white female who emigrated from Europe and speaks very little English. She sat docilely, had blunted affect, and did not speak. She lives with a daughter and the daughter’s husband.

white female who emigrated from Europe and speaks very little English. She sat docilely, had blunted affect, and did not speak. She lives with a daughter and the daughter’s husband. Her health has been failing over the last 2 years and she stays home in front of the TV or staring blankly. The family report that Sonia has had several mini-strokes that keep her in bed for a time, she sundowns (becomes agitated and moans at night), and she needs help to transfer, eat, and toilet. There was no known family history of mental, suicide, or substance problems. The daughter, Debra, wanted to know what treatment was available, but did not want to put her mother in a nursing home. The son-in-law, Rick, was feeling overburdened and complained and cried that Sonia would often punch and hit him while he was helping her. The daughter worked out of the home so the son-in-law was the caregiver most of the day.

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