Question of the Week #481

A 90 year old man with history of advanced dementia is brought to hospital with aspiration pneumonia. This is his 5th episode of Aspiration pneumonia in the past 1 year. He is accompanied by his daughter who also happens to be his healthcare proxy. She wants to focus on her father’s comfort as the goal of care and requests no further diagnostic interventions and she would like to avoid further hospitalizations. She wants to know what would make him eligible to receive hospice care. Based on which of the following factors, can he be qualified for hospice?

A. His advanced age

B. Diagnosis of advanced dementia

C. Prognosis

D. His wishes to die at home

Question of the Week # 385

385)  A 74 year old man with advanced dementia is sent from nursing for evaluation of umbilical hernia. He is accompanied by his sister who thought that the bulge looked ” ugly” and demanded that he be evaluated for surgery.  The patient has been nursing home bound for the past four years. There is no history of nausea or vomiting. When fed, he eats normally. The patient is not oriented and is unable to give further history. He does not have living will or a power of attorney. On examination, his vitals are stable. He appears comfortable. Abdominal examination showed a palpable bulge in the umbilical area which is reducible. There is no erythema and the patient winces when pressure is applied. There is no rigidity. When tried to explain him about possible surgery, the patient does not comprehend. He is not oriented to place, person or time. Which of the following is the most appropriate action at this time?

A) Do not consent for surgery

B) Obtain Psychiatry evaluation for Capacity assessment

C) Re-Evaluate his competence to make decisions

D) Consent him for surgery

E) Obtain Consent from his sister

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