Differentials
Dementia
SIGNS / SYMPTOMS
Patients may present with delusions or paranoia and failure to thrive.
INVESTIGATIONS
Further evaluation with home health agency and psychiatrist involvement may assist in the diagnosis. Caution needs to be exercised in patients with dementia with paranoia who may falsely accuse a caregiver of theft or abuse.
Falls in older adults
SIGNS / SYMPTOMS
Identifying the circumstances surrounding the fall and the symptoms associated with the fall helps to determine the underlying cause.
INVESTIGATIONS
Evaluation of neurological issues and other sensory systems can help with the evaluation of recurrent falls. Injury should be consistent with type of fall.
Medicine non-adherence
SIGNS / SYMPTOMS
Features of underlying illness re-emerge (e.g., hypertension, thyroid disease, diabetes mellitus).
INVESTIGATIONS
Tests may indicate poor control of underlying disease.
Previous history suggestive of non-adherence is helpful in delineating this issue. There is great potential for misuse with opioids and tranquillisers.
Substance misuse
SIGNS / SYMPTOMS
Behavioural symptoms are caused by the direct physiological effects of substance use or as a result of substance withdrawal.
INVESTIGATIONS
Urine and blood testing for illicit substances.
Depression
SIGNS / SYMPTOMS
May present with severe cognitive disturbance (memory deficits) as a result of the depression.
INVESTIGATIONS
Further evaluation with home health agency and psychiatrist involvement may assist in the diagnosis.
It is recommended that clinicians use specific diagnostic testing for older people (e.g., the Geriatric Depression Scale) or for older people with cognitive impairment (e.g., the Cornell Scale for Depression in Dementia). Cornell Scale for Depression in Dementia Opens in new window
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