CONSULTATION
Sex: F
Age:95

Mrs. ___ is a 95 year old white female who was admitted to the hospital after she fell at home and was diagnosed with a nondisplaced fracture. Had CT of the pelvis, nondisplaced fracture involving both greater and lesser trochanters on the right.

PAST MEDICAL HISTORY: The patient's past medical history is significant for B12 vitamin deficiency, history of pneumonia, status post CVA, GERD.

CURRENT MEDICATIONS: The patient's current medications include:
1. Meclizine.
2. Oscal. 
3. Neurontin 200 mg twice a day. 
4. Aspirin. 
5. Lexapro 10 mg in the morning.
6. Colace 100 mg twice a day.
7. Detrol LA.
8. Combivent.
9. Mycostatin.
10. Heparin twice a day.
11. Protonix.

LABORATORY DATA: RBC within normal limits. Increased cholesterol equals 274.

PAST PSYCHIATRIC HISTORY: "I don't remember." The patient is not aware who prescribed her Lexapro. She said that it must be Dr. ___ who ordered her medications. That is the only doctor I see. As per review of the chart, there is note of a social worker who indicated the patient has significant difficulties to take care of herself and they are questioning the patient's ability to be placed in a nursing home. As the social worker spoke to the patient's son, he indicated that the patient has increasing difficulties to take care of herself and has difficulties to care for herself, and also she has more difficult time to deal with her financial situation, and there was a question at times that she has been having some psychotic symptoms, being delusional. The patient's son indicated there is a significant family history of Alzheimer's disease. He indicated the patient has a sister who has a history of dementia.

MENTAL STATUS EXAMINATION: "I am very upset about this. I should know it is
year I don't know." She questions, "you don't put me away for this. President, I don't like him, but forgot his name". The patient is able to name day of the week, but has significant difficulty to name them backwards. The patient's thought process is slow. She states, "I am here because I cracked my head". The patient indicated that she is not depressed, and she indicated she will be more than happy to be placed in a nursing home. She said, "to being old, it sucks, but I know I have to probably go away". Denied currently any auditory or visual hallucinations. No delusions elicited. The patient is alert, and significant difficulties with recent memories.

ASSESSMENT AND PLAN: Dementia, NOS, history of depression.
1. There has been significant recent memory deficit. I do not know if that was noticed in the past. There is no prior history available at present. If we are concerned about the patient's depressive state, the patient is treated with Lexapro 10 mg, which is sufficient treatment for depression, if that was the consideration of the patient's treaters. The patient currently is agreeable to be placed in a nursing home. If there are plans to discharge the patient home I would strongly recommend an OT evaluation about the patient's ability to care for herself. As per note of the social worker, family questions patient's possibility to be placed in a nursing home because she has been unable to function independently. Currently the patient does not present with any psychotic symptoms. I will not consider to start any psychotropic medications currently.

Thank you for participating in the care of this patient. I will also recommend an evaluation of thyroid hormone.

Thank you. Please call Psychiatry for additional questions.


