DEPARTMENT OF REHABILITATION AND AGE CARE UNIT

16 June Mrs Hilda Hamill

2023 DOB: 13/11/41
Raafa Cambrai Village
Dr MERRIWA WA 6030
Hannah H: 9304 5186
M: 0487 844 629
UR: mn377958
Williamson
Merriwa Medical Centre
U16/44 Baltimore Parade
MERRIWA WA 6030

Dear Dr Williamson,

Principal Issues:
1. Alzheimer’s dementia
1.1. Predominantly amnesic features
1.2. Blood screening unremarkable (June 2022)
1.3. CT head (January 2022) showed probable calcified meningioma as an incidental finding, but
no other significant features
1.4. PET/CT brain (April 2023) showed small patchy areas of hypometabolism involving the
temporoparietal lobes. No hypometabolism seen in the precuneus or posterior cingulate
bilaterally. Overall appearances are non-specific, but could reflect early/evolving
Alzheimer’s dementia
1.5. No longer driving
1.6. EPA and EPG allocated to son Andrew
1.7. ACAT assessment done, awaiting services

Medical History:
1. Osteoporosis
2. Hay fever
3. Left groin abscess 2018
3.1. Surgical management at JHC

Medications:
Denosumab 60 mg six monthly

Observations:
HR 88, BP sitting 131/63, BP standing 120/57, SpO2 96%. Weight 64.8 kg
MMSE 20/30 (17 March 2023)

I had the pleasure of reviewing Hilda accompanied by her son Andrew and daughter-in-law Liv in the
Memory Clinic. Hilda prefers to be called May, which is her second name. I first met May, Andrew
and Liv in March 2023 after she was referred by her GP for concerns regarding confusion during her
GP consultations. It was discussed with them during this consultation that May likely had an emerging
neurodegenerative disease such as Alzheimer’s dementia. She was sent for a PET/CT, which showed
small patchy areas of hypometabolism involving the temporoparietal lobes, which could reflect early
evolving Alzheimer’s dementia. She was also seen by our occupational therapist in Day Therapy Unit
on 25 May 2023, where she had education regarding stages of dementia and was given
recommendations for pendant alarms, help with showering, shopping, and social support. The initial
plan was for May to also see our social worker in Day Therapy Unit, but with the assistance from the
occupational therapist Andrew was able to complete a self-referral for My Aged Care. This week they
have had an ACAT assessment completed, but they are unaware of which home care package she
will be allocated. Andrew and Liv are keen to get more social support for May. Since we last saw
them, they have also completed an enduring power of attorney and guardian with Andrew allocated
both. They were given written information on last review regarding Dementia Australia and
Alzheimer’s WA. Andrew has contacted these organisations and found the information given useful.

Hilda Hamill / 2

May has remained relatively stable at home since we last saw her. May has not deteriorated
significantly with her cognition since our last review, however Andrew and Liv feel that she is slightly
more moody and frustrated than normal. She particularly gets more frustrated with Liv, who she has
always had good relations with in the past. May is now receiving three to four meals cooked meals
supplied by her retirement village, and she reports enjoying these. Andrew and Liv are still supplying
the rest of her frozen meals. I note that she has not lost any weight since our last assessment.
Another change has been that she was previously spending weekends over Andrew and Liv’s house,
but May prefers to stay at home now instead as she is more comfortable in her home. Andrew and Liv
are visiting on Wednesdays and Fridays to have a coffee and take her out for shopping. May’s alcohol
intake has slightly increased since we saw her last. She is now having approximately a bottle of wine
per week. Andrew reports that her cognitive function has not seemed to decline with the slight
increase of alcohol use and she has had no falls. Otherwise, May is similar to our last review and
there are no new safety issues reported on today’s review. Andrew reports that he has spoken briefly
to May’s daughter Susan in regards to her new diagnosis of Alzheimer’s dementia. Andrew feels she
may be in denial or lacking insight into this diagnosis. Andrew plans to talk to her again in regards to
this.

Impression:
May is an 81-year-old woman from home alone in a retirement village with probable Alzheimer’s
dementia. She appears to be coping well currently with good family support and is likely to have
services commencing in the near future. No safety issues have been raised today.

Plan:
1. Andrew and Liv would like to come back to memory clinic one more time for review as they are still
coming to terms with May’s diagnosis and their increased responsibilities. We will review them again
in six months’ time and likely discharge May after this review should everything remain stable. I have
advised them however that we would be happy to see her again in clinic if anything should change in
the future.

Thank you for your ongoing care of May.

Yours sincerely,

Sighted but not signed

Dr Julia McFarlane Dr Steven Jujnovich

Senior Registrar Consultant Physician
Dept. of Rehab & Aged Care PRACWA Associate
JM/ms
JHC File
DTU