Melissa Kiesel
Elder assignment #2
My visit with Bruce began first with both an APGAR score and OARS
assessment. The conclusion I came to, based on both assessment tool findings,
suggested Bruce had a good social support system as well as adequate family
support. Based on Bruce’s nutritional screening, Bruce is at moderate nutritional
risk. I was however able to obtain an adequate economic status based on my results
and observation. Bruce is still working full time and his wife works as well. They live
in a beautiful home and have adequate financial means to supply food. Bruce
however struggles with having a poor appetite since his hospital visit and does not
always have the energy to prepare meals. Both of these factors contribute to a risk
of poor nutritional intake. Bruce’s Barthel index suggested a generalized sense of
independence. The only activities Bruce finds difficult to perform include cooking
dinner and needing some assistance with climbing stairs, but his wife helps him
with food preparation and he often avoids stairs. After a sleep assessment, I noted
that sleep has become a problem. Bruce often times does not feel rested upon
waking up and has a hard time falling asleep. However, Bruce reported both are
becoming easier with help from a counselor and anti-depression medications. The
last question we talked about with advance directives. Bruce noted that he has a
living will and all the paperwork for advance directives, he has however not had the
time to fill them out.
Increased chronic diseases and health problems are associated with a greater
risk for depression. For Bruce, his appetite has decreased since his recent
hospitalization. He has had difficulty sleeping, low energy, and feelings of sadness.
Risk factors include medications, past history of depression, and recent life
threatening illness (Meiner, 2011). Due to both Bruce's risks for depression and the
signs and symptoms of depression, I suggested multiple interventions to help.
First and foremost, I educated Bruce on the importance of physical activity.
The National Service Framework for Older People (Atwal, 2013) emphasizes the
importance of including physical activity everyday in the older adult. I provided
community resources including contact information on the closest fitness center. I
also stressed the importance of improved diet and nutrition, immunizations and
strategies for preventing falls, strokes, and additional myocardial infarctions.
Education was provided about an increased risk for depression and mood disorders
due to drugs such as antihypertensive, steroids, and analgesics. I provided
information on the importance of continual follow up with Bruce's primary care
provided and medication management. I assured he had made additional follow up
appointments and assistance Bruce with additional contact information in case of a
psychological emergency. I also included support service information such as Lions
Club, Adopt a grandparent, and senior community center contact information.
Bruce's social support includes a network of friends, family and community support
but I felt that if he had additional information he might consider more community
involvement. The last topic we discussed was counseling. I instructed Bruce on in
importance of continuing counseling and again assured follow up appointments
were made. The visit ended with conversation on my involvement and follow up for
our next visit.
Atwal, A. (2013). Occupational therapy and older people (2nd ed.). Chichester, West
Sussex: Wiley-Blackwell.
Meiner, S. (2011). Gerontologic nursing (4th ed.). St. Louis, Mo.: Mosby Elsevier.