Case study – Aspiration pneumonia in patient with dementia

An example of effective collaborative care at home

Mrs G, 90 years, has a neurodegenerative disease with fronto-temporal dementia, non-convulsive seizure disorder, fasciculation, muscle atrophy, history of dysphagia and numerous past hospitalisations for UTI and aspiration pneumonia. She is cared for at home by her loving family, home care services and a very supportive GP, Dr B.

In view of her progressive deterioration, recurrent infections and care givers’ burden, she was referred to Sydney District Nursing (SDN) for symptom management and support.

Intervention started with a joint home assessment by SDN with the Palliative Care physician and the development of an advanced care plan and NFR ambulance care plan with the family, with aim of treatment of reversible symptoms at home. She was commenced on Clonazepam oral drops for seizures, received wound care for a grade 2 sacral pressure injury and offered an individualised visit regime by SDN for monitoring of her condition and carers education and support. An action plan for end of life care and management of respiratory distress was established with the Palliative Care medical team and the GP and emergency subcutaneous medications were organised.

In the following six months, SDN identified two separate episodes of clinical deterioration characterised by decreased loss of consciousness, drowsiness, delirium, fever and inability to take oral medications. Escalation of deterioration to her GP led to diagnosis of URTI and concomitant UTI and the prescription of an IV antibiotic regime (Ceftriaxone 1gr daily) that was administered by SDN at home via a peripheral cannula.

In both instances, her GP referred her to the Concord Hospital in the Home clinic who assessed Mrs G at home and provided advice on antibiotic stewardship. Her GP maintained medical governance, receiving regular updates on her condition and about discussions at case reviews by SDN and the Palliative Care team.

Currently her infections have resolved, she is afebrile, more alert and comfortable, tolerating soft diet, and has resumed chest physiotherapy.

This primary health care partnership was extremely successful in achieving Mrs G’s advanced care plan goals. Her family is pleased that she was able to remain at home, avoiding further hospital admissions, and that a collaborative team is available to provide support and to manage further acute infective events and end of life care.

For further information on how SDN can assist you in managing your palliative and complex needs patients at home and for referrals, you can access HealthPathways Sydney or contact the Access Care Team seven days a week on 1800 722 276

Article submitted by Claudia Pollauszach, A/Hospital in the Home Clinical Nurse Consultant, Sydney District Nursing, SLHD