NSG6340 Adult Health Primary Care
Week 4 Discussion
You are seeing a 79 y/o male in your clinic. Mr. A has been a patient of yours for several years. Today his wife is with him and reports that Mr. A has been more forgetful and she is concerned. Mr. A made several wrong turns getting home from Church last week, today he was unable to locate the clinic when driving today. He became quite angry when Mrs. A suggested she should drive today. There is a dent on the fender of the car that Mr. A cannot describe how it happened. Mr. A also had a bruise on his arm that day. Mrs. A does not like to leave Mr. A home alone for any period of time any longer as he gets anxious then agitated. One week ago, Mr. A called 911 convinced that Mrs. A had been abducted when she was taking the garbage to the curb. She was only out of the house for 5 minutes.
During your exam you conduct a Folstein MMSE. Mr. A scores 21/30. When testing for Visual Fields, he shows deficits in bilateral peripheral vision of approximately 15 degrees. He has slowed motor movements, and decreased rotation of his head/neck, showing limitation of rotation to 40 degrees in both directions without discomfort. Mr. A has a slightly shuffled gait, but no instability. The remainder of your workup shows Mr. A does not have further deficits. Your diagnosis is Early Dementia, and you reassure Mrs. A that the limitations he exhibits in peripheral vision and neck range of motion can be considered a normal aging change for him.
Discuss the concerns regarding Mr. A’s continued driving. What assessments should be done to determine Mr. A’s driving skills. What is the obligation of the provider in this circumstance? Outline a plan of care for how to proceed with Mr. and Mrs. A.
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