Steven F. Jacobson
Western Governors University
When an elderly person is injured and then discharged from the hospital their needs often extend beyond care one would immediately think of. There are concerns related to their ability to meet all the various requirements for return to previous level of functioning. The patient needs to not only take their medications, make appointments but they may need to change all or some portion of their lives in order to recover and prevent further injury. Involvement of family and other resources is a complicated process that not only involves the patient and their family but numerous other members of the interdisciplinary healthcare team. Scenario
In this scenario, a 72 year old male patient, Mr. Trosack, is discharged from the hospital after surgery to replace a fractured hip. He does not participate in regular health screenings and does not take any prescription medications. His wife died two years ago and he continues to live in the same 2nd story apartment he has lived in for 40 years. He has one son who lives nearby but often works long hours. The patient also owns a bakery and would like to continue to own and operate the bakery upon discharge. Three Healthcare Issues
As the case manager there are many issues with this patient that must be addressed. The top three concerns I have established include: medication regimen, diet, and access to follow up appointments. Each of these concerns are important based on information obtained from patient and family interviews and knowledge about the patient and his past medical history.
Medication regimen may be the hardest and most important. Mr. Trosback self admittedly does not take any medication and arrived at the hospital with undiagnosed hypertension. He also does not like the idea of being “disabled” and his impaired mobility along with his need to take medications he did not have to take before could be met with resistance. His son also reported during the interview that he doesn’t think he needs the medication to control his diabetes. Mr. Trosack needs to have the ability to obtain his medications, which may be impacted because of decreased mobility, know the importance and purpose of his medications, when, how and how many to take and also be familiar with the medication side effects.
Maintaining a healthy diet is an additional concern. Mr. Trosack’s kitchen is clean and well maintained but not large enough to maneuver a walker. He also has additional dietary requirements with his diagnosis of NIDDM. His mobility not only impacts his ability to maneuver in the kitchen but his ability to obtain groceries and carry them up the stairs.
Follow up appointments will be difficult to maintain since the patient self admittedly has not had a physical evaluation in over 10 years. With his history of not getting regular health screenings coupled his attitude about being “disabled” and having to take medications, a regular schedule of appointments and therapy may not be his priority. This may be compounded considering the strain his mobility and 2nd floor apartment would place on his ambulating to a transportation source. Interdisciplinary Team Members
In order to successfully plan for Mr. Trosback’s discharge from the hospital and eventual return to adaptive functioning, numerous members of an interdisciplinary team need to be able to coordinate care and services. These team members include not only the case manager but also the staff nurse, occupational and physical therapy (PT/OT), mental health professional, social worker and dietician. Each person will have a specific role in Mr. Trosback’s recovery and in order to be most effective and studies have shown that the interdisciplinary team is key to integration of services and successful patient outcomes with the increasing complexity of the healthcare environment (Strasser, Uomoto &...