Home is Where the Hurt Is

falls-in-elderly

It’s not yet “officially” winter, but I am officially on winter break! I took my last final one week ago, and I’ve been at home relaxing and enjoying a break from the intense grad school life ever since then. I’ve had time to visit family, hang out with friends, and just have some time to myself, all of which are much-needed after a long, busy semester. I’m definitely trying not to worry too much about what will be happening in 2015, although I am patiently waiting to find out more about my first Fieldwork II placement – I requested a placement in a large VA hospital, so that I will have the chance to work with veterans for the first time, and I’m hoping I’ll get it! But wherever I end up, I’m sure it’ll be a great learning experience!

Anyway, while I was at home talking with my grandmother yesterday, I had a worrisome conversation with a neighbor that put a focus on the needs of our aging population and how OT might be able to help meet these needs.

Note: As I was writing this blog post, it kind of ended up sounding something like an occupational therapy evaluation note. I didn’t mean for this to happen, but I kept writing and left it that way because I think it’s good practice for me and it provides a glimpse of what OT documentation looks like when written by a grad student with one semester of OT school under her belt (although there are plenty of great documentation examples from REAL OT’s out there!)

My neighbor, “Mrs. Johnson,” is 79 years old, and she lives in a one-story ranch-style home with a basement she accesses via one flight of stairs. She lives with her 22- year-old granddaughter, her elderly spouse, and another older adult male. She uses a single-point cane to ambulate, and she is active in the community, completing shopping and social activities independently on most occasions. Mrs. Johnson is talkative, friendly, and cognitively aware, although she reported having some difficulty with her memory in recent years. She is overweight, and reports having a “weak bladder.” She has not been to the doctor in recent months, but she is going to visit her primary care physician in early January 2015.

I first became concerned about Mrs. Johnson when she informed me that she had recently had several falls, and that they had happened not just in her home, but out in public settings as well. Specifically, she described one incident in which her shoe caught on a chair in her home and she fell. She then had to be helped up by her elderly husband, but because of her weight and his advanced age and decreased strength, it was very challenging for him to help her up. He eventually succeeded, but she expressed concern about whether he would be able to do it again if she needed help again in the future. Additionally, Mrs. Johnson described an occasion on which she was leaving a store and fell in the parking lot and could not get up without the help of two young men who noticed her. Finally, she mentioned a third incident in which she was shopping at a shoe store, fell, and was unable to get up for 30 minutes (her words) because there were very few people shopping and she was embarrassed to call for help. At one point she asked a man to help her up, which he did. Again, Mrs. Johnson reported feeling very embarrassed about these incidents, and describes how she “made a joke out of it” with the people who came to her aid.
Mrs. Johnson also stated that she had not informed any of her family members about her recent falls. Except for her husband, who helped her on one occasion, no other family members were aware of her past falls.

Mrs. Johnson didn’t seem to be taking the situation very seriously, but I was horrified! I couldn’t believe that she had had three recent falls and that none of her family members knew. It was such a dangerous situation she was putting herself in, but I didn’t know what to say that would help her understand what a serious issue her falls were. It also didn’t help that she basically saw me as a slightly taller and better-dressed version of the child she had known 15 years ago.

On the other hand…I knew that I wouldn’t be able to just walk away from the situation and not say anything. Darn ethics!! So I took a deep breath and asked Mrs. Johnson whether she might be interested in receiving physical therapy services for her issues with falling. I briefly explained to her that PTs work with people to help them learn how to get around safely and independently as they age, and that seeing one might benefit her. I also mentioned that a provider could come to her home and look at ways that she could get around more safely there. Then my grandmother (true to form, and sassy as ever) scolded her for not saying anything to her family and advised her to talk to her doctor about her issues at her upcoming appointment. Mrs. Johnson seemed to be listening to me when I was telling her about the benefits of PT, and about the dangers of falling. However, I’m not sure if she plans to act on my recommendations or talk to her doctor. I’m still worried about her, and I hope to check in with my grandma to see what she ends up doing.

At the end of our conversation, I was uncertain about Mrs. Johnson’s future but thankful for the learning experience. After talking with her, I was better able to understand different aspects of concepts I learned in classes this semester, such as interviewing skills, client factors, the role OTs can play in healthcare, and OT’s scope of practice.

As an OT, understanding the context in which I gathered this information is very important and part of the holistic approach to interviewing, evaluation, treatment, and practice that is so unique to our profession. When my neighbor was describing her situation, she was addressing my grandmother, her longtime friend and neighbor in a friendly conversation that happened in her driveway. She was making jokes about getting older and the challenges that came along with it, and did not appear to be extremely concerned about her falls. In this setting, she was very comfortable, and seemed to feel no need to hide anything about her falls. However, if her husband had been part of the conversation, or if she had been addressing a nurse or her doctor, she might not have provided the same information. It is important to use the client interview to gather as much information as possible about the context AND content of their problems as possible so that you can provide the best treatment possible.

Regarding client factors I gained a better understand of how the physical and other changes that occur during the aging process can mean that clients experience emotions like embarrassment and pride that make them less likely to want to make changes to their lives – even ones that would keep them safer. I was also able to consider the type of intervention I might plan for Mrs. Johnson. In her case, I think I would have recommended that she consult with a home-health therapist as well as making an appointment with a physical therapist for her mobility and falls. Although OTs work with clients to increase functional mobility related to accomplish activities of daily living (ADL) and other occupations inside and outside of the home, I think that a PT would have a lot of valuable knowledge about equipment and interventions that would also improve Mrs. Johnson’s safety and health.

Ultimately, I didn’t go home for the break expecting to “use” anything I learned over the semester. So imagine my surprise when I was faced with a situation in which I was able to draw on my recently-acquired knowledge of professional ethics, client interviewing, intervention planning, and professional scope of practice just one week after heading home! The experience with my neighbor definitely made me excited to encounter and think through real client situations in the future!

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