A 94-year-old widow who is a resident of an assisted care facility was diagnosed with Alzheimer’s dementia a year ago shortly after admission to the care facility. Her memory was slowly declining over the past 5 years. She was no longer able to balance her checkbook, forgetting to turn the stove off, forgetting where things were placed and waking up after a nap terrified stating she could not remember where she was. The patient has also demonstrated a gradual decline in activities of daily living (ADLs). For example, she cannot remember how to feed herself, how to comb her hair, how to clean herself after using the toilet. She becomes disoriented at the facility and cannot remember the number to her room. There is an increase in sun-downing behavior over the past 4 months with difficulty falling asleep and restlessness. The patient takes Calcium supplements 1000mg/day after having a parathyroidectomy 5 years ago. The patient’s daughter manages her finances and has been designated as the patient’s health care advocate. The patient recently fell 3 weeks ago and was found on the floor after rolling off of the couch. She has increasingly had bouts of crying, restlessness, and agitation. Nine months ago she was placed on hospice. Xanax was prescribed for anxiety with the dose gradually increased from .50 mg to 1mg 4x/day. Tramadol was prescribed for shoulder pain due to chronic arthritis.