The objectives of this study are to discuss how social isolation can affect an older adult's recovery from surgery or illness and to identify safety issues when older adults return home from the hospital after a major illness or surgery. This work will additionally assess the safety of an older adults living environment in a given scenario and determine appropriate discharge placement for an older adult based on a given physical or psychological status. This work will explain how specified psychological factors can play a role in the recovery process. Finally this work will assess the adequacy of the family or caregiver's knowledge of skills necessary to deliver care to an older adult in a given situation and collaborate with a given patient's family to develop a plan of care for an older adult upon discharge from the hospital.
Assessment of the Situation
This patient is an older adult by the name of Henry Trosack. He is 72 years of age and is in excellent health but has not had a physical examination for ten years preceding his surgery although he does take vitamins each day. Mr. Trosack wearing reading glasses and has 60% loss of hearing in his left ear. Mr. Trosack in combination with his brother manages a family-owned bakery. Mr. Trosack lives in a two-bedroom apartment on the second floor. Mr. Trosack fell while taking out the trash down the long flight of steps leading to the ground floor of the apartment building.
While Mr. Trosack was in the hospital for the hip replacement surgery, he was prescribed Lopressor 25 mg bid for an average B/P of 160/100. Mr. Trosack was also diagnosed with noninsulin-dependent diabetes for which he was prescribed Glocophage 500 mg twice a day. Mr. Trosack is able to perform his own blood pressure checks and has been issued a glucometer for use at home. Mr. Trosack is also overweight at 5'7" and 210 lbs. Mr. Trosack uses a walker and this will be his only means of assisted mobility. It is important that Mr. Trosack is determined that he will be going to the bakery.
The family of Mr. Trosack was interviewed and they do not understand the need for medications being taken at certain times and are skeptical that Mr. Trosack has diabetes. The family does not want outside nursing care and do not intend to stay with Mr. Trosack. Mr. Trosack's apartment has some safety problems which need to be addressed and specifically the need for delivery of groceries and someone to take out the garbage due to the two flights of steps leading to the apartment.
In addition, there is expired food in the refrigerator and out of date prescriptions in Mr. Trosack's medicine cabinet. There are also multiple scatter rugs throughout the apartment. There are three healthcare issues present and this will require an interdisciplinary team in addressing the patient's discharge. This team will be comprised of the dietician, the physical therapist, and the nurse.
The problems that are identified in regards to the discharge of Mr. Trosack include lack of support for care following surgery combined with a need for assistance in performing the following tasks: (1) taking medication on time and as prescribed; (2) taking garbage out and bringing groceries in to his upstairs apartment; (3) help with preparing meals and eating the foods that are healthy in light of diabetes and overweight in patient; (4) need to take blood pressure and glucose readings on a daily basis and (5) the fact that this patient does not hear well in one ear and has affected eyesight as well as that the patient will be maneuvering on a walker in a small apartment following THR surgery. If Mr. Trosack is to stay alone in his apartment (without a family member present) then Mr. Trosack will need someone to assist him at the very least from early in the morning until he goes to bed each night. There is also the danger that Mr. Trosack will suffer a fall during the night getting up to go to the bathroom or to get something to drink.
II. Discharge Plan of Care
The dietician will address the needs of the patient in terms of his diet which must take into consideration that Mr. Trosack is a diabetic. Mr. Trosack will be instructed of what foods he should and should not consume with diabetes and with his need to lose weight. If it is determined that Mr. Trosack will return to his apartment following his discharge then the physical therapist will provide instructions for Mr. Trosack concerning his mobility and his use of the walker in moving about in his small apartment as well as instructing the patient on what exercises he should perform to gain maximum mobility following a total hip replacement surgery. The third case worker, the nurse, will instruct Mr. Trosack concerning the following issues:
(1) Groceries being delivered to his apartment;
(2) Garbage being taken downstairs from his apartment;
(3) Removal of the small scatter rugs located throughout his apartment.
(4) Daily use of glucometer checking his blood sugar;
(5) Daily checking of his blood pressure.
(6) Follow-up appointments and transportation to and from these appointments.
(7) What medications that the patient will be taking, why it is important to take them, when to take the mediations, discuss as well potential side effects and what to do if he experiences side effects from the medications. The nurse will additionally counsel the patient in planning how he will refill his medications.
There are other discharge options available for Mr. Trosack and these have been reviewed by the case workers for the patient. There are specifically three options available including:
(1) Home therapy;
(2) Outpatient therapy; and (3) Rehab facility therapy. (Sweet, nd, Wong & Wong, 1999, DeFrances & Podgornik, 2006)
Rehab facility therapy will involve "direct transfer from the hospital to a rehab facility." (Sweet, nd, Wong & Wong, 1999, DeFrances & Podgornik, 2006) This is an option available for older patients who live alone and in the case of Mr. Trosack, is the most appropriate choice for discharge. Mr. Trosack will remain in Rehab therapy for several weeks depending on how quickly he recovers. This option is chosen because Mr. Trosack does not have family members that are intelligently and actively involved in his aftercare. The work of Scheerlinck (2003) states as follows concerning discharge of elderly patients following total hip replacement surgery:
"Early rehabilitation and social reintegration of elderly individuals with a hip fracture is a major concern in the orthopedic department. A specially trained "social nurse" discusses rehabilitation options with the hip fracture patients and their relatives immediately after surgery. In accordance with the physiotherapist and the surgeon, the most suitable solution is selected. When rehabilitation in the home environment or with relatives is no longer an option, a standardized form is sent to a rehabilitation center. Depending on the vacancies in these centers and the health status of the patient a date of transfer is planned." (Scheerlinck, 2003)
Mr. Trosack will remain at the rehabilitation center until it is affirmed that he will be able to maneuver the steps leading to his apartment safely. Mr. Trosack will receive counseling from his caseworkers on a proper diet for diabetics, training in monitoring his blood pressure and blood sugar levels and will be offered an eye examination to see if he is in need of prescription eyeglasses. As well, Mr. Trosack will be fitted with a hearing aid.
Summary and Conclusion
It is the opinion on this writer that the most appropriate form of discharge has been chosen for Mr. Trosack and that he will experience more optimal recovery in a rehabilitation center following his having had total…