A Nursing Home Resident With Somatic and Psychiatric Multimorbidity

Care for nursing home residents is complex. A case challenge is presented on a resident with significant somatic and psychiatric multimorbidity, including irritable bowel syndrome and dementia. During the encounter, the resident did not manifest short-term memory impairment and indicated that irritable bowel syndrome was her most distressing illness. The challenge posed by pharmacologic management of irritable bowel syndrome with comorbid dementia is discussed. This case highlights a conflict between geriatric prescribing guidelines that recommend against taking an anticholinergic medication for pain associated with irritable bowel syndrome and the resident's choice to continue taking an anticholinergic medication.