Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Driving and Dementia Case Study: Assessing the Fitness to Drive of an Elderly Man, Study notes of History

A case study of an 85-year-old man named Mr. G., who is living with his wife and has a number of health conditions, including osteoarthritis, lumbar spinal stenosis, Parkinson's disease, macular degeneration, glaucoma, diabetes, and high blood pressure. information about Mr. G.'s medical history, medications, physical examination, cognitive examination, and family interview. The case study also includes questions for the reader to answer regarding the patient's driving ability and cognitive diagnosis. The document aims to help healthcare professionals assess the fitness to drive of elderly patients with dementia and other health conditions.

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

slupdoggy
slupdoggy 🇬🇧

3.4

(5)

215 documents

1 / 6

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Driving & Dementia Case Study 1
Driving and Dementia Case Study
Review the following case study one section at a time, responding to the questions posed following the
information provided. Expert opinion about how to respond to the case can be found at the end.
PART A: Case Information
Background
Mr. G. is an 85 year old man living with his wife
Non-smoker, 2 – 3 beer per day
Past Medical History:
Osteoarthritis (neck, knees)
Lumbar spinal stenosis with radicular pain and weakness in feet
Mild Parkinson’s disease X 1 year
Macular Degeneration & Glaucoma
Diabetes with peripheral neuropathy and neuropathic pain
poor diabetic control
HTN
Medications:
Sinemet
Oxybutinin (Ditropan)
Nortryptilline and Gabapentin for neuropathic pain.
Tylenol #3 PRN – takes 4 – 6 per day
Glyburide and Insulin
Oxazepam QHS PRN for sleep
Adalat XL 120 mg OD
Physical Examination:
Pulse 60 and BP 110/70 supine
Pulse 60 and BP 80/50 standing. Denies postural lightheadedness but slightly unsteady when first
standing. Does admit that on occasion he does get more “dizzy” and has to sit down.
Mild restriction in neck turning
Possible left upper quadrant visual field loss (borderline finding)
Pain in knees with movement
Decreased light touch and proprioception in feet
Mild ankle weakness
Failed 2 of 3 Ruler Drop Reaction Time Tests (Failed = dropped ruler)
pf3
pf4
pf5

Partial preview of the text

Download Driving and Dementia Case Study: Assessing the Fitness to Drive of an Elderly Man and more Study notes History in PDF only on Docsity!

Driving and Dementia Case Study

Review the following case study one section at a time, responding to the questions posed following the information provided. Expert opinion about how to respond to the case can be found at the end.

PART A: Case Information

Background

 Mr. G. is an 85 year old man living with his wife  Non-smoker, 2 – 3 beer per day  Past Medical History:  Osteoarthritis (neck, knees)  Lumbar spinal stenosis with radicular pain and weakness in feet  Mild Parkinson’s disease X 1 year  Macular Degeneration & Glaucoma  Diabetes with peripheral neuropathy and neuropathic pain  poor diabetic control  HTN

Medications:

 Sinemet  Oxybutinin (Ditropan)  Nortryptilline and Gabapentin for neuropathic pain.  Tylenol #3 PRN – takes 4 – 6 per day  Glyburide and Insulin  Oxazepam QHS PRN for sleep  Adalat XL 120 mg OD

Physical Examination:

 Pulse 60 and BP 110/70 supine  Pulse 60 and BP 80/50 standing. Denies postural lightheadedness but slightly unsteady when first standing. Does admit that on occasion he does get more “dizzy” and has to sit down.  Mild restriction in neck turning  Possible left upper quadrant visual field loss (borderline finding)  Pain in knees with movement  Decreased light touch and proprioception in feet  Mild ankle weakness  Failed 2 of 3 Ruler Drop Reaction Time Tests (Failed = dropped ruler)

Cognitive Examination:

 Somewhat slow in answering questions  MMSE 25 / 30 (0/3 recall, problems with pentagon drawing)  MOCA 19 / 30 (0/5 recall, problems with Trails, Cube drawing, Clock drawing)  Trails A – 1 minute 10 seconds, 1 error  Trails B – 5 minutes 20 seconds, 5 errors

Family Interview:

 Progressive mild decline in memory X 2 years  No major impact on Function. Still able to bank, cook, shop and use TV remote. Some mild problems remembering to take medications.  Wife feels patient is “a great driver and has never had accidents”. Daughter cannot voice any specific concerns but seems worried.

PART A: Questions

  1. Using the 10-Minute Office-Based Dementia and Driving Checklist, is the patient safe to drive at this time?  List any contraindications to driving.
  2. What is the cognitive diagnosis?
  3. What actions would you pursue with respect to driving?  Are there any potentially reversible factors?

PART C: Case Information

1 year later…  Memory problems worse  Some impact on high level IADLs – medication use  MMSE 24 / 30 (0/3 recall, more problems with pentagon drawing)  MOCA 20 / 30 (0/5 recall, more problems with Clock and Cube drawing)  Trails A – 55 seconds, 0 errors  Trails B – 2 minutes 50 seconds, 2 errors  Appears cognitively slow again  Family history unchanged

PART C: Questions

  1. Using the 10-Minute Office-Based Dementia and Driving Checklist, is the patient safe to drive at this time?  List any contraindications to driving.
  2. What is the cognitive diagnosis?
  3. What actions would you pursue with respect to driving?

PART C: Further Information

 Passes – allowed to continue to drive.  Initiate discussion regarding the inevitability of eventual driving cessation  Arrange follow-up every 6 – 12 months regarding fitness-to-drive

PART D: Case Information

2 years later…  Dementia has progressed despite aggressively addressing all reversible factors and attempting cholinesterase inhibitor therapy  Having difficulty with several IADLs – medication use, banking, cooking and possibly TV remote use  MMSE 19 / 30  MOCA 15 / 30  Trails A – 85 seconds, 1 error  Trails B – 6 minutes 50 seconds, 6 errors  Slow mentation is obvious  Slow parkinsonian movements – can no longer catch ruler during Ruler Drop Reaction Time Test  Wife is now expressing concerns regarding driving. She reports 2 near misses where patient almost struck a car and a pedestrian.

PART D: Questions

  1. Using the 10-Minute Office-Based Dementia and Driving Checklist, is the patient safe to drive at this time?  List any contraindications to driving.
  2. What is the cognitive diagnosis?
  3. What actions would you pursue with respect to driving?