Case 5.3 Ms. Rosa Mateo
Karen Kline works for Elder Services in a midsize city in the southwestern part of the United States. She has been working with Rosa Mateo, age 80, for 5 years, helping her to obtain light housekeeping assistance and secure a visiting nurse to monitor blood pressure and medications, as well as providing other components of general case management. Karen has not seen Rosa in 2 weeks, but when she comes to her apartment, Rosa refuses to let her in, accusing her of trying to steal her Social Security check. Karen soothes her fears, reminding Rosa that she is her case manager and not the individual who has been victimizing older adults in the neighborhood. Rosa appears to settle down and lets her in. For almost an hour, they discuss Rosa’s concern about a recent respiratory ailment and the spiraling cost of antibiotics.
Karen suspects that Rosa supplements her medication with a healthy dose of vodka on a regular basis and perhaps chooses to purchase alcohol rather than food with her limited income. Today, Karen notices Rosa seems unusually distracted and agitated. She gets up and walks around, glancing furtively out the window every time she passes it. When Karen asks her what she is looking at, Rosa begins to cry and expresses concerns about some man who has been looking in her window. She begs Karen to take her out of the apartment and place her somewhere where the man cannot find her. When Karen goes to comfort Rosa, she becomes verbally and physically abusive.
- What symptoms does Ms. Mateo exhibit that suggest she has depression, dementia, or delirium?
- What risk factors support a diagnosis of one of those conditions?
- What is the next step for the social worker in this case?
Table 5.2 Differentiating Characteristics of Depression, Dementia, and Delirium
| Depression | Dementia | Delifium | |
| Presenting Symptoms | Depressed mood, negative self
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Difficultly with memory; disorientation to time, place, and individual; disturbances in intellectual reasoning and thinkings | Disorientation, mental confusion, emotional liability, manic-like behavior, hallucinations
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| Onset | Gradual; may be connected to onset of physical illness, loss of family or friends, changes in financial or living situation
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Gradual; progressive loss of intellectual functioning, increasing confusion, loss of ability to perform familiar tasks
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Sudden; may occur following illness or surgery; deterioration in functioning progresses very quickly
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| Cognitive features | Loss of cognitive functioning is rare, but older adult has difficulty concentrating and making decisions and may experience minor memory loss
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Difficulty remembering recent events, learning new tasks, and communicating; becomes confused easily about directions and personal location even in familiar area
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Mental confusion and disorientation occurs rapidly; fluctuating levels of awareness with severe difficulties maintaining attention
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| Emotional features | Loss of interest or pleasure in favorite activities; persistent sadness, irritability, guilt, and hopelessness; seems lethargic and apathetic or intensely worried
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Passive and withdrawn as the older adult loses touch with the immediate environment; may become agitated when confronted about cognitive losses
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Agitated, erratic mood swings, anxious, uncooperative; may become aggressive physically and verbally toward others
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| Physical features | Appetite and sleep disturbances; vague somatic complaints that do not respond to medical treatment; looks very sad
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Looks “lost” and confused; may dress inappropriately or show signs of lack of self-care
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May have a “wild-eyed” look and appear very disoriented, and physical appearance may be disheveled
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| Risk factors | Family history of depression, social isolation, physical illness, low income, taking medications known for side effect of depression
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Family history of Alzheimer’s disease or Down syndrome; advanced age
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Taking multiple medications, history of drug or alcohol use, poor nutrition and hydration, recent illnesses or surgery, presence of Parkinson’s disease or multiple sclerosis, or generally having poor health
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RELATED: Case 5.2 Mr. Charles Curry
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