Monday, June 23, 2008


An 80 year old woman living in a retirement home presents with generalized weakness. She says she can't get out of bed because she's just too tired every morning. It's been going on for several months. The onset has been gradual and she can't recall any inciting factors. At the nursing home, she has her own room and says that she goes days without talking to anyone. Her husband passed away several years ago. At that time, she had an MI. Currently, she has severe arthritis which gives her chronic uncontrolled pain. She is on high dose anti-inflammatories, a statin, a beta-blocker, an ACE-inhibitor, and alendronate.

The nursing home attendant also says that the patient has not been eating very much, been losing significant weight, and has stopped doing her daily crossword puzzle. She's been sleeping excessively and moves a lot slower than usual.

Challenge: What's on the top of your differential?


tree said...

Depression :(

Craig said...


Major depressive disorder is often missed in older populations leading to unnecessary suffering, impaired functional status, increased mortality, and increased use of health care resources. Risk factors include female sex, social isolation, being hospitalized, having a comorbid medical condition, uncontrolled pain, and widowed/divorced/separated marital status. Major depression requires 5/9 of the following symptoms for nearly every day for 2 weeks: depressed mood, loss of interests/pleasure (the patient must have at least one of these two), change in sleep, change in appetite or weight, change in psychomotor activity, loss of energy, trouble concentrating, thoughts of worthlessness or guilt, thoughts of death or suicide.

Source: UpToDate.