Coroner's Finding: PEMBERTON Graham Ashton
Deceased
Graham Ashton Pemberton
Demographics
87y, male
Date of death
2016-02-05
Finding date
2019-10-29
Cause of death
aspiration pneumonia, urinary tract infection and general inanition complicating advanced Alzheimer's dementia
AI-generated summary
Graham Pemberton, 87 years old with advanced Alzheimer's dementia, died of aspiration pneumonia, urinary tract infection, and general inanition. He was admitted to hospital multiple times in 2015 with behavioural disturbance, agitation, and medical complications including urinary retention and pneumonia. He required escalating levels of care including catheterisation, restraints (mittens), and eventually palliative care. The coroner found the care provided during the last three months appropriate and the death not preventable. Mental Health Act Inpatient Treatment Orders were deemed necessary and lawful. The case illustrates challenges in managing aggressive behaviour and medical complications in dementia patients, with appropriate multidisciplinary team involvement and symptom management throughout his hospitalisation.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Clinical conditions
Contributing factors
- advanced Alzheimer's dementia with severe cognitive decline
- agitation and aggressive behaviour
- recurrent urinary retention and infections
- difficulty swallowing
- post-operative delirium following suprapubic catheter insertion
- inability to safely manage catheter
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