Eva is a 77 year-old widow living alone in her own home. She has been expressing a belief that a man is entering the roof space of her house at night, and that while he is up there he has tapped her phone and installed devices to spy on her during the day. She believes that this is somehow linked to her being German and having lived in Berlin during the war years. She thinks that some people believe her to have been a Nazi, though she never had any connection to the party.

Her house is neatly kept and well maintained, though the manhole is left open and there is a ladder leading into the roof space. Eva shows signs of anxiety and restlessness, frequently returning to the ladder to see if she can catch a glimpse of the intruder. She is so concerned about this man that her sleep has been affected. She will often wake during the night thinking that she has heard a noise and will get up to investigate. She estimates that she’s only getting a couple of hours of broken sleep a night, though sometimes ‘catnaps’ during the day. When speaking about her beliefs, Eva is matter-of fact. She realises that other people do not believe her, as she has tried calling the police on a number of occasions and when they attend they just ‘humour’ her but don’t seem to do anything about catching ‘the man’.

Although Eva has no serious physical health problems she is small and somewhat frail. She is sometimes unsteady on her feet, and combined with her tendency to frequently climb the ladder this is putting her at an increased risk of falling. She is capable of attending to her own care needs and is generally well groomed and appropriately dressed.

A mini-mental state examination shows Eva to be cognitively intact, with no evidence of problems with memory, orientation or comprehension. She is an occasional social drinker. She has no close friends, and only one of her 3 children lives in the same city as her. In the past she has had conflict with her neighbours, as she believed they were poisoning her trees and throwing rubbish in her yard. Eva is generally suspicious of others and does not have a close relationship with any of her children or grandchildren. She says she is very lonely and feels sad about this.

Eva lives in a semi-rural area where there are few support services for older people. She does not have access to a car or public transport, relying on having her groceries ordered by phone and home delivered, and uses taxis for those occasions when she needs to get to appointments. The only Senior Citizen’s Centre in the town is not appropriate for her to attend as the activities are menial and do not provide her with any satisfaction.

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