Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Aggression, Chronic kidney disease, Cognitive disorder, Condition aggravated, Dementia
Clinical narrative: Admission Date and Time: 1/29/2024  3:10 PM Discharge Date: 2/12/2024 Attending Physicians: DO, MD, MD, PA Discharge Physician: DO Admission Diagnosis: Displaced intertrochanteric fracture of left femur, initial encounter for closed fracture (HCC) Discharge Diagnosis: Displaced intertrochanteric fracture of left femur, initial encounter for closed fracture (HCC)                                              PREMORBID FUNCTIONAL STATUS Premorbid Functional Status:  Level of Independence: Independent with transfers; Independent with ambulation  IADL:  IADL Comments: Pt reports being IND w/ all IADLs at baseline; shares household responsibilities with her husband  BADL:  BADL Comments: Pt reports being IND w/ all BADLs at baseline  REHABILITATION COURSE  Patient is a pleasant 85 YO female who presented 1/29/2024 3:10 PM to Facility after primary admission to  Hospital for a GLF.  She has history of dementia and noted that she fell and broke 'something, I think one of the bones in my left hip.'  She notes no pain except when up to therapy which she says she has been able to do.  She says she has memory problems but has no current questions or concerns (except about our TV channel choices and whether she will be away from the deer in her yard too long).    From dc summary: Hospital Course: No notes on file Patient is an 85yr old female with a history of HTN, CAD, Hypothyroidism, HLD, Gout Dementia who presented with left hip fracture following fall. Today she is seen sitting in chair out of bed, has no new problems.   Left intertrochanteric femur fracture - Ortho on board and patient is s/p IM nailing POD#6. Dressing remains intact until postop appointment. PT/OT today - WBAT left LE.  CM on board - Referral to Facility - Peer to peer done 01/26/24 but was declined IPR admission. FAST APPEAL done and patient for discharge today to Facility  Dementia - no behavioral issues  CKD stage 3b - Stable and improving.  Possible Cognitive Impairment - Son reported to me on 1/26 that the patient has been very aggressive, violent and abusive at home towards their father and that they are really concerned for their fathers health. He also reports some memory lapses in her. SLP made assessment of mild cognitive impairment vs mild dementia. However,  a definitive diagnosis of Mild Cognitive Impairment or Dementia should not be made based on this test alone. Further testing of a patient's cognitive status is warranted by a neuropsychologist.     When medically stable, the patient was discharged to facility for acute inpatient rehabilitation of functional and cognitive deficits.  Symptoms related to these abovementioned conditions and events were well-controlled, and the patient was discharged medically stable and improved. There were no significant acute episodes that affected length of stay or tolerance to therapies.   The patient was also provided orthotics / durable medical equipment to ensure improved function and safety in the rehabilitation and home setting.  Occupational, Physical and Speech Language Pathology therapists and a Neuropsychologist were consulted for evaluation and treatment so as to best determine the amount and extent of services required for cognitive and functional optimization. The patient received a minimum of 180 minutes of therapy per day for 5 out of 7 days, or more than 15 hours of intensive therapy over the course of a week.   While in the unit, the acute rehabilitation service also held interdisciplinary team conferences on a weekly basis to establish specific short- and long-term goals during rehabilitation, and for discharge. Barriers to discharge were also noted and updated as they were addressed. Plans to assure continuity and coordination of care after discharge from the acute rehabilitation unit were also established and explained to the patient and care provider(s). Discharged to SNF.