Coroner's Finding: BLAIN Kathleen Olive Florence

79y · Female·acute myocardial infarction and acute pulmonary oedema

A 79-year-old woman with stroke and cardiac history was admitted for rehabilitation but developed treatment-resistant depression. Despite comprehensive multidisciplinary management including medication trials (mirtazapine, citalopram, venlafaxine), nasogastric and PEG feeding support, and five ECT treatments (preceded by appropriate cardiology and neurology clearance), her condition deteriorated. She had poor engagement with rehabilitation, reduced oral intake, and progressive physical deconditioning. The coroner found her medical treatment was appropriate throughout and made no recommendations. The clinical lesson is that treatment-resistant depression in elderly patients with multiple comorbidities requires intensive coordinated care, but some patients may not respond despite optimal interventions. Early consideration of prognosis and goals of care, which appears to have occurred here, is essential.