Mr. James Robinson is a 72
year-old man who is brought by his daughter because of depression,
difficulty swallowing and weight loss. Mr. Robinson says he has the
- He has had Parkinson's disease for 7
- He was widowed 8 months ago.
- He has been living with his daughter and
son-in-law for the past 7 months, but they are increasingly having
trouble caring for him.
- He has lost 17 pounds since his wife's
- He has recently been experiencing
coughing and choking episodes when eating.
- He describes himself as being tired all
the time and feels he's a burden to his family.
- He says he thinks it would be better for
everyone if he "just wasn't around."
Physical exam: elderly man of
moderate build in no apparent distress.
- Mr. Robinson's height is 5' 10" and his
weight is 156 pounds.
- This means he has had a 10% drop
in weight since his wife's death.
- Vitals: Temp 98.6oF, BP
132/80, P 78/min and regular, R 18 without labor.
- Chest clear, heart sounds normal with no
- Abdomen with no masses, bowel sounds
- Neurological exam: stooped shoulders,
rolling tremor, cogwheel rigidity.
So, is he losing weight because he's
depressed and not eating or
has trouble swallowing?