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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Margaret Wilson and discuss your management plan with her.

Scenario

Margaret and Don Wilson have been your patients for many years. Don has developed Alzheimer’s disease. You made the diagnosis on the basis of a typical history and an unremarkable organic screen. Don has been seeing a geriatrician who has started him on donepezil (Aricept) with little response to date. Margaret is generally healthy but is carrying Don’s care almost single-handedly and you are concerned about how she is coping.

The following information is on her summary sheet:

  • Age

  • 74

  • Past medical history

  • Osteoarthritis

  • Medication

  • Paracetamol 665 mg 2 tds

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Married

  • Non-smoker

  • Alcohol intake—two standard drinks per week.

INSTRUCTIONS FOR THE PATIENT, MARGARET WILSON

You and your husband, Don, have been coming to see this doctor for many years. Don is 76 and has recently been diagnosed with Alzheimer’s disease. He sees a visiting geriatrician (Dr Sue Davies), who has prescribed a medication—Aricept—but so far there doesn’t seem to be any improvement. You are finding his care very draining and are worried about how you are going to manage. Don is anxious when you are not nearby, so he follows you around the house or garden and seems to need your reassurance all the time. He asks the same things over and over again and needs assistance with all but the most basic activities. You have found yourself getting increasingly frustrated with him and have lost your temper with him lately. You have never been physically violent, but you worry about what might happen if things continue the way they are. Dr Davies suggested Don go to home group once or twice a week, but he doesn’t want to go and usually refuses. You have stopped going out to most of your usual activities (walking, croquet and bridge) because you don’t feel you can leave Don alone. You have lost contact with most of your friends and can feel yourself being worn down emotionally.

Your appetite is normal and you are sleeping reasonably well, but you often worry about what is going to happen to Don. Your mood is dominated by worry about Don but is otherwise OK and your energy levels seem normal. Your children live interstate and are busy with their own lives. You don’t have anyone you feel you can share your worries with, and you are grieving the relationship you previously had with Don where you could talk about things. If the doctor raises possible placement in care, you respond by saying, ‘Oh, I could never do that’. Don needs almost constant help, and you have heard stories about people being neglected in nursing homes. You can’t bear to imagine Don wasting away by himself in ...

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