Thank you very much for asking me to see Ms. Doukogianis for a geriatric assessment. The main concern is that of falls.
She is an 86-year-old woman who was born in Greece and came to Canada in the 1950s. She is a widow since 2004. She has 2 children, 1 son Anthony and another daughter in Greece. Her daughter-in-law Karen is with her for the interview today. She lives alone in a condominium. She speaks several languages including Greek, Italian and English. She is a retired restaurant owner. She has about 4 years of high school education.
Thank you very much for the detailed notes and previous investigation results. These are very helpful in understanding her situation and the workup that she has had done before. The problem list is especially helpful.
She has a history of falling starting about 5-6 years ago. There is no precipitating factor. She cannot help falling and it is not exactly clear whether she has associated loss of consciousness or not. Apparently she is drowsy and gets confused for a few minutes. It happens up to once a day and may happen while she is walking. There is no precipitating factor. On further asking, there seems to be brief periods of syncope at times but not with every fall. She went to Greece from June 16th to September 16th for 3 months. She had fallen 4 times there. She had been on the floor for up to 10 minutes. She is back from Greece it has not happened anymore. There, she was helped up by the paramedics.
She saw Dr. Randi Rose, our cardiologist in North York General Hospital and had a Holter for 2 weeks twice. There is some tremor but apparently no symptoms and no associated loss of consciousness or incontinence. As I look back into the history, there was a history of paroxysmal atrial fibrillation in October 2012. Prior to that, she had a stress test in the year 2000. She had EKGs in August last year that showed sinus arrhythmia and marked left axis deviation. There is a right bundle branch block with left anterior fascicular block and left ventricular hypertrophy. Echocardiogram in August last year showed mild diastolic dysfunction and mild mitral and tricuspid regurgitation, but normal systolic function.
There is no dizziness on postural change. She does not use a cane or walker for a walking aid. There is no history of depression and she denied being depressed.
Although she complained about no weight loss, she has a decline in appetite. She eats mainly 2 meals a day and skips lunch.
Her long-term memory seems to be preserved whereas there is a decrease in short-term memory. She is safe with the stove and the tap. She is more repetitive. This is particularly so when she was in Greece. She denies being depressed.
For her ADLs, she is independent in all aspects of basic ADLs. She is also independent in the instrumental ADLs. She can ambulate independently with occasional falls. She bathes herself. For instrumental ADLs she does the shopping, cooking, cleaning and laundry. She manages her own...