Case #1:

Joe is a 92-year-old patient who has been admitted to Loyola and appears on your list of patients to be followed. He has a history of diabetes, indigestion, constipation and congestive heart failure for the past three years. He lives in his own apartment with a dog and a bird, and very seldom gets out. His stepson, the only relative except for a grandnephew in Los Angeles, manages Joe's finances and is his landlord. Joe's wife died five years ago. His income needs have been met by a small pension and Social Security. Joe does not see or hear well and has difficulty getting around due to old age . His stepson lives across town but comes frequently and provides groceries and assistance with a bath occasionally. Joe has had the flu for a week with a high fever, poor fluid intake and dehydration and vomiting.

Joe has been self-sufficient at home, but because of the flu , his personal situation has been altered. He can barely help himself. He sleeps most of the time and is slightly confused. He knows who he is, where he is, and that he is ill, but he is confused about the time of day and the date. His chest and head are still very congested and he has a heavy productive cough. His hearing has decreased. Since he is frail, his skin is further irritated by dehydration and almost two weeks in bed at home and in the hospital. His buttocks, elbows and heels are very reddened. Your team has ordered IV therapy for dehydration, which is now complete. You are going to continue, orally, his heart medications, antibiotics and decongestants, potassium and vitamins. He also gets insulin shots twice a day; these have replaced oral medications for diabetes.