Case study of an older lady with recent weight loss
The videos are about an older lady aged 78 consulting her doctor on her recent weight loss.
Please watch the videos. Try to identify the factors which contribute to the lady's weight loss.
Multiple medications
Timing of her medications to be taken on an empty stomach, making her timing of meals difficult to coordinate.
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Reduced Food Availability and Choice
Stopped cooking for herself due to Parkinson's Disease.
Cold pre-prepared breakfast, catered and bought food not to her liking; too oily and too salty.
Diabetes - need to reduce carbohydrate and fat intake.
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Parkinson's Disease
Tremors in her hands, swallowing problems.
Uncomfortable dentures
Not wearing dentures.
Prefers soft food and soup instead.
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Social factors
Eating alone in the daytime.
Depression due to sudden death of husband.
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Transcript
Dr A is giving a consultation to Mrs.L, a 78 years old patient on her recent weight loss.
Dr A: Good morning Madam, my name is Dr Aida, please may I confirm your name and age please?
Mrs.L: Good morning Dr Aida, My name is Doris Lim and I am 78 years old. You can call me Mrs Lim.
Dr A: Great. Mrs Lim, please can you tell me why you are in clinic today?
Mrs L: Yes, Dr. I have Parkinson’s disease for nearly 5 years now, high blood pressure for about 20 years and diabetes for about 10 years.
Dr A: I see, is it alright if I ask a few more questions to see if we can find out the reasons you are losing weight?
Mrs Lim:Yes Dr, please go ahead
Dr A: Mrs Lim, have you any long-term medical conditions?
Mrs L: Yes, Dr. I have Parkinson’s disease for nearly 5 years now, high blood pressure for about 20 years and diabetes for about 10 years.
Dr A: Are you on medications for your conditions and do you know the names of your medications?
Mrs L: Yes Dr, I am on Madopar for my Parkinson’s, amlodipine for blood pressure and metformin for diabetes. But doctor I find the Madopar troublesome, I have to take in on an empty stomach one hour before food or two hours after food. My Parkinson’s doctor tells me if I don’t do that, my Madopar may not get absorbed properly. The Madopar is 4 times a day and I have to time my food around that, sometimes, my meals get delayed.
Dr A: I see. How is your appetite in general Mrs L?
Mrs L: It is fair I would say, but less than before. I used to be able to cook for myself, but with the Parkinson’s I have slowed down a lot and I am clumsier, so I have stopped cooking. Now my daughter prepares breakfast before she goes to work. If I wake up late, the food is cold, it’s not so tasty. I also think my medications leave a funny taste in my mouth, so the food tastes different.
Dr A: How about your other meals Mrs L?
Mrs L: For lunch, my daughter has arranged for daily delivery of food from a catering company. Sometimes I do not like the food, it is too oily or too salty or just not what I am used to. Then my daughter packs home food on her way home after work. It’s the same, the quality of the food can be good or not great sometimes, it’s just luck. With my diabetes, I am told not too much carbohydrate , sugar or fat, and you know, outside food has plenty of that. So it’s really difficult, I end up eating the same thing.
Dr A: Do you finish your meals Mrs L?
Mrs. L: I try to eat at least three quarters of my meal Dr. Sometimes if the shaking in my hands from Parkinson’s acts up, I eat slower to avoid spilling food.
Dr A: Have you any problems with chewing and swallowing your food Mrs L?
Mrs L: I have a few of my own teeth left. I have dentures, but they are not very comfortable. So most times, I prefer soft food and don’t wear my dentures. My swallowing is a bit slow too, maybe with the Parkinson’s? My mouth can feel dry. I always need soup or water with my food, especially if its meat.
Dr A: I see. Who do you live with Mrs L?
Mrs L: I live with my daughter, but she’s at work everyday except Sundays. Her work hours are quite long. My husband passed away just over 6 months ago.
Dr A: I am really sorry to hear that Mrs L. May I ask was he unwell for a long time, or was it all of a sudden?
Mrs L: It really was very sudden, he had a very big heart attack, and he was gone in one day…
Dr A: I am really sorry to hear that. How are you feeling nowadays Mrs L? How is your mood.
Mrs L: Well my mood is not great nowadays, not very happy or interested in things. Sometimes I just keep thinking back to that day. Still quite sad really.
Dr A: I see. Well Mrs L, is there anything else you would like to tell me?
Mrs L: No that’s it Dr, It’s the weight loss my family is worried about.
Dr A: The Mrs L, would you mind if I examined you? Then we can decide whether we need to organize a few tests. I will also refer you to our dietitian to see if she he can help. Would that be alright with you?
Mrs L: Yes Dr, please go ahead.