Two years later, you are asked to review Rose again as the renal team are concerned that Rose is appearing to neglect herself.  They report that she has been ignoring food that she has bought for her.  Jacinta informs you that Rose regained her interest in housework after your initial treatment, but recently has not been cleaning her flat as much.  She has also been neglecting her personal hygiene whereas she used to bathe regularly and present well groomed.

Rose has forgotten Jacinta’s name on occasion and also has forgotten when pension week is a few times.  She has recently started talking about returning home to dig up Doris’ body.  Jacinta informs you that once Rose commenced the antidepressant medication after the last time she saw you, she spoke of rejoining her old circle of friends and playing cards.  However, she now has trouble playing cards and has withdrawn from her circle of friends and the game again.  The renal team have not noted any deterioration in her renal status although there may be a concern about aluminium toxicity related to her continuing dialysis.  Rose does not appear depressed and regularly takes her medication as prescribed.