Question

Geriatric Case Study Worksheet

Case Study #1

Mr. S is a 79-year-old with multiple medical problems, but primarily suffering from heart disease. He is retaining fluid in his legs and feet, sometimes limiting his mobility. Mr. S has difficulty keeping his multiple medications organized and taking them as prescribed. He lives with his daughter, who is balancing the needs of her young family with her aging father. Mr. S hates burdening his daughter with his medical problems and tries to help by assisting with some of the daily house chores. He seldom leaves the house, as most of his friends have either moved away or have died. Most of the time he stays in his room to not get in the way of his daughter.  

Case Study #2

Mrs. M is a 90-year-old woman and has been a resident of a long-term care community since her husband died 8 years ago. Her health status is fair. She has DM2 (controlled by oral medication) and rheumatoid arthritis. At the community center, she has her own apartment, which she maintains with minimal assistance, receives one hot meal each day in a common dining room, and has access to a full range of services, such as a beauty shop, recreational facilities, and a chapel. She is generally happy in this setting. She has no immediate family nearby, and the cost of the facility was covered by a large, one-time gift from her now deceased husband. Recently, she has become weaker and has had difficulty walking, attending activities including meals, and doing some of her ADLs due to her RA.

Theories to Consider:

Every theory offers a different view of the problem(s).  I encourage you think beyond what we can do or offer as providers, and look towards a view of inclusion and what the patient wants for themselves.  Here are a few suggestions from your text: Troutman-Jordan’s Theory of Successful Aging (text, Chap 28); Watson’s Unitary Caring Science and Theory (text, Chap 18); Meleis’s Transition theory (text, Chap 20; Kolcaba’s Comfort Theory.

You do not have to use any of the above theories, instead you can find others from the text or outside of nursing.  One that comes to mind is the Intersectional Theory (1989, Crenshaw) that addresses how interventions from other disciplines may be appropriate and supports viewing the patient beyond just their disease process.  While this theory was originally thought of as “race based” it has developed overtime to address multiple factors regarding social determinants and social impairments to health.  

Questions:

1. As the NP and primary care provider (PCP) for these two individuals, compare your delivery of care for these two situations. Select a nursing theory or model for each case study, and apply their principles to these case studies.

2. Describe how you would apply the biopsychosocial model (BPSM) to the healthcare management of these patients. Make sure that you include the concepts of client, health, environment, and nursing.

3. As an advanced practice nurse, select and apply a behavioral change theory to manage these patients’ cases and situations.

4. Discuss some of the financial constraints in managing healthcare for the geriatric population.

5. What are some ethical challenges that could be encountered in caring for the geriatric population?

Answer 1

O’Connor and Vallerand (1994) examined the relationship between long-term care residents’ adjustment and their motivational style and environment. Older adults with self-determined motivational styles were better adjusted when they live in homes that provides opportunities for freedom and choice, whereas residents with less self-determined motivational styles were better adjusted when they live in high-constraint environment. in the case of Mr. S he is having medical problems along with that he has to depend her daughter for each and everything. the complex of dependency works out during the old age time. during old age social isolation is a problem. The care should be provided according to patients wish with specific precautions for independent care that let him feel self responsible and independent. he should be engaged in activities like walking, participating in social events, reading books and so on so as to get rid of the feelings of burden to her daughter and family.

on the other hand, Mrs M is living a competent life alone, with courage and discipline which make her unique besides her health issues. Her case can be well described by Activity theory, that describes the psycho social ageing process. Activity theory emphasizes the importance of ongoing social activity.This theory suggests that a person's self-concept is related to the roles held by that person i.e. retiring may not be so harmful if the person actively maintains other roles, such as familial roles, recreational roles, volunteer & community roles. To maintain a positive sense of self she must substitute new roles for those that are lost because of age and type of activity should be according to her wish and not by age.

BIO PSYCHO SOCIAL MODEL- mainly involves the interconnection between the biological, psychological and social environment.

Client's physical health, emotional status and the society in which he / she leaves depends his adaptability to environment. These three will eventually leads to the acceptance of care provided and help to live a diverse life.

Mr. S- Motivational behavioral skills model can be applied, as he needs motivation and support to be cope with the feeling of isolation and be independent.

Mrs. M - Self determination theory can be applied, as she is a self determined with highly competent ideas for caring herself.

FINANCIAL CONSTRAINTS IN MANAGING HEALTH CARE

the geriatric population is heterogenuos and it is very difficult to collect information about them without adequate resources such as annual census, mortality and morbidity rate assessment e.tc. the another cause is the increase in chronic illness that puts a great burden on the healthcare sector. the healthcare sector has to spend more finance for the proper caring and manage of these illness. the increase in oldage homes and the lack of proper resources tends to be another constraint.

some of the ethical challenges encountered in caring geriatric population are ensuring informed consent and confidentiality, determining decision-making capacity, promoting advance care planning and the use of advance directives, surrogate decision making, withdrawing and withholding interventions, using cardiopulmonary resuscitation and do-not-resuscitate orders, responding to requests for interventions, allocating health care resources, and recommending nursing home care.