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Interdisciplinary Geriatric Assessment:
Mr. Ames

medical & social history

Mr. Ames is a 67-year-old white male who resides with his wife on ten acres of wooded property in rural Missouri. Mr. Ames and his father-in-law built their present two-story home with the first floor fully wheelchair accessible to accommodate his mother-in-law, who used a wheelchair prior to her death two years ago. Mr. Ames and his wife live on the first floor and use the top floor of the home as visitor's quarters when their 3 children and 7 grandchildren visit.

Mr. Ames has a 20-year history of type 2 diabetes mellitus, complicated by retinopathy, peripheral and autonomic neuropathy, coronary artery disease and peripheral vascular disease. He has had progressive amputations of his toes and right forefoot. In addition, he has had a four-vessel coronary artery bypass. Five years ago, because of chronic renal failure he received a kidney transplant, with the kidney being donated by his son. Four years ago he had a cholecystectomy (pdf). Prior to his kidney transplant he had been hypertensive. Following the transplant he has had orthostatic hypotension which is controlled by making postural changes slowly, sleeping with the head of the bed raised, and a high salt diet. Also, because of the kidney transplant he takes immunosuppressive drugs. His prescriptions which cost over $1200 per month are partially covered by insurance.

Ten years ago Mr Ames quit his 1 to 1 ½ packs of cigarettes per day smoking habit of 30 years. He denies chest pain or shortness of breath but he does have a persistent cough. His wife states that he snores at night and is occasionally restless. He sleeps best propped up with two pillows. He denies leg pain with ambulation; however, he describes his feet as “pretty numb.” He has not reported any falls but recognizes a fall could be a problem.

Prior to his kidney transplant, Mr. Ames sold real estate and Mrs. Ames worked part time at a local discount store. Since the transplant, Mr. Ames no longer works and Mrs. Ames started working full time as a night manager at the discount store to maintain her own health insurance. By working nights she can assist him as needed during the day and can transport him to and from his frequent medical appointments.