BPSD

[GP Address] 1 November 2024 Dr. Eleanor Vance, Re: Mrs. Agnes Willow DOB: 12/03/1938 Thank you for referring Mrs. Willow, who was reviewed at Willowbrook Aged Care Facility on 1 November 2024. A Comprehensive Geriatric Assessment was performed. The issues discussed were: Issues: 1. Agitation and Wandering 1. Impression: Moderate to severe Alzheimer's disease with associated behavioural and psychological symptoms of dementia (BPSD), including agitation and wandering. Likely Alzheimer's subtype. Brodaty Scale: 18 Behavioural profile: Agitation, restlessness, pacing, and attempts to leave the facility unsupervised. Verbal aggression towards staff and other residents. Treatment planned: Discontinue donepezil due to lack of efficacy and side effects. Start risperidone 0.5mg at night. Review in 2 weeks. Non-Pharmacological: Implement a structured daily routine, provide regular opportunities for exercise and social interaction, and ensure a safe and familiar environment. Consider music therapy and aromatherapy. Relevant Referrals: Referral to a geriatric psychiatrist for further assessment and management of BPSD. 2. Urinary Incontinence [Document impression or likely diagnosis for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Urge incontinence secondary to detrusor overactivity. [Document differential diagnosis for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Rule out urinary tract infection, constipation, and other reversible causes. [Document investigations planned for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Urinalysis and urine culture. [Document treatment planned for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Bladder training, fluid management, and consider anticholinergic medication if appropriate. [Document relevant referrals for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Referral to a continence nurse. 3. Poor Oral Intake [Document impression or likely diagnosis for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Poor oral intake secondary to dysphagia and decreased appetite. [Document differential diagnosis for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Rule out dental problems, medication side effects, and depression. [Document investigations planned for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Swallowing assessment by a speech pathologist. [Document treatment planned for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Modify diet to include thickened fluids and soft foods. Consider nutritional supplements. [Document relevant referrals for this issue] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in full sentences.) Referral to a speech pathologist and a dietician. Past Medical History * Alzheimer's disease (diagnosed 2018) * Hypertension (diagnosed 2010) * Osteoarthritis (diagnosed 2015) * Urinary Incontinence (diagnosed 2023) BACKGROUND AND HISTORY Mrs. Willow is an 86-year-old female with a diagnosis of Alzheimer's disease. She was referred for assessment of increasing agitation, wandering, and behavioural disturbances. She has been a resident at Willowbrook Aged Care Facility for the past 6 months. Her daughter reports that her mother's memory has been progressively declining over the past five years. She has difficulty with short-term memory and often repeats questions. She is frequently disoriented to time and place. Mrs. Willow's daughter states, "Mum gets very agitated in the afternoons and tries to leave the facility. She doesn't understand where she is going." She also has a history of hypertension and osteoarthritis. Mrs. Willow's mobility is limited due to her osteoarthritis, and she uses a walker for ambulation. She has experienced several falls in the past year, but no injuries have been reported. She has recently been experiencing urinary incontinence and poor oral intake. Memory Concerns Onset of memory decline was approximately five years ago. The pattern of decline is progressive, with increasing difficulty with short-term memory, and frequent repetition of questions. Family observations include difficulty remembering recent events and appointments. Functional Decline Loss of independence in Activities of Daily Living (ADLs) is evident. Mrs. Willow requires assistance with dressing, bathing, and toileting. She is unable to manage her medications independently. She is also unable to prepare meals or manage finances. Living Environment & Family Support Mrs. Willow resides at Willowbrook Aged Care Facility. Her daughter visits regularly and is actively involved in her care. She has two grandchildren who also visit occasionally. The family is supportive and involved in her care. Systems Review Weight Change: Unintentional weight loss of 5kg in the last 6 months. Falls: History of falls in the last 12 months, with no injuries reported. Mood: Frequently agitated and restless. Sleep: Sleeps poorly, with frequent nighttime awakenings. Pain: Reports mild pain in her knees due to osteoarthritis. Mobility/Aids Used: Uses a walker for ambulation. Bowels: Constipation. Bladder: Urinary incontinence. Memory: Significant memory impairment. Hearing: No reported hearing loss. Vision: No reported visual disturbances. Medications on Initial Review * Donepezil 5mg daily * Lisinopril 10mg daily * Paracetamol as needed for pain Allergies No known allergies. Suggested Medications Following Consultation Discontinue: Donepezil Adjust: Risperidone 0.5mg at night Social History Lives: Willowbrook Aged Care Facility. Children: One daughter. Grandchildren: Two. Born in: United Kingdom. Emigrated to Australia in: 1960. ADLs (Personal): Requires assistance with dressing, bathing, and toileting. ADLs (Domestic): Unable to perform domestic activities. Community Engagement: Limited social activities. Services in place: Respite care for the daughter. Driving: No longer drives. Falls (last 12 months): Multiple falls. Mobility Aid: Walker. Education: Completed secondary school. Employment History: Worked as a secretary. EPOA/Guardianship: Enduring Power of Attorney in place. My Aged Care: Registered with My Aged Care. Smoking/Alcohol: Non-smoker, occasional alcohol consumption in the past. Vaccinations: Up to date with vaccinations. Family History: Mother had Alzheimer's disease. Exercise: Limited exercise due to mobility issues. Physical Examination Heart Rate: 80 bpm Blood Pressure: 140/80 mmHg Neuro: Mini-Mental State Examination (MMSE) score of 12/30. Weight: 55 kg Gait: Slow and unsteady gait. Pathology Urinalysis pending. Cognitive Assessment Tool: Mini-Mental State Examination (MMSE) Score: 12/30 Interpretation: Severe cognitive impairment. Comments: Significant impairment in memory, orientation, and executive function. Summary Mrs. Willow is an 86-year-old female with a diagnosis of Alzheimer's disease, presenting with increasing agitation, wandering, urinary incontinence, and poor oral intake. The focus of treatment is to manage her behavioural symptoms, improve her functional status, and address her medical issues. Follow-up * Review in 2 weeks to assess response to risperidone. * Follow-up with geriatric psychiatrist. * Review of urinalysis results and management of urinary incontinence. * Review of swallowing assessment and dietary modifications. Kind regards, Dr. Emily Carter Geriatrician Willowbrook Aged Care Facility