Table 2.

Select Instances of Potentially Delayed Care

Without dementia
Pneumonia	73y, F Presented to primary care with a cough for 3 days, “similar to prior cough illness thought to be pneumonia” Prescribed an oral antibiotic with plan to “fill later in case of worsening”; no additional evaluation or follow-up scheduled Several days later, she was admitted to the hospital with pneumonia and sepsis
Congestive Heart Failure	93y, F Contacted her outpatient team, got initial recommendations by telephone (e.g., elevating bed for comfort) No further evaluation or outpatient visit scheduled Friend visited several days later, found her in severe respiratory dress, called 911 on her behalf
With dementia
Pneumonia	76y, M Patient presents to urgent care with sore throat and headache Seen the next day in clinic with occasional temperature to 102F and confusion; discharged with plan to take acetaminophen Patient on multiple chronic medications, will not accept help or reminders from his wife. The third day, after multiple calls by wife to nurse triage plus another urgent care visit prompted by fever and confusion (e.g., “peeing on the floor”), he was admitted.
Congestive Heart Failure	81y, F Patient presented to the outpatient office reporting worsening symptoms (e.g., productive barking cough) over 3 days; symptom onset had been 10 days earlier “grunting respirations, speaks in short sentences” Documentation mentions spouse with “advanced dementia” Presented with pulse oximetry on room air 88%, respiratory rate of 30/min 911 called by clinic staff