Georgia Koppel is an 81-year-old widow brought to the ED by neighbors who found her in her yard, wandering and disoriented.(This case is a composite based on my experience.) They reported that Ms. Koppel had a noisy cough and mild confusion earlier in the week. Physical examination and a chest X-ray show dehydration and pneumonia. A Foley catheter is inserted and her urine is dark amber. Her mucous membranes are dry. Anxious, restless, and oriented only to self, Ms. Koppel can’t provide a history. Her neighbors say that she lives alone and has no children; they are unsure whether she has any living relatives. Ms. Koppel is hospitalized; iv fluids, antibiotics, and oxygen are ordered. To begin planning for hospital care and for discharge, the nurse attempts to perform a functional assessment. She asks Ms. Koppel about her ability to perform activities of daily living (ADLs) such as grooming, eating, and using the toilet and instrumental activities of daily living (IADLs) such as managing her finances and arranging transportation. However, Ms. Koppel is disoriented and cannot respond to questions, so the nurse defers the assessment.