1 / 12

Managing the Threatening Elder in a Healthcare Facility

An 83-year-old dementia patient in a wheelchair with multiple medical issues expresses suicidal thoughts and desires to leave the facility. Managing her condition requires a comprehensive plan to mitigate self-harm risks.

guinivere-crolly
Download Presentation

Managing the Threatening Elder in a Healthcare Facility

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Threatening Elder

  2. Case • 83-year-old demented female • Wheelchair-bound • Multiple medical problems • Angry • Wants to leave the facility • Believes she can live independently • Says the 5 words • “I want to kill myself!” • Never noted before today

  3. Medical Problems • Osteoarthritis • Total hip replacement on the right • Glaucoma • High blood pressure • Heart disease • Hypothyroidism • Poor gait, now in wheelchair • Dementia • Depression • Constipation • GERD

  4. Medical Problems • Problematic for self-harm • Increased pain and frustration • Worsening depression • Thyroid disease • Lessened ambulation • Loss of independence • Confusion causes: • Dementia • Depression • Constipation • Thyroid disease • Pain

  5. Medications • Ultram • Acetaminophen • Timolol • Furosemide • Metoprolol • L-thyroxine • Sertraline • Omeprazole • MOM • Senna • Donepezil

  6. Medications • Delirium could be an issue here • Ultram • Too much or too little levothyroxine • Poorly treated depression • Sertraline too low • Or just not effective • Too low dose of thyroxine • Leads to worsened mood

  7. Laboratory • Recently: • TSH • CBC • CMP • Vitamin D • Vitamin B12 • UA • All came back normal

  8. Assess the Threat • Risks • No previous attempts, ideations • But has depression • No family history • Not a white male • No new health or social stress • Desire to go home is longstanding • She is a bit less cognitively impaired than peers • But still moderately-severely demented

  9. Opportunity • Minimal opportunities exist • Non-ambulatory • Could not leave the facility on her own • All potential methods removed • Finger foods, no utensils • Blind cords, shoestrings, belts taken • Cognition is poor enough a plan is unlikely • MMSE 11/30 • Commonly confused enough to need help with ADL steps

  10. Information to Provider • All medical conditions, medications • Rule out medical precipitant • When did this ideation begin? • About 30 minutes ago • What circumstances were present? • Shift change, staff exiting • What did she actually say or do? • “ What’s the use…I might as well…” • Context of these comments? • Being told she could not leave and go home • Angry with staff for refusing to take her home • What is she doing now? • Back in her room, no further comments

  11. Plan • One-to-one for one hour • Can she be redirected? • Every 15 minute checks • For the remainder of the shift • Removed all potential self-harm opportunity • Utensils, cords, watch pills be swallowed, e.g. • Document all statements, actions • Reassess every hour and note in chart

  12. Plan • Remember: • An assessment by a provider can be done over the phone • Does not require a transfer to another medical facility • If significant risks and opportunity exists a transfer to an ER may be appropriate • Make sure there is risk, however • Avoid the expensive round-trip ambulance ride • Costs everyone, especially a confused, frightened resident

More Related