Case Study
This case study introduces you to William McHughes, an 86-year-old man living on the Sunshine
Coast in a retirement village with Harriet, aged 80 years, his wife of 52 years. They have no children
but since moving into the village 15 years ago, they have a strong network of friends and neighbours.
William was diagnosed with dementia eight years ago, preceded by about three years of gradual
changes to his cognition and behaviours. He is now quite physically frail and needs assistance with
daily living including getting in and out of bed, walking to the bathroom or loungeroom, showering
and eating. His awareness of his surroundings is fading, and he has trouble finding his words to
speak.
Clinical Presentation
William presents to the hospital following a short period of heightened confusion. He had a fall at
home when Harriet was trying to help him get out of his lounge chair as he was hurrying to get to
the toilet. They both fell to the ground and William appears to have sustained an injury to his right
lower arm and was incontinent of urine. Harriet was uninjured but has come with William to hospital
and is clearly upset.
William has now been admitted to the surgical ward awaiting orthopaedic review. Harriet is sitting
by his bed, still upset about his fall and their predicament. On examination, you can see that William
is a very frail older man who is confused, disorientated, guarding his right arm from movement or
touch, and yelling out. He remains incontinent of urine and is constantly reaching to his pubic area
with his uninjured hand.
Harriet is William’s Enduring Power of Attorney and has indicated that she wishes for William to
have his arm injury assessed and his confusion investigated. She just wants to him to be well enough
to take back home to be in his unit and amongst their network of friends.
Part One: Clinical Assessment
1. Dementia is a progressive, incurable and life-limiting disease, and is often amenable to palliative
and end-of-life care. Explain which PEoLC trajectory applies to William; you can use a diagram to
illustrate. Considering the life-expectancy people with dementia in Australian, what might
William’s Life expectancy be now?
2. Although William has specific clinical issues, how would you conduct an assessment to identify the
impact of his illness and clinical presentation on his whole life?
3. How would you assess William’s confusion? What assessment tool/s could you use?
4. How would you assess William’s urinary symptoms? What assessment tool/s could you use?
5. What social aspects of William and Harriet’s life are important to address in your assessment?
Part Two: Care Management
6. Given the advanced state of William’s disease and current injury, explain who might be part of
his multidisciplinary team and why it is important for them to work together.
7. Explain how you would manage William’s confusion while he is in hospital. What are the most
important care strategies?
8. Explain how you would manage William’s urinary symptoms while he is in hospital. What are the
most important care strategies?
9. Harriet has clearly stated that she wants to be able to take William home when he is well
enough. Which health care professionals or others might be able to support them at home?