ACE.D triptych

George Palo


George Palo is a 90-year-old male who has been diagnosed with early stage dementia. George's wife Anna died two years ago and he moved into a small one-bedroom apartment in a retirement community, independent living setting. George has five children, but only his oldest daughter Maggie lives nearby. George has been relatively healthy over his long life with the exception of high blood pressure which is controlled with medication. He is very independent and loves to be outdoors, walking his golden retriever, Max. Maggie and her siblings are trying to support their dad's independence as long as possible, but are cognizant of his age and concerned about his overall safety. 


George discusses his journey through widowerhood and the experience of losing his home when he moved to the retirement community. He is grateful that his family was able to find a place that allowed him to keep his 13-year-old golden retriever Max. George relates how he and his wife, Anna, were actively involved in their local humane society and how they adopted Max as a puppy. He takes great pride in his independence and admits he is quite stubborn and not very accepting of help from others, especially strangers. He is unaware that he is getting more forgetful and often repeats himself during the monologue. He appreciates the help that his daughter Maggie provides, and is concerned about making too many demands on her time. George is passionate about sustaining his independence and is adamant about never going to a nursing home.

Scenario 1 Scenario 2 Scenario 3

The resident nurse for the retirement community conducts a weekly blood pressure clinic. Three weeks ago, she found a marked increase in George's blood pressure. George became annoyed when she asked if he was taking his medications. George has not returned for the past two weeks so the nurse contacted George's daughter Maggie, who reported other behavioral changes. Together they arrange to have a community health nurse visit George to conduct an assessment. This nurse will be expected to use appropriate tools to assess his cognition and to suggest to both Maggie and George some ways to support George in maintaining his function and independence.

It is three months later. George was evaluated by his primary physician, who found that his diagnosis has progressed from mild cognitive impairment to mild dementia, Alzheimer's type, and started George on Galantamine. His blood pressure is back under control and he seemed to be managing well until a few weeks ago when Max, George's 13-year-old golden retriever died. Maggie asks the community health nurse to make another visit. During this visit, the nurse will be expected to use appropriate tools to assess his depression, provide emotional support for his loss, reassess his cognition and discuss adjustments in his activities that can help to maintain his optimal level of function and independence.

Three more months have passed. George fell and sustained a femoral neck fracture that was repaired with an open reduction and internal fixation. He has just been discharged and is staying at Maggie's house with physical therapy ordered daily and visits by the community health nurse twice a week. This scenario takes place during the first visit by the nurse. The nurse will be expected to do a physical and functional assessment, review his medications, and reassess his cognition. The nurse will also contact the physical therapist, use the SBAR technique to report findings, and collaborate on criteria and goals for George's return to his apartment.

Finish the Story Assignment

Learners have now seen George at three snapshots in time. What do they think his life will be like three months from now?

Author Information

Susan Gross Forneris, PhD, RN, CNE, CHSE-A
National League for Nursing
Washington, DC


The George Palo unfolding case content was reviewed in 2019.