John Kelly is 82 years old and was admitted to the ward this morning via A&E having fallen at home. John is a widower and has been living on his own for the last 6 years since his wife died. He has 4 grown up children (3 sons and a daughter), 7 grandchildren and 12 great grandchildren.

John’s eldest son and daughter-in-law live nearest to John, so came to the hospital with him and are now on the ward. Physically John appears to be well and, although bruised, x-rays show that he has no fractures. However, John seems to be confused and when you ask his son about this, he insists that his father is ‘just being awkward as usual’. However, John’s daughter-in-law appears concerned and reports that she thinks John has become increasingly confused over the last 2 weeks.

Observations

· Airway: Patent, no issues. Able to talk in full sentences.

· Breathing: RR – 16 breaths per minute, SpO2 – 93% on air. No wheezing or added sounds.

· Cardiovascular: HR 80 bpm, BP 160/80 mmhg (normal range for him). Has passed small amounts of urine frequently since admission. Peripherally warm.

· Disability: AVCPU Confusion – GCS 13/15 [E(4) V(3) M(6)]. John seems very quiet and easily distracted by what is going on around him. He also keeps asking for his wife and trying to leave to find her.

· Exposure: Temperature 36.8°C. No rashes or breaks to the skin observed.

Signs and Symptoms

· Reports ‘being sore’ but is vague about where he has pain.

Past Medical History

· Knee replacement 10 years ago.

· Family reports he was depressed for about a year after his wife died.

· Anxiety Disorder

Current Medication

· Furosemide 20mg

Family History

· Mother died of cancer aged 38 when he was 7.

· Father died in his sleep aged 78.

· John’s younger sister has been recently diagnosed with Alzheimer’s disease.

Social History

· Non-smoker

· Goes to the pub on a Friday lunchtime and has 2 pints of beer. Likes a shot of whisky every night before bed.

· Doesn’t like cooking so tends to rely on microwave meals but does have a roast dinner at his eldest son’s house every Sunday.

· Usually active – still walks to the local shop for his paper every day.