Importance of questioning of falls in mental changes: A subdural hematoma case
Introduction: Falling is an important condition that is frequently encountered in the elderly and may require emergency admission and hospitalization due to serious problems. Incidence of traumatic brain injury increases with age. Therefore, it is important to question fall history in the elderly and take preventive measures. Studies on falls are limited in home health care receiving elders. In this case, a subdural hematoma detected by questioning falls is presented.
Case report: A 91-year-old male patient with no disease other than dementia, has been receiving home health care for 1 year. His relatives requested a visit due to decrease in reactions. In this visit, the patient was bed-dependent, his general condition was moderate, non-orientated and non-cooperative. Vitals were stable, physical examination revealed no feature other than ecchymosis, 7-8cm in diameter, around the left eye. History of trauma was questioned. The patient had fallen a few times recently, however medical assistance wasn’t sought. We referred the patient to emergency room for further examination and imaging. Neurological examination was noted as natural but cranial CT revealed chronic subdural collection in both hemispheres and acute collections in left hemisphere. The patient was consulted to neurosurgery, an operation was recommended. But the patient’s son stated that his father didn’t want surgery, so they refused. Upon suspicion of negligence/abuse, social services was contacted and the fourth visit was planned.
Discussion: This case emphasizes questioning history of falls and the importance of noting change in the general condition of the elderly while providing home health care.
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