Clinical Case 8 of 15 · ~739 words
Clinical Case No. 8. Dementia, Family Care and Delirium During Physical Illness
Gradual functional decline
Mei is 79. She lives with her husband in Burnaby; their daughter lives nearby and visits several times a week. The family has established routines: Sunday lunch, walks along a familiar route and conversations with the grandchildren. Mei enjoys cooking, although over the past two years she has increasingly needed help with the sequence of preparing dishes.
At first, the difficulties seemed like forgetfulness: repeated questions, lost bills and confusion about dates. Later, she took her morning medication twice and could no longer manage paying for shopping. Her husband took over these tasks, so household life appeared almost unchanged for a long time. Discussing who now did what revealed the actual decline in independence.
Assessment considers hearing, vision, language, education and previous functioning. Cognitive testing is supplemented by medication information, depressive symptoms, neurological examination, laboratory investigations and neuroimaging. The picture is consistent with dementia, most likely of Alzheimer type, with vascular risk factors.
They discuss donepezil, its expected symptomatic benefit, and gastrointestinal and cardiac adverse effects. At home, they arrange pharmacy packs, agreed supervision of dosing, help with finances and safe kitchen use. Behavioural symptoms and care needs are reviewed at subsequent appointments. [133, 134]
What family support involves
Her husband has osteoarthritis and needs respite; their daughter works. A home assessment covers available support hours, bathing, mobility, food and night-time sleep. It determines home support and respite options; contributions towards some services depend on income. [135, 136]
Her husband says he is managing, then admits that for almost a month he has left home only with Mei. Their daughter begins taking time off work. Care needs have gradually occupied the time previously available for rest and personal tasks.
The family and team agree on home help and daytime activity. Some support begins later than expected. During the interim, the daughter takes specified days, and regular respite is arranged for her father.
Acute change after a gastrointestinal infection
After several days of diarrhoea and reduced fluid intake, Mei suddenly becomes disoriented, cannot sustain a conversation, and alternates between falling asleep and trying to get up in the middle of the night. She stops recognizing her bedroom. Her husband knows her usual state and insists that this began quickly, rather than gradually over recent years.
In hospital, dehydration is identified: sodium is 149 mmol/L and creatinine 112 µmol/L, compared with a previous 72. Acute onset and fluctuating attention and activity are consistent with delirium superimposed on dementia. [137]
The medical team treats the cause and corrects fluid balance with laboratory monitoring. They review medications, pain, constipation, urinary retention and sleep. Glasses, a hearing aid, daylight and her daughter's familiar voice support orientation.
The psychiatrist helps assess delirium and behavioural difficulties. Environmental overload is reduced, with support for mobilization and orientation; together with correction of the physical illness, these measures prove sufficient. [137, 134]
Recovery after delirium
Sodium and renal function improve, and fluctuations in attention diminish. Mei still needs more help than before the infection. The team plans another functional assessment after further recovery.
The occupational therapist checks whether Mei can find the bathroom, stand safely, use a cup and follow a simple sequence. Her daughter describes familiar cues at home. These findings inform the discharge plan and the next home visit.
Mei returns home with increased support. Later, her night-time needs grow; she, her husband and their daughter begin considering long-term care with the team.
Waiting for long-term care
The waiting list affects the family's decisions. The Office of the Seniors Advocate report Monitoring Seniors Services 2025, released in 2026, records 7,029 people waiting as of 31 March 2025. Their mean elapsed wait was 287 days. [70]
While waiting, Mei's needs change, her priority is reviewed and the family receives the interim support available. Temporary assistance does not always match the family's ideal schedule. Small gaps are felt most keenly at this point in the larger system: one night without respite, one cancelled ride, one change of worker to someone who does not yet know Mei's habits.
When a suitable place becomes available, the family participates in the transition. Her husband continues bringing familiar tea, and her daughter brings photographs and music. Care changes address, but relationships continue. Follow-up includes nutrition, mobility, pain, sleep and understanding Mei's wishes as far as she can express them.