In late 2004, Ms N was a 77-year-old retiree. She had
completed high school and worked for many years as a
nursing assistant and a factory worker. Ms N lived alone
in a modest senior housing apartment in a miIDle-class
urban neighborhood. She received income from Social
Security and support from her only child, a daughter who
lived nearby. Her health insurance consisted of coverage
by Medicare Parts A and B and her states Medicaid program.
She had a history of hypertension with left ventricular hypertrophy, peripheral vascular disease with a left belowknee amputation, chronic obstructive pulmonary disease
(COPD), glaucoma, keratitis, osteoarthritis with chronic right
shoulder pain, and degenerative intervertebral disk disease. In conversation, she was alert, conversant, and oriented to time, place, and person. Physical examination did
not detect abnormality of her heart, lungs, abdomen, nervous system, or skin. She had a well-healed left lower tibial
stump and nonpalpable right dorsalis pedis and posterior
tibial pulses. Her seated brachial blood pressure was 100/78
mm Hg; her intraocular pressures were 28 mm Hg (right
eye) and 21 mm Hg (left eye). Her routine red and white
blood cell counts, platelets, serum electrolytes, liver function studies, creatinine, and blood urea nitrogen values were
normal.
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