Clinical Geriatrics

Case Presentation
Mr. M is a 78-year-old male who lives at home with his wife. He suffers from dementia of the Alzheimer’s type that was diagnosed four years ago. Mr. M also has diabetes, hypertension, and coronary artery disease. His medications include metformin 500 mg twice daily, glipizide 5 mg once daily, lisinopril 10 mg once daily, metoprolol 50 mg twice daily, aspirin 81 mg once daily, and donepezil 10 mg once daily. Over the past three to four months, Mr. M has become increasingly resistant to showering and changing his clothes. He also frequently spits out his medications, and his wife is uncertain whether he is really taking them. In order to help with daily care, Mrs. M hired a home health aide for four hours a day three times per week. The aide is able to wash Mr. M in bed and changes his clothes. However, he often yells, curses, and makes loud moaning noises during care.

Case Presentation
Mr. P is an 87-year-old man who has had dementia of the Alzheimer’s type for more than ten years. He has lived with his daughter, Mrs. S, and her husband for the past seven years since the death of his wife. Mrs. S brings him to his primary care physician to ask if anything can be done to help him.

Mr. P requires assistance with bathing, dressing, and meals. He can eat foods such as sandwiches with his hands but can no longer hold utensils and must be hand-fed in order to consume enough food. He has been incontinent of bladder and bowel functions for the past t

Case Presentation

Ms. M is a 45-year-old divorced woman who makes an appointment for her 78-year-old mother with a psychiatrist. On the day of the appointment, Ms. M arrives alone, asking to meet with the psychiatrist. Ms. M appears distressed and worried. She explains that her mother, Mrs. S, has not left her apartment in the past four years. Ms. M has arranged for food to be delivered and has hired a housekeeper who performs cleaning and laundry tasks. She has tried numerous times to take her mother out, but Mrs. S refuses.

Ms. M describes her mother as an “anxious person”

Case Presentation

Mr. K is a 58-year-old Caucasian male with a long-standing history of diabetes mellitus, hypertension, and chronic kidney disease who has been on continuous ambulatory peritoneal dialysis for 3 years. Initially, treatment achieved good adequacy of dialysis, and the patient reported a feeling of well-being. During the last 6 months, however, his dissatisfaction with dialysis increased, which he attributed to the increased time needed to perform exchanges and his weight gain. Mr. K underwent right lower-extremity, below-knee amputation secondary to gangrenous foot as

Introduction

In 2005, On Lok Senior Health Services, a comprehensive long-term care health plan for the frail elderly, took on the challenge of offering in-house mental health services for its senior population.1 The On Lok Lifeways mental health team faced the complex task of providing quality mental healthcare to an extremely diverse population. To illustrate the enormity of this challenge: On Lok serves more than 1100 elderly persons who speak over 30 different languages. Cultural and linguistic diversity render it nearly impossible to offer mental health services to patients in