Advanced Applications of Home-Based Primary Care Workshop-Minerva Case Study

Minerva Case Study

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Minerva Barbas, an 86-year-old female with a history of congestive heart failure (CHF) exacerbation, leg edema, cellulitis, and moderate Alzheimer’s disease, was recently hospitalized at Memorial Hospital. Following her discharge two days ago, she was seen for a post-discharge visit. Minerva's condition has led to multiple hospital admissions over the past year for leg edema, cellulitis, and a urinary tract infection (UTI) complicated by mental status changes.<br /><br />Her Alzheimer's diagnosis, made six years ago, has been associated with worsening behavioral disturbances over the past 6-9 months, including increased forgetfulness, repetitive questioning, agitation during personal care, and episodes of verbal and physical aggression. Minerva's son, who holds her Healthcare Power of Attorney (HPOA), and her daughter, her primary caregiver, have reported these behavioral concerns.<br /><br />The patient's comprehensive health history includes heart failure with reduced ejection fraction (HFrEF, EF 35%), Alzheimer's dementia, stroke (CVA) with residual dysphagia, coronary artery disease (CAD), hypertension (HTN), chronic kidney disease (CKD) stage 3, macular degeneration, osteoarthritis, hypothyroidism, gastroesophageal reflux disease (GERD), right-sided mastectomy due to breast cancer, and recurrent UTIs. She has received several immunizations, including influenza, Pneumovax, Prevnar, Tdap, and Zostavax. Her surgical history is notable for a mastectomy.<br /><br />Minerva’s physical examination revealed stable vital signs; however, she demonstrated signs of irritability, knee flexor contractures, and a significant stage 4 pressure ulcer. She requires assistance with all activities of daily living (ADLs), is minimally ambulatory, and uses adult incontinence products. Her caregivers expressed concerns over managing her CHF and leg swelling, improving her mobility, and addressing her mood and behavior.<br /><br />Currently, Minerva is on multiple medications, including Donepezil, Memantine, Isosorbide, Furosemide, Metoprolol, and others for her various conditions. The family seeks advice on preventing hospitalizations, improving her mobility to reduce caregiving burden, managing her mood and behavior, and reducing the frequency of UTIs. The care team will need to consider interventions that address these multifaceted needs to improve Minerva's quality of life and support her family's caregiving efforts.

Keywords

Minerva Barbas

congestive heart failure

Alzheimer's disease

cellulitis

urinary tract infection

behavioral disturbances

chronic kidney disease

pressure ulcer

caregiving burden

medications