You have been asked to complete a Home Medicines Review for Joanna, an 80-year-old woman. Her medical history reveals that over the past two years she has had a gradual decline in her cognitive function, primarily manifesting as difficulty with names and memory impairment. Three months ago, Joanna started risperidone 0.5 mg twice daily because of increased agitation and nocturnal wandering.
Joanna recently had a visit to the emergency department of a local hospital for an injury from a fall. This was due to a pre-syncopal episode at home, and resulted in a fracture. No underlying cardiac or neurological event was identified as the cause of the fall. The fracture was treated conservatively, and she was discharged with tramadol 50 mg capsules. Directions were to take one capsule four times daily as needed.
Joanna’s medical history includes insomnia, hypertension and depression. Her current medicines are:
- aspirin 100 mg in the morning
- risperidone 0.5 mg twice daily
- diltiazem CR 180 mg at night
- paroxetine 20 mg in the morning
- temazepam 20 mg at night
- tramadol 50 mg four times daily as needed.
Joanna is cared for by her daughter Natalie, who lives with her. Natalie works evenings three days per week and on those nights Joanna is at home by herself.
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