108IS CONTINUING TREATMENT THE RIGHT THING TO DO IN A FRAIL OLDER PRISONER WITH DEMENTIA?

Abstract

A 79 years old frail prisoner with advanced vascular dementia, ischemic heart disease and type 2 diabetes was admitted following an unwitnessed fall, and right sided weakness. Clinically, he had acute stroke. He was treated for community acquired pneumonia and dehydration with intravenous fluid and antibiotics. CT head showed established left sided infarct. He had no family. Collateral history was obtained from prison's medical officer. He had been bedbound but transferred to a toilet next to his bed. He was dependent for his activities of daily living. He had declined to take medications for 3 months and ate only a few biscuits daily. He did not communicate and lacked capacity to decide on medical treatment. He developed a further episode of pneumonia and was given intravenous antibiotics. He improved again but he was still not eating and drinking. He was uncooperative with any medical intervention. It was decided between psychiatrist, prison medical officer and consultant that a palliative approach would be in his best interest. Key learning points: All investigations and treatment should be performed based on patient's best interest. Best interest assessment should be made based on patient's previous wishes and views closed to him. However, when patient has no consultee, multidisciplinary and second opinions are important. Consider involving Independent Mental Health Advocate (IMHA) in managing complex patient who lacks capacity in deciding medical treatment. Obtained collateral history from people who look after patients, as patients baseline should be taken into account while formulating management plans.