Case Summary

Patient Details

87 year old woman

Current medical history

• Cerebrovascular  disease
  • Partial anterior circulation stroke 5 years ago
  • Vascular dementia 3 years ago
• Hypertension
• Ischaemic Heart Disease
  • Atrial Fibrillation 2 years
  • Myocardial Infarction 15 years ago

• Type 2 Diabetes
• Osteoporosis: Fracture vertebrae L2 1 year ago; T score -3.2 at hip on DEXA scan
• Recurrent UTIs
• MMSE 22/30 ACE-R 66/100
• COPD with moderate airflow obstruction
• Hypothyroidism

Results

• HbA_1C 40 mmol/mol (6.6%)
• BP 106/56 mmHg
• Urine Albumin/Creat ratio: trace micro-albuminuria
• Creatinine 124 umol/L; eGFR 45 ml/min and stable at this level
• Weight 43 kg

Current Medication

• Levothyroxine 150 micrograms once daily
• Alendronate 70 mg once a week
• Calcichew D3 Forte 1 tab twice daily
• Metformin 1 g three times daily
• Gliclazide 160 mg twice daily
• Perindopril 4 mg  once daily
• Indapamide 2.5 mg  once daily
• Rivaroxaban 20 mg once daily
• Clopidogrel 75 mg  once daily
• Atorvastatin 80 mg once a day
• Mirtazapine 30 mg at night
• Zopiclone 7.5 mg at night
• Paracetamol 1 g four times daily
• Omeprazole 20 mg  once daily
• Seretide 250 1 puff twice/day
• Salbutamol, as required
• Ipratropium inhaler 4 times daily
• Oxybutynin  5 mg twice daily
• Trimethoprim 200 mg  once daily prophylaxis

Current Function

Lives at home with husband who is cognitively intact but mobility limited due to heart failure. Steadily worsening memory. Needs regular reorientation by husband. Marked increase in confusion with infection. Continence a particular issue with nocturia. Needs a lot of encouragement to eat and drink enough. Main trips out the house are to speciality hospital clinics and GP.

Most Recent Consultations

Recent Admissions: Osteoporotic fracture lead to sudden loss in mobility one year ago. Delirium whilst in hospital. Flu-like illness 3 months ago. Admitted with confusion, hypoglycaemia and AKI.