Question

Gary Rawlings is 71 years old. He lives at home with his wife, Karen, and son, Doug. He recently was hospitalized for a stage 4 pressure ulcer to his heel. Gary suffers from diabetes and high blood pressure. Gary is unable to walk far distances due to his heel. Karen recently bought Gary a motorized wheelchair for Gary to get around easier. (Learning Objectives 1, 4, 7, and 8.)

1. What if…Gary is having difficulty getting around the house, due to lack of mobility? You are doing an initial home health visit with him. What things do you need to watch for to advise Gary to be safe in the home and when Gary goes out?
2. What if…Gary attends weekly church outings with close friends in the congregation? He wishes to still attend these meetings, even though he is still struggling with the infection in his leg. What can you discuss with Gary about his risks of further infection?
3. What if…You realize Gary is still having a lot of concerns with mobility? What referrals can you place to help Gary improve in his current status?
4. What if…Mrs. Rawlings asked you to explain how aging affects a person’s safety? What information would you discuss with her?
5. What if…Mr. Rawlings’ son, Doug, is concerned about the changes he should make to the house to ensure his father’s safety? What information can you give him to help address his concerns?
6. What if…You feel it’s important that the Rawlings family understand the factors that contribute to falls in the older adult. What information will you provide?

Answer 1

#. Things that needs to be watched for to advise Gary to be safe in the home and when Gary goes out are :-

- Disease ID bracelet

- Proper functioning of the wheelchair

- Proper dressing of the wound

- Avoid moisture

- Keep the feets dry and moisturised

- Avoid injury

#. His risk for further infection :-

As he is a diabetic , he needs to pay more attention to his wound as it will take more time to heal than the normal . Already having an ulcer is a complication itself . Proper care of the ulcer through medication , nutritious is very important because if he does take care then it can further lead to gangrene and amputation may be needed if not controlled.

#. Referrals for Gary :-

- Community health center

- Diabetes support group

- Rehabilitation center

#. With aging a person's sensory organs functioning gets dimnished . As follows :-

Integumentary

- thinning of epidermis

- loss of SubQ fat

- loss of pigment

- loss of elasticity

- diminished oil

Musculoskeletal

- loss of muscle strength/size

- loss of bone density

- degenerative joint cartilage

Nervous

- slower nerve conduction

- reduced cerebral circulation

- referred circulatory problems (CVA, cerebral hypoxia, transient ischemic attacks)

Eyes

- diminished adjustment of lens to accommodation (presbyopia)

- lens cloud (cataracts)

- loss of ciliary function (glaucoma, poor night vision)

Ears

- loss of auditory hair cells (organs of Corti); resulting in loss of upper frequencies

- ossicles becomes fixed (presbycusis)

Other Senses

- diminished smell and taste (loss of appetite)

All these can lead to injury and affects the safety of the elderly patient.

#. Changes to be made in the house for safety :-

- install bath rails

- provide adequate lighting

- dispose throw rugs

- keep floor dry

- use large prints writing

- provide extra time

- conduct home check

- maintainence of temperature

- proper ventilation

- don't leave alone

#. Factors that lead to fall are :-

- Improper lighting

- Loosing control

- Dizziness

- Slippery floor

- Inbetween objects

- Musculoskeletal or nervous problems

- Improper gait

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