An 88-year-old woman with multi-infarct dementia and behavioural disturbance was detained under the Mental Health Act following assault of her GP. She presented with abdominal symptoms and deteriorating vital signs, transferred to hospital with sepsis of unknown origin (possibly perforated bowel, diverticulitis, colitis, or ischaemic bowel). Clinical lesson: early recognition of physical illness in elderly patients with dementia and behavioural problems is challenging but critical. The patient had complained of abdominal symptoms for months at the aged care facility. Difficulty examining agitated patients should trigger alternative diagnostic approaches (imaging, blood work despite non-cooperation). Family preference for comfort care was documented. The coroner found care appropriate and made no recommendations.
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Specialties
geriatric medicinepsychiatrygeneral practiceemergency medicine
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