Case 3

Mrs Jones, an 88-year-old lady is brought to the department by ambulance.

Her neighbours called for assistance when they heard her shouting outside. She was found to be in her night dress outside and appeared to be shouting at the washing line. The ambulance crew report that her house is very cold but otherwise appeared to be in good order.

Mrs Jones had been seen in the department approximately two months previously following a fall. The notes from the time report a Glasgow Coma Scale (GCS) of 15/15 with no abnormal physical findings.

A telephone number for her niece is available from the previous notes. On contacting the niece, she is surprised to hear that her aunt is in the hospital. She tells you that she visited her a week ago and she seemed to be “in good spirits.” She reports that her aunt has had several recent falls and she is concerned about how she is managing at home.

Which of the following would be required as part of your initial assessment?

What is your differential diagnosis?

What is your management plan for Mrs Jones?

See if you can think of five further investigations.