Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam.

Question:

Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home.  As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you.

Background:

Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.

PMH:

Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization.  She also has a history of HTN and high cholesterol.

Current medications:

HCTZ 25mg daily

Evista 60mg daily

Multivitamin daily

Surgeries:

Appendectomy as a child in Ireland (date unknown)

1968- Cesarean section

Allergies: Denies food, drug, or environmental allergies

Vaccination History:

Cannot remember when she had her last influenza vaccine

Does not recall having received a Pneumovax

Her last TD was greater than 10 years ago

Has not had the herpes zoster vaccine

Screening History:

Last Colonoscopy was 12 years ago

Last mammogram was 4 years ago

Has never had a DEXA/Bone Density Test

Social history:

Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.

Family history:

Both parents are deceased but lived disease-free up into their late 90s.  She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.

Discussion

• Differential Diagnoses with rationale
• Further ROS questions needed to develop DD
• Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
• Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis
•  Include one evidence based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.