1. Case 1

2. A.J. 94 year old lady in residential home Dementia Aortic stenosis Chronic Kidney Disease, stage 3 OA knees Hypertension Glaucoma

3. A.J. contd. P.M.H. September 2011 Transient Ischaemic Attack May 2002 Right cataract extraction and implant Medication Clopidogrel 75mg daily Maxidex eye drops 0.1% daily to R eye Laxido orange Zeroderm ointment

4. A.J. contd. Hospital admissions: 2008 admitted from home after a fall Anterior dislocation of shoulder CKD diagnosed Aortic stenosis confirmed on echo Discharged to residential home

5. A.J. contd. 2010 admitted after further fall Displaced fracture R distal humerus –fixed internally CT scan head – no bleed 2011 admitted after an episode of weakness and slurred speech with no evidence of infarct or bleed on CT scan- diagnosed as TIA Echo confirmed aortic stenosis and 24 hour tape and blood tests normal other than known CKD.

6. A.J. contd. Discharged back to residential home but became more aggressive and transferred to different home April 2013 ISSUES: New G.P. with no prior knowledge of person No formal diagnosis of dementia in records DNACPR was in place( G.P. had done after T.I.A.) Elderly, more frail, no plans in place for future care Settled in home, mobilises with help, eats and drinks well