27 Oct Mrs. Fox, a 75-year-old woman, was admitted to a residential care community for therapy after a fall

Mrs. Fox, a 75-year-old woman, was admitted to a residential care community for therapy after a fall. In her interview with social services, she was cooperative and initially tried to answer all the questions, but many times she gave up rather quickly. Her affect was flat, and she denied experiencing visual or auditory hallucinations. She was able to maintain her attention and made fair eye contact. She stated that she would sometimes cry and that her memory was “not bad.” She reported a good appetite, stated she had no trouble sleeping, and denied any feelings of depression. Mrs. Fox appeared to have a hearing impairment, but she noted that her vision was fine. She continued to attend church services and was able to say the Rosary. She indicated that she was not feeling well and would like to feel better. Mrs. Fox has multiple physical problems for which she is presently receiving medical treatment. She has been diagnosed with dementia (Alzheimer’s type). She has periods of suspiciousness and believes that people are removing things from her room. She often sits in her room in various stages of unsuitable dress at inappropriate times. The staff reports that she has been confused for about a year but has been significantly impaired for the past two months. Mrs. Fox shows a significant problem with recent memory, and her remote memory is also impaired. She is now beginning to wander, and her suspiciousness may be the result of her frustration over things she cannot find or cannot explain. In other words, she is using various defense mechanisms to make sense of her erratic, unpredictable world. She lacks insight into her impaired memory and other symptoms. She showed no improvement after taking the prescribed medication for her Alzheimer’s disease; instead, she showed both cognitive decline and progression of the disease. As noted, she admitted to sometimes crying. She also needs medication to induce sleep and, according to staff, has seemed sad for the last two weeks. Mrs. Fox’s prognosis is poor, but several interventions can improve her quality of life. The confused behavior and memory problems will only worsen as she enters the severe stage; at that point, sitting and lying down will replace wandering as the disease progresses.

QUESTIONS

1. In what stage of Alzheimer’s disease is Mrs. Fox? What symptoms support your answer?

2. What behavior will indicate that Mrs. Fox is entering the severe stage of Alzheimer’s disease?

3. What types of programs could the staff at the residential care community use to help improve Mrs. Fox’s cognitive function and quality of life?