Tuesday, May 1, 2012

Blogs to Boards: Question 11

This is the eleventh in a series of 41 posts from both GeriPal and Pallimed to get our physician readers ready for the hospice and palliative medicine boards. Every week GeriPal and Pallimed alternates publishing a new question, as well as a discussion of possible answers to the question (click here for the full list of questions).  

Question 11

Mr. Z is a 87 year old with advanced dementia living in a nursing home. At baseline he cannot recognize family members, is dependent on all ADLs (dressing, toileting, bathing) but does not have urinary or fecal incontinence. He speaks about 1-2 intelligible words per day and he has had progressive loss of ability to ambulate. He is now admitted to the hospital after sustaining a hip fracture from a fall.

When discussing treatment options for his hip fracture, his wife asks you how long he likely has to live.
Given his current state of health, what would be the most appropriate answer:

a) Given that he does not meet FAST 7C criteria his prognosis is likely greater than 6 months
b) He meets NHPCO Guidelines for hospice eligibility which means he likely has less than a 6 month prognosis
c) Given his advanced dementia and recent hip fracture, his 6 month mortality risk exceeds 50%
d) As with most individuals with advanced dementia, his life expectancy is likely weeks to months


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