Gerontology

An 86-year-old African American female was admitted to the hospital after experiencing a seizure while waiting for a swallow evaluation as an outpatient. Her family members report that the patient has baseline advanced dementia, which has been worsening over the last year. She is not verbal but is able to conduct a meaningful conversation. The patient was moved to a an assisted living facility after the death of her husband 2 years ago. Patient appears healthy in general.

PAST MEDICAL HISTORY

* dementia * hypertension * constipation

MEDICATIONS * Iron supplements * ferrous sulfate 325 mg * asprin 81 mg * Colace (docusate) 300 mg

FAMILY HISTORY * Late onset of dementia (father) * Anemia (mother) * Hypertension (brother) * Depression (mother)

SOCIAL HISTORY

The patient is a resident of a nursing home and is completely dependent on the activities provided for and care of the assisted living facility. She has lived there for a little over 2 years. Family members visit her often. The patient does not smoke or drink substantial amounts of alcohol.

PHYSICAL EXAMINATION

Vital signs showed:

* heart rate of 94 bpm * normal temperature of 36.5 C * respirations 12 per minute * blood pressure 120/87 mm * Hg (36.5-94-14-120/87).

OTHER FINDINGS

* The chest was clear to auscultation bilaterally * The cardiovascular system (CVS) examination showed that she had clear heart sounds (clear S1S2) but she was tachycardic. There were no murmurs, or gallops * The examination of the extremities showed no cyanosis or edema She had a decreased skin turgor. * The neurological examination showed that she was somnolent, but without focal findings of neurological