Case 2: Mrs. James

Provider

History

Mrs. James is a 72-year-old widow who lives alone. She has no medical problems and takes no medications. Her son came to visit from California and noted old bruising under her right eye and that she was not herself. She seemed confused, and unable to remember recent events. He was very concerned. He called his mother’s doctor and he was told to bring her to the ED.

Physical Exam

Mrs. James is awake and oriented x 3: Blood pressure 140/80, Heart rate 88. She is underweight, with a bruise under her right eye. She also has an old bruise on her right lateral chest. You believe you smell alcohol on her breath.

Alcohol Screen

She drinks daily She has 2-4 per evening She likes highballs (whisky with a little soda)

Physician Advice

One standard drink per evening Referral to geriatric assessment unit

Patient: Mrs. James

History

You are 72, a widow for the past year, living independently, and very lonely. Your son moved to California 6 months ago. You have been increasing your alcohol intake from the usual one highball in the afternoon to 2-3 throughout the evening until you feel sleepy enough to go to bed. You have noticed some bruising around your eye and chest, but can’t remember falling. Your son just came for an unexpected visit. He became very upset about the bruise on your eye. He insists that you go to the ED. You have no idea why.

Negotiation

You are not very happy about this. On a scale of 1-10 you chose a 3. Pros It’s the only thing you enjoy. It helps with the loneliness. Sometimes you can get the neighbors to come over for a short visit for afternoon drinks.

Cons

You have not had the energy to go to your sewing class at the senior center. You are initially tired in the evening, but your sleep is interrupted multiple times during the night. You have fallen on the way to the bathroom at night, although you think this is from the slippery throw rug in the bathroom, not your balance.

Patient Goal

The best you will agree to is 1-2 drinks per evening. You agree to a geriatric assessment.