Geriatrics
Students will study normal aging process, physical, psychosocial and cognitive dysfunctions common to the elderly and OT interventions through OT frames of reference and adaptation. Designated as a service-learning course.
Elderly Person Visit - Service Learning
The elderly person I interviewed, I will call her Mary for purposes of this paper, is 75 years old and lives with her husband of 56 years. She was very enthused to sit down and chat with me, and allow me to walk through her home. She shared experiences and problems that she has, and was excited about the information and resources that I left with her.
Mary and I sat down together and went over the Prevention Behavior Questionaire, and she was very honest in her answers. She has some heart disease, that is under control with medication, and some arthritis, but otherwise is pretty healthy. She said that in the summer, she gets regular exercise by gardening and going for walks, but in the winter-time, it is a little bit different. She gets cold very easily, and so she doesn’t want to go outside much. Sometimes she tags along with her husband to the local recreation center and walks around the track while he is in on a bike. Mary said that her personality is such that she is a worrier, and has a moderate amount of stress in her life, so she will meditate and take a lot of hot baths to deal with that. She weighs less then she has in 30 years, and feels that her weight is average, but she said she has quite a sweet tooth and doesn’t monitor her fat intake. She takes medicine for high cholesterol, and according to the questionnaire, does not eat enough bread and cereal, fruits and vegetables, beans, milk or dairy products, as she doesn’t have much of an appetite. She admitted to falling about 3 months ago when she was in her camping trailer. She got up in the night to use the restroom, and missed one of the descending steps. She did tell her family about the incident, and has since put a nightlight in the area of the fall. When I asked Mary if there was anything that she would like to change about her health, she told me that she has some nerve damage in her right arm. It happened during a surgery for an unrelated problem, and when she woke up from the surgery, she had lost feeling in her right hand. She has had some physical therapy for it, but it continues to worsen. She is slowly loosing her ability to grip and also to feel. If Mary is not concentrating, she picks up pans that are too heavy, forgetting that she doesn’t have the grip that she used to, and will drop them. She would love to have more use of that arm and hand.
Mary has a strong support system. Her husband is healthy and according to her, a “work horse”. She has 5 married children, 4 of which live close by, and 8 grandchildren that are close and stop by often to check on them. She has never had any instruction on fall prevention, so she was very eager to learn about techniques that they could implement. I asked her if she ever felt off balance or dizzy, and she said that she does. Sometimes her heart rhythm problem makes her light headed and gives her “noodle legs”. The hardest activity for her is to walk up the stairs when she is carrying something in her hands, and she cant hold on to the railing, especially if she is feeling dizzy at the time. I explained the importance of always holding on to the railing, and suggested to her to not fill her arms so much, that that was dangerous and risky. The diminishing grip in her right hand, also causes Mary to struggle to hold on to the tubes and bottles associated with putting on her makeup.
Upon completion of a home evaluation, I made a list and discussed some of my findings with Mary. They were:
Ø Loose throw rugs in the kitchen and bathrooms
Ø Slippery floor in bathtub
Ø Two small pets, a dog and a cat
Ø Stairs
Ø Poorly fitted shoes
Ø Sliding doors on tub
Ø Tub handrails
Mary’s house was beautiful, clean and clear of all clutter. As we went though the list of items that I felt made her at risk for falling, I could see that Mary was right. Her husband was a “work horse”, and had already adapted many things around the house. We talked about the solutions to the list I had made, such as taking out the throw rugs, or putting some rubber backing on them to make them stick to the floor tighter. She understood how helpful it would be to get a bath mat for the tub so it wouldn’t be so slick, and also some handrails put on the side of her strong hand for gripping as she climbs over to enter the tub. I also told her that she might find it helpful in the future, to have her husband remove the tub doors altogether, and hang a curtain for easier access.
As we were walking around, I noticed the shoes that Mary was wearing were slip on shoes, and quite a bit too big. She said that she didn’t wear them out, but just around the house. I explained the importance of wearing shoes that fit, preferable one that could be laced up, as falls most commonly occur in places where elders perform most self-care activities, sich as by the bed, and in the bathroom. Mary and her husband had also recently acquired 2 small pets, a dog and a cat, and did admit to having them under foot all the time, especially at night. We discussed the fact that this can be dangerous, especially when you are not used to it, and she agreed to at least get nightlights in the bedroom and bathroom, so she could see where they were when she got up in the night. The last item we went over was the stairs. She had already said that she had a hard time if her hands were full and couldn’t hold on, but I noticed that it would probably help her to have a handrail on the wall, along with the regular railing. That way, she could hold on with her unaffected hand, whether going up, or down.
The last topic that I discussed with Mary was the handout on Fall Prevention. I chose the handout from the National Center For Injury Prevention and Control. It was a checklist of 17 questions that went into detail of hazards room by room. It starts with the floors, and asks about clutter, wires and cords, throw rugs and furniture that may be in your path. Next it has you take a look at your stairs both inside and outside your home. Are there objects on the stairs, or are some broken or uneven? It talks about the importance of lighting and having handrails, and having the carpet firmly attached or using rubber treads on the steps. The questions about the kitchen had to do with keeping things used most often on the lower shelves, and using rubber mats in the tub and shower, along with grab bars inside the tub and by the toilet. It ends with the importance of lighting in the bedroom, whether it’s a lamp by the bed, or nightlights to light your path to the bathroom. After the questions, it gives a few tips that the person may not have thought about, like exercising regularly or having your doctor look at your medicines, as some can make you sleepy or dizzy. I liked this handout the best because of the format of asking questions, and the helpful tips at the end. I think it encouraged the elderly person to actually think about their own home, and the risks there.
The handout from the Mayo Clinic was my second favorite. It started with saying that falls are a leading cause of injury in older adults, but that fear shouldn’t rule your life. Instead it says to consider 6 tips that it lists. Making an apt. with your doctor to go over medicines etc., to exercise regularly, wearing sensible shoes, removing hazards and clutter, lighting up your living space, and using assistive devices like walkers and canes.
The last handout that I looked at was from stopfalls.org. It also has a list of items to check, but includes having your vision checked regularly, and to be aware of uneven surfaces. There is also an extra checklist that involves home modification and making your home safer.
LIST OF RESOURCES
Medical Equipment
Petersen Medical
325 E University Pkwy
Orem, Utah 84058
801-374-8101
HIC Home Medical Equipment
289 w 1250 n
Provo, Utah 84604
801-224-3382
UCAT
1595 w 500 s
SLC, Utah
801-887-9539
Alpine Home Medical Equipment
1481 n State St
Provo, Utah 84604
801-852-0077
ALL Medical Supply and DME
4232 s 500 w
SLC, Utah 84123
801-263-1400
ONLINE
Sammons Preston: ALD – Mobility
http://pattersonmedical.com
TRANSPORTATION
Mobility Transportation
801-226-5060
UTA
1-888-RIDE-UTA
SLC AIRPORT
1-801-575-2401
Health Dept.
Utah County Health Dept.
151 s University Ave 84601
Provo, Utah 84601
801-851-7054
Bureau of Medicaid Services
UDOH- Division of Health Care Financing PO Box 143106
SLC, Utah 84114-3106
801-538-6155
Senior Center
54 E Main St
American Fork, Utah 84003
801-763-3090
American Fork Rec Center
454 n Center St
American Fork, Utah 84003
801-763-3080
Meals on Wheels American Fork
Liz Merrell 801-229-3821
Senior Services of Utah
801-979-6365
Lindon Aquatics Center
100 N State St
Lindon, Utah 84042
801-610-4160
Extra Questions
1. Do you have someone close by to call, in case you ever fall or have an emergency?
Yes, she has 5 married children, 4 that live close by, and 8 grandchildren. She has a large support system.
2. Have you ever had instruction on fall prevention: education or health promotion strategies?
No.
3. Do you ever feel dizzy or off balance?
Yes, her heart medication will make her feel like she has noodle legs.
4. Are there any activities you feel you can’t do, but wish you could?
Her grip is diminishing, and she can’t put on her make-up sometimes.
5. Do you feel like you have control over your own life, and/or the quality of your health?
Yes
Reflection
At the end of the visit, I felt like we had both learned something about fall prevention. I learned so much by actually walking through her home with the risks and fall prevention in mind. Mary was excited to go over the list of questions with her husband, and was ready to make some changes that would take some of the risks away. It was fun to visit with her and I felt like I had helped her out in some way by evaluating her home for safety, and giving her some tips on ways that she could improve. She was so willing to listen and learn. It was a good experience, and will be very helpful in the future, when I need to do this for clients. It helped me to be aware of those large and small things in our houses that can be risk factors for the elderly. I definitely learned a lot.