You meet your first patient of the morning. A.K. is a 65-year-old Caucasian male who you are seeing for the first time. Both wife and daughter are present.  

Background

He reports that he has had an 18 pound unintentional weight loss in the last 2 months “I am just not hungry anymore, and when I do eat, I get full so fast. In fact, it is really hard to eat, and I don’t eat nearly as much as usual, even though I eat 3 times every day”. He also reports feeling more tired than usual. “I am not sleeping very well. My wife wakes me up when I am snoring, or when she thinks I am not breathing. I used to have sleep apnea, but I don’t think I have it anymore. Besides, that mask is so horrible to wear.” He reports day time somnolence. He reports that he is at the clinic today because of his wife and daughter’s concern about his weight loss and loss of appetite.

PMH

Mr. A.K. has a history of hypertension, cataracts, and osteoarthritis.  

Current medications: 

Ibuprofen	600 mg po TID
Lisinopril	20 mg po QD
Hydrochlorothiazide	25 mg PO QD
Simvastatin	20 mg po QD
Vitamin D3	50,000 units po weekly
Omeprazole	40 mg po QD
Sudafed	50 mg po TID prn

Surgeries      

            April 2010-Right cataract extraction with Intraocular Lens Placement

            June 2010- Left cataract extraction with Intraocular Lens Placement

            November 2011-Left total knee arthroplasty 

Allergies: No known drug or food allergies. Allergies to latex causing difficulty breathing and to bee stings, causing widespread edema and airway obstruction.  

Vaccination History

He receives annual flu shots “most of the time”. His last one was 18 months ago.

Received a Pneumovax “the day I turned 65”. 

His last TD was greater than 10 years ago.

Has not had the herpes zoster vaccine.

Social history

He has an 8^th grade education and is a retired concrete finisher. He lives with his wife of 45 years and his daughter lives next door. He enjoys working in his back yard garden and recently tripped over the garden hose last week where his neighbor had to come and help him up.  

Family history

Both parents are deceased. Father died of a heart attack at the age of 80; mother died of breast cancer at the age of 76. He has one daughter who is 45 years old and has hypertension. Hypertension, coronary artery disease, and cancer runs in the family.

Habits

He drinks one 4 ounce glass of red wine nightly; previous smoker of 30 years; he quit for 10 years, and is now smoking ¼ pack per day for the last 6 months.  

Discussion Part One:

• Provide the differential diagnoses (DD) with rationale 
• Further ROS questions needed to develop DD. 
• Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.