognitive testing was undertaken during this admission.

She presented 8 weeks after discharge after a piece of paper she left on her heater caught fire. She let herself out of the house. Her neighbor called the Fire Department and the Ambulance service brought her to our tertiary hospital for assessment of smoke inhalation. Carboxyhemoglobin was 2% (<0.8%). No injury was sustained. She felt well and wanted to return home with her brother the next day.

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