Robert (83) and Judith (78) have been a married for the past 59 years, and currently live in a small village in Kent: Nursing Case Study, CU, UK

Robert (83) and Judith (78) have been married for the past 59 years, and currently live in a small village in Kent. They have two sons Michael (58) and Marcus (56).

Robert retired at the age of 65 from his publishing executive job in London. Since retirement he has been very active in the local horticultural society and was a keen golfer, playing at least twice a week for over 30 years. He has a leg ulcer on his right leg that developed after a fall and has been putting dressings (that he buys in the pharmacy) on it to keep in covered. He still drives a car but is less steady on his feet and therefore has stopped playing golf.

Judith was a stay-at-home mother who has always participated in local charitable works and is very active within the local Church of England. They have a wide circle of friends both in their village and from Roberts publishing career in London. They own a villa in Tuscany and try to visit at least 3 times a year, COVID 19 stopped this and they have not been abroad for the last 18 months. Robert is an ex-smoker and was diagnosed with Peripheral Vascular disease (PVD) two years ago.

Their eldest son Michael lives in Cumbria with his wife, Jane, and their two children Samantha (12) and Robert (8). They try to visit Robert and Judith at least 3 times a year (including Christmas) and Jane phones weekly.

Their younger son Marcus is single, lives in London and works as an investment banker. He rarely sees his parents and Judith tries to contact him at least once a month, but seldom catches him in.

Robert Marsden Enigma 1

Day 1: Judith calls the GP asking for a home visit as Robert is complaining of severe pain on passing urine; he has been incontinent overnight; his urine is very cloudy and offensive and he is holding his lower abdomen. He has developed acute confusion and is becoming aggressive, pushing her away when she tries to help him. A paramedic attends the home following a 111 call as the GP was not available to visit and diagnoses a urinary tract infection (UTI). She commences Robert on IV antibiotics to be delivered by the community rapid response team.

Day 10: Robert and Judith visit the Nurse Practitioner in the surgery for a follow up. Robert insists he is feeling much better and states: “All is good now”. Judith expresses concern to the nurse that Roberts’s confusion still seems to be there. He is very forgetful and often appears absent and vague, staring into space for long periods of time. She says that this has been getting worse for the last 6 months, but the urine infection really seems to have made it a lot worse recently. Robert snaps angrily at Judith saying: “Don’t be foolish, everyone forgets things occasionally, it’s perfectly normal woman!”. He does agree however to be seen at the memory clinic.

Day 15:     Robert has attended the memory clinic with Judith, still insisting that there is nothing wrong and wants to show Judith “once and for all”.

Robert is diagnosed with early-stage dementia at the clinic.

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