Case Study: 74-Year-Old African American Woman Ms. Richardso
Case Study A 74 Year Old African American Woman Ms Richardson Was Br
Analyze the clinical case of Ms. Richardson, a 74-year-old African American woman, presenting with confusion, neglect, and apparent psychiatric symptoms, including inability to recall the current month and hospital. She exhibits signs of physical neglect, possible substance-related issues, and a history suggestive of prior psychiatric medication use. The case includes subjective complaints of pain, weakness, and swallowing difficulties, along with objective findings such as unkempt appearance, disorientation, and behavioral disturbances. The police report indicates a situation involving animal distress, firearm possession, and dangerous living conditions, complicating her mental and physical health status.
Based on this case, identify a primary diagnosis and two differential diagnoses supported by DSM-5 criteria, including corresponding ICD-10 codes. Discuss appropriate pharmacological treatment, referencing current clinical guidelines, and justify your choices. Additionally, outline non-pharmacological interventions aligned with evidence-based practices and propose a health promotion intervention suitable for Ms. Richardson as part of a comprehensive, patient-centered care approach.
Paper For Above instruction
Introduction
Ms. Richardson’s case exemplifies complex interplay between psychiatric, physical, and social factors impacting an elderly patient's health. Her presentation with confusion, neglect, and uncertain mental status indicates acute and possibly chronic psychiatric issues compounded by physical health problems such as uncontrolled diabetes. The initial assessment must incorporate a thorough understanding of her psychological state, medical history, social environment, and potential risks to formulate an effective treatment plan supported by current clinical guidelines.
Summary of Clinical Case and Significant Data
Ms. Richardson, a 74-year-old African American woman, was brought to the emergency room by the police after neighbors reported concerning behaviors. She appeared unkempt, confused, and unresponsive, with physical neglect evident in her environment—filthy apartment, littered with dog feces, and a snarling dog shot with a tranquilizer gun. She was wearing only a bra and unable to accurately recall the date or her current hospital setting. She acknowledged feeling sick, weak, and experiencing shoulder pain, with a history of not eating for three days.
Subjectively, she denies hearing voices or having prior psychiatric hospitalization but admits to seeing a psychiatrist ‘near downtown’ who prescribed a medication she referred to as “allal,” likely Haldol (haloperidol). She also mentions a toy gun brought by her deceased brother, denying current firearm possession. Objectively, her disorientation, neglectful appearance, and reports of weakness suggest both medical and psychiatric alterations needing immediate attention.
Primary and Differential Diagnoses
Primary Diagnosis
Major Neurocognitive Disorder (Dementia) due to Alzheimer’s Disease (DSM-5 Code: 294.01; ICD-10 Code: F03.90)
This diagnosis is supported by her recent confusion, disorientation, neglect, and memory impairments, including inability to recall the month. Although the differential could include other forms of dementia or delirium, her presentation and history of prior psychiatric medication resistance suggest a neurodegenerative process, possibly Alzheimer’s disease, exacerbated by metabolic disturbances.
Differential Diagnoses
- Delirium, due to a General Medical Condition (DSM-5 Code: 293.0; ICD-10 Code: F05)
- Major depressive disorder with psychotic features (DSM-5 Code: 296.24; ICD-10 Code: F33.3)
Delirium is plausible given her acute presentation and physical health issues, such as uncontrolled diabetes and pain, which can precipitate cognitive disturbances. Depression may also contribute, especially considering her social isolation and medication non-compliance, although her lack of prior psychiatric history makes it less likely as the primary cause.
Pharmacological Treatment
The management of her neurocognitive disorder, coupled with acute delirium and possible agitation, may include low-dose antipsychotics such as haloperidol, given its efficacy in controlling agitation in elderly patients (Wong et al., 2019). Current clinical guidelines recommend cautious use of antipsychotics due to increased mortality risk in dementia patients, emphasizing non-pharmacological approaches first (National Institute for Health and Care Excellence [NICE], 2018). If medications are indicated, the lowest effective dose for the shortest duration should be used, with close monitoring of adverse effects such as extrapyramidal symptoms and cardiac QT prolongation.
Additionally, management of her uncontrolled diabetes with insulin therapy is crucial, as hyperglycemia may worsen cognitive function and contribute to delirium (American Diabetes Association [ADA], 2021). Supportive care with hydration, correction of metabolic imbalances, and analgesia for shoulder pain should be integrated into her pharmacological plan.
Non-Pharmacological Interventions
Non-pharmacological strategies are essential in managing her cognitive and behavioral symptoms. These include orientation protocols (clocks, calendars), minimizing environmental disturbances, and providing a structured routine to reduce confusion (Van der Ploeg et al., 2019). Cognitive stimulation therapy and reminiscence therapy can help improve her engagement and mental functioning. Social support initiatives, including involving family or community services, are vital given her social isolation.
Behavioral interventions to address agitation or aggression, such as validation therapy or preferred activity engagement, are supported by evidence (Livingston et al., 2019). Staff training in dementia care and ensuring a safe environment minimizes risks associated with wandering, animal encounters, and unsafe behaviors.
Health Promotion Interventions
Comprehensive health promotion for Ms. Richardson should focus on holistic elder care, emphasizing medication adherence, nutrition, social engagement, and management of chronic diseases. Developing a tailored case management program involving home health services or community outreach can facilitate medication compliance, monitor her physical and mental health, and reduce hazards in her living environment (Kales et al., 2019). Education for her and her caregivers about disease management, recognizing early signs of deterioration, and safety precautions (e.g., firearm safety, pet management) is integral. Addressing social determinants such as isolation, housing conditions, and access to healthcare will promote overall well-being and stability.
Conclusion
Ms. Richardson’s case underscores the importance of an integrated, patient-centered approach combining clinical assessment, appropriate pharmacological management, supportive non-drug interventions, and health promotion to improve quality of life and safety. Her complex needs require collaboration among healthcare professionals, social workers, and community resources, aligning treatment with current guidelines to optimize her outcomes.
References
- American Diabetes Association. (2021). 14. Management of Diabetes in Older Adults. Diabetes Care, 44(Supplement 1), S168–S179. https://doi.org/10.2337/dc21-S014
- Kales, H. C., et al. (2019). Person-centered care planning for nursing home residents with dementia: The PAIR model. Journal of the American Geriatrics Society, 67(10), 2114–2121. https://doi.org/10.1111/jgs.16023
- Livingston, G., et al. (2019). Non-pharmacological interventions for agitation in dementia: Systematic review of randomized controlled trials. The British Journal of Psychiatry, 214(2), 76–83. https://doi.org/10.1192/bjp.2018.263
- National Institute for Health and Care Excellence. (2018). Dementia: Assessment, management and support for people living with dementia and their carers. NICE Guideline [NG97].
- Van der Ploeg, E. S., et al. (2019). Cognitive stimulation therapy for dementia: A systematic review. Aging & Mental Health, 23(11), 1445–1454. https://doi.org/10.1080/13607863.2018.1476090
- Wong, C., et al. (2019). Pharmacological management of agitation in dementia. Cochrane Database of Systematic Reviews, 10, CD009067. https://doi.org/10.1002/14651858.CD009067.pub2