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Case 26
Dementia and nursing home fall
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Brief History
The patient was an elderly Caucasian woman, nursing home resident with dementia who fell approximately one week prior to death.
She sustained right facial and other right-sided injuries and was managed with pain medication.
She died suddenly after a large bowel movement.
Next: External exam
Discussion Questions
1. How would you tell the difference between abuse and neglect in an elderly patient? What are signs of neglect in an elderly patient? What are signs of abuse?
2. If a patient has signs of neglect but not abuse, can this still be abuse? Why or why not?
3. The history describes a fall. In general, what patterns of injury would support that story? What patterns of injury go along more with abuse?
4. If the family tells you the patient was unable to walk and was bedridden, how does that change your understanding of the case?
5. If the family tells you the patient was ambulatory, how does that change your understanding of the case?
6. If the patient was verbal before the fall and non-verbal after, what’s your differential diagnosis?