Transcript AUTONOMY/CAPACITY - Arizona Geriatrics Society

CASE STUDY #1
AUTONOMY, CAPACITY, & DUTY
TO REPORT
Faustina Dannenfelser
Joanne Gurin, MD
Emily Kile, Esq.
Roy Yaari, MD
CASE #1
• AB, 82 yo female with gradual onset of
memory loss for 8 years
• Mini-Mental Status Exam (MMSE) 21/30
(normal at least 24)
• Montreal Cognitive Assessment (MoCA)
13/30 (normal at least 26)
CASE #1 (cont.)
• Dependent on her husband for all
Instrumental Activities of Daily Living
(IADLs)
• Refuses to bathe over several months and
wears soiled clothing
• Is physically and verbally aggressive and
refusing to take any medications
• Drinks at least 4 glasses of wine/day
CASE #1 (cont.)
• Presents to office two daughters
– one daughter has co-Medical Power Of Attorney
(MPOA)/Financial POA for both parents with her
brother who lives out of town
• Daughters report that patient’s husband
may also be cognitively impaired along with
excessive alcohol use
• The couple live independently and refuse
help in the home except for their daughters
CASE #1 (cont.)
• Full workup has demonstrated conclusive
diagnosis of mild-moderate Alzheimer dementia
with behavioral impairments of agitation,
delusions, and refusal to take medications
• Treatment options reviewed
– Initiate quetiapine (dissolve in liquid)
– Restart donepezil and memantine when she
accepts medications
• Recommended that husband come in for
evaluation
CASE #1 (cont.)
• BB is 88 yo male with decline in cognitive
function in past 2 years
– Forgets to pay bills and has been prey to
solicitors
– Poor short-term memory
– MMSE 26/30; MoCA 22/30
• Significant alcohol consumption
throughout the day
• Drives within a 2-mile radius of home
CASE #1 (cont.)
• Full workup has demonstrated conclusive
diagnosis of mild Alzheimer dementia
• Initiate donepezil
• Recommended that caregiver be initiated
in the home to assist with meal
preparation, medication administration,
grooming and pleasant events
CASE #1 (cont.)
• Daughters work to obtain in home
caregiver but BB fires her within 3 days
• BB reports that he is giving his wife the
quetiapine each day
• Daughters report that neither parent is
getting his/her medications routinely and
the situation continues to get worse
• Daughter would like to pursue
guardianship
CASE 1 – QUESTION #1
BB is incompetent.
1. TRUE
2. FALSE
CASE 1 – QUESTION #2
BB has full decision-making capacity.
1.TRUE
2.FALSE
CASE 1 – QUESTION #3
By Arizona statute, who has decision-making
capacity if BB loses his?
1.Daughter
2.Son
3.A consensus of all 4 adult children
4.Physician
CASE 1 – QUESTION #4
Are AB and BB vulnerable adults and do they
have the right to live independently?
1.Yes, they are vulnerable and should be
allowed to live independently
2.No, they are NOT vulnerable and should
be allowed to live independently
3.Yes, they ARE vulnerable and should NOT
be allowed to live independently