Living at Risk

Marta is a 73 year-old woman, living in her own apartment. She has early-stage dementia with non-insulin-dependent diabetes (requiring oral medications), mild renal impairment, obesity, and moderate COPD due to previous smoking history.  Her son, Ivan, came to visit after a 10-month absence and was shocked by the state of her apartment. He found a charred saucepan on her stove, garbage that had not been taken out for weeks, a foul-smelling cat litter box, and moulding food in the fridge. He took Marta in to her family doctor to express his concerns about her living situation. Her family doctor completed an assessment that revealed, among other things, that Marta has not been taking her medication reliably and that she has deficits in executive functioning. After determining that Marta lacks decision-making capacity in the areas of health care and accommodation, the family doctor activated Marta’s Personal Directive in these domains. In her Personal Directive, Marta has named Ivan as her Agent...
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Difficult Discharge

It is Thursday afternoon.  You receive a call from one of the hospital Discharge Planners, Zahra.  Zahra requests your assistance with decision making about a patient named Mr. Roberts. She provides you with a summary of what has happened since Mr. Roberts was admitted to the hospital six weeks ago. Zahra explains that Mr. Roberts is an 83 year old who police brought to the hospital six weeks ago. The police had received a call about an elderly man walking back and forth on the same street over the course of two hours during a snowstorm, without a winter coat or boots.  The police told the Emergency Department staff that Mr. Roberts was unable to tell them his address, and that he appeared disoriented and confused. Mr. Roberts was admitted to hospital with a urinary tract infection (UTI), delirium, and ‘failure to thrive.’ Dr. Suleman identifies and contacts Mr. Roberts’ substitute decision makerDr. Suleman was Mr. Roberts’ physician on admission to the...
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