Telephone Consultations – Case Report

Below is a note written to me by the granddaughter of an 88 year old female who wanted to know about nursing home placement. The patient had a baseline dementia, but was now displaying paranoid behavior and could no longer be maintained in her home where she lived with her husband.

After careful questioning, I learned that the patient had been on an anti-depressant that had been abruptly stopped, and this was most likely the cause for the sudden change in her mental status. Many medications cause a withdrawal reaction when stopped all at once; this reaction can be minimized by slowly tapering the medication off.

I recommended that she ask the physician for a low dose anti-psychotic medication to manage the symptoms until the anti-depressant medication had left her system. In addition, I suggested she call hospice. Though her grandmother was not actively dying, the criteria for hospice is broad and her grandmother had a slowly progressive pulmonary condition for which she qualified. The services of hospice plus the availability of the telephone consultations with myself, supported the patient until she died in the comfort of her home with her family holding her hand.

“Thanks so much for being so good to me.....I thank God everyday for sending all these angels into my life and you are one of them! The hospice staff is incredible!! After speaking with you and the hospice staff and relaying all the info to my dad, he now feels at peace with his decision to keep her at home instead of sending her to a nursing home....thank you so much!!”