Mrs. Smith
The general impression of Mrs. Smith so far are that she is nearing an end-of-life phase: she is becoming weaker, tired, does not feel like going out much, and experiences a general sadness -- though she says she does not feel "sad exactly." Her general mood is pensive, somewhat concerned about her frailty -- definitely concerned about having another fall like she had last year and becoming dependent upon caretakers. Her fears are founded on the experience of friends and just an overall awareness of the fact that she is aging -- now 80 -- and will not be able to live independently forever. This is no doubt causing some slight depression -- which is not uncommon or unusual in seniors at this age (Shulman, 2007). Likewise her gait pattern -- slow, "reduced walking speed, arm swing and vertical head movements" are indicative of "sadness and depression" (Michalak et al., 2009). This would bear out the sense that she is feeling dysphoric lately, withdrawing from society, not going to the store, not seeing friends as much as she used to. She is aging and perhaps beginning to reflect a little more on the uncertainty of what lies ahead than living in the present, in the here and now.
What else I would like to know about Mrs. Smith is her daily routine, who manages her meal preparations, her daily medications (if any -- so as to prevent accidental overdose), what percent of
As for psychological issues, I would want to know more about her family background, whether there is any history of depression in her family or in her own past. I would also like to know if she has considered any plans for the future -- it would be good to address the elephant in the room; it could in fact alleviate some of the heaviness that is weighing in her mind. I would like to know what she has considered doing should she require caretaking in the future -- whether she would turn to her son, whether she would like to go to assisted living. She may not want to talk about this subject, but it could be broached for the sake of clarity. To make her feel better about, possible alternatives -- such as home care -- could be discussed; perhaps talking through options could help ease her mind and reduce her sadness. It is important to address these issues and get seniors talking because "ending social isolation" can be very helpful in addressing sadness issues (Grundberg et al., 2016).
Differential diagnoses for Mrs. Smith are depression due to persistent sleep disturbances, dysphoria. Degenerative CNS disease is another; chronic fatigue syndrome, anxiety, Type I collagen mutations, and Major depressive disorder are others. She may also suffer from aortic stenosis -- judging from the murmur heard at the right upper…
