several interventions often attempted in such cases was demonstrated. The ineffectiveness of medication trials was due to noncompliance.
Despite the lack of frank dementia and relatively mild (for age) cognitive deficits, this patient's safe independent functioning was severely compromised and her functional capacities had declined. She needs significant supervision but was resistant and openly hostile to any limitations or assistance. It may be that some of the resistance to treatment could be alleviated by limiting her health provider contact to a single primary health care worker (if not medically contraindicated). This contact may draw the patient out from her socially isolated tendencies while still providing appropriate medical care (Reyes-Ortiz, 2001). Involvement in an adult daycare program may also provide similar benefits (Reyes-Ortiz, 2001).
Behavioral change and functional decline are the final common outcome of myriad clinical conditions confronted in the care of elderly patients. Careful differential diagnosis is critical to appropriate treatment selection, particularly with ever increasing pharmacological options. This case demonstrates the challenges created by psychiatric illness, and particularly Axis II psychopathology, in the elderly and emphasizes the value of psychometric testing to the diagnostic process.