Using the Biopsychosocial Model for Evaluating Patient Needs

Biopsychosocial Assessment: Morris S. Schwartz

Morris Schwartz, a former sociology professor, was diagnosed recently with amyotrophic lateral sclerosis (ALS) and presented in the clinic expressing concern about morning bouts of atypical anxiety, fear, self-pity, and crying (Albom, 1997, p. 56). Mr. Schwartz's day-to-day medical needs are provided by a palliative care nurse in his home and has no desire to be transitioned into a nursing home or hospice center as he reaches the end of his life. What follows is a biopsychosocial assessment of Mr. Schwartz, or Morrie as he prefers.

Biological

Morrie was in his mid-70s when diagnosed with ALS ("Morris S. Schwartz," 1995) and was probably already experiencing many of the physical symptoms of aging (Zasrow & Kirst-Ashman, 1997, p. 546-555). ALS is a progressive neurodegenerative disease of the central nervous system, resulting in the gradual paralysis of the limb, respiratory, and bulbar muscles (Foley, Timonen, & Hardiman, 2014). Although 15 and 35% of ALS patients will develop frontotemporal dementia or cognitive impairment, respectively, Morrie does not suffer from these symptoms. The expected life expectancy following diagnosis is 2-4 years, but in reality this period is much shorter. The peak age of onset for most ALS patients is in the 60s, so Morrie developed the disease at a more advanced age and will probably progress at a faster rate.

At the micro level, Morrie can no longer meet all of his physiological needs and over time his inability to engage in daily living activities will rapidly decline (Albom, 1997); therefore, he will grow increasingly dependent on the mezzo systems with his wife, nurse, friends, and other family members to meet his feeding, bathing, and other needs. The interventions ALS patient would typically receive today, depending on need, would be the drug riluzole, feeding tubes, and respiratory assistance devices (Sreedharan & Brown, 2013). On a macro level, all of Morrie's physiological needs are being met by the U.S. health system. Even though mechanical ventilation support would be provided, Morrie's advanced directive contains a DNR (do not resuscitate) should he eventually be unable to breathe on his own. If the biological items on the biopsychosocial INTERMED instrument were used to evaluate Morrie, he would score high on disease chronicity, diagnostic dilemma, symptom severity, impairment, diagnostic/therapeutic challenge, complications, and life threat (Mazzocato et al., 2000; INTERMED Foundation, 2009).

Psychological

Morrie is a heterosexual Caucasian elderly male, living in an affluent Northeastern city in the United States (Albom, 1997; "Morris S. Schwartz, 1995). On a macro or community level Morrie does not suffer from racial, ethnic, gender, or sexual-orientation discrimination, but as an elderly person with ALS ageism and disability would confer a lower societal status (Zasrow & Kirst-Ashman, 1997, p. 576). The lower societal status could threaten Morrie's mental health, but he appears to be adequately buffered by strong mezzo systems with family, friends, students, and former colleagues (Ogden & Jackson, 1999).

Morrie's concern about his morning bouts of melancholy appear to be just that, nothing more than the normal grieving process formulated by Kubler-Ross (Zasrow & Kirst-Ashman, 1997, p. 590). The relevant stages would be stage 2 and 4, but Morrie put strict time limits on his morning bouts of self-pity (Albom, 1997, p. 56-57). Accordingly, his concerns are not sufficiently worrisome to warrant clinical intervention. The primary psychological concerns for ALS patients are mild cognitive impairment, loss of insight, mental rigidity, and dementia (Mitsumoto & Rabkin, 2007), but Morrie remains cognitively intact and active.

According to Erickson, successful aging requires acceptance of reality and the approach of death (Zasrow & Kirst-Ashman, 1997, p. 574-575). Morrie has been quite successful in this regard, even to the point documenting his demise with former student Mitch Albom. According to Peck, successful aging requires three adjustments. The first adjustment is from the role of wage-earner to retiree, which Morrie successfully managed by grieving the loss of his old role as teacher and establishing a mentoring role with Albom. Morrie has also accepted the fact that he is gradually losing his ability to walk, write, or even hold lengthy conversations and has transcended these limitations by remaining intellectually involved on micro and mezzo levels. The third adjustment necessary for successful aging is self-transcendence, which Morrie accomplished by shifting his attention away from self-pity by sharing his death with loved ones. If the psychological items on the INTERMED instrument were used to evaluate Morrie, he would score very low on all items (Mazzocato et al., 2000; INTERMED Foundation, 2009). Psychologically, Morrie is doing very well.

Sociological