Case study ( 1216 views as of February 22, 2018 )
Filomena is an 82-year-old resident of an independent living facility. She caught a cold that has been 'going around' for the last few weeks, and now feels like she is more short of breath than usual and is coughing more than usual for her. She normally gets around with a walker, and tries to participate in community activities most days, but for the last few weeks hasn't been able to move between more than her couch, the bedroom and the bathroom. Her family has been bringing in groceries.
Filomena has had a heart attach in the past, and required an angiogram with 2 stents. She has non-insulin dependent diabetes, and life-long asthma, that has now been re-classfied as Chronic Obstructive Pulmonary Disease (COPD). She takes a daily puffer with a long-acting beta-agonist, and a steroid combined, and has a 'blue puffer' that she uses only when she needs it.
Shortness of breath in an older patient, particularly in females, can be many things. At the very least, she needs to see her primary care provider, but many patients with Filomena's symptoms are first assessed in an emergency department or urgent care clinic. Ruling out cardiac causes for her symptoms would be prudent, and excluding serious bacterial infections would be common. If it is determined that the problem is a flare-up of her lung disease following the recent 'cold', then additional medications may be prescribed.
Filomena may also benefit from follow-up and teaching from respiratory illness specialists. Also, her decline in function is important to consider, and she may benefit from other services focused on maintaining independence and quality of life for elderly patients.Author: Dr. Adam Lund