Elderly Visit Shawna Satteson October 22, 2013 In partial completion for OTA 2350 Geriatrics Lyndsay Fait

Introduction I had the opportunity to go visit my grandpa, who I call Papa, to ask him questions from the Prevention Behavior Questionnaire. I had some concerns with his health that I was able to address with the additional five questions which I will discuss. I was able to go through his home and complete a safety evaluation and recommend some modifications that would allow him to function more safely in his home. He does not appear to require adaptive equipment at this time, but I did provide him with a list and some examples for in the future if such items become necessary. I will discuss the list of local resources that I shared with my grandpa. I will also explain the fall prevention handout that I selected for him and state the reasons for my selection. I learned a great deal from completing this assignment and will share how it has contributed to my development as an occupational therapy practitioner. Prevention Behavior Questionnaire My grandpa and I went through the Prevention Behavior Questionnaire one question at a time. It was quite interesting to hear his responses. He is the type of person who doesnt like to complain or acknowledge that there is anything wrong, so sometimes he struggled to answer my questions. He reported poor hearing and diabetes as having the most impact on his health. He said that he felt like he had little control over his hearing, and that if he enjoyed cooking he could better control his diabetes. My grandpa loves golfing and taking his dog out for walks and goes on a weekly basis in the warmer months. In the winter time he tries to take his dog out but the weather limits this activity. Sudoku is his stress reliever for the day, and he enjoys reading from a variety of magazines. When I asked him who he eats with for dinner he seemed a little upset. He eats with his dog of course. He has specific routines for meals, reporting that for breakfast its usually Carls Jr., for lunch Artic Circle, and for dinner McDonalds. He also stated that once in a while a family

member or neighbor will bring him dinner. He eats terribly. He said he doesnt worry about things like sodium intake, or blood cholesterol levels. He said the doctor checks his blood cholesterol levels when he goes in for his appointments. He said he has had one fall in the last 3 months but nothing prior to this. I worried about this as he is very private regarding such issues. There could have been more but I doubt he would willingly share this information with anyone. He finds stairs to be a challenge as it hurts his knees. Although he eats terribly he seems to be in good health. He hates being treated like hes senile, and wishes he could hear what people were saying better. Additional Questions I had additional questions regarding my grandpas health and well-being. I clean for him on a regular basis and have worried about certain issues. I used this opportunity to address my concerns. I have worried about his medications. Does he know what hes taking or what they are for? His answer to this question was that he takes them because the doctor told him to. He said that he had a list somewhere that told him what each one was for, but when he looked for the list he couldnt find it anywhere. Who makes sure his medications are being refilled? He said that between his two daughters, the medications always manage to be filled. How does he know when to take them? How does he know if he has already taken his medications? When I asked these questions it became apparent that this has been on ongoing problem. He knows when to take the pills, but from the sound of it he forgets and has over taken medication on a regular basis. How safe does he feel in his own home? I asked this question because I have a family member who lives with him off and on. This family member is suspected to have stolen from my grandpa and has a history of violence (not toward my grandpa). He answered this question by saying he was as safe as he could be. As a family we are working hard to prevent this family member from living with him, but it has been a huge challenge. What does he do for social participation? I worry about my papa as he used to do everything with my grandma. Since my grandma has passed away he never does anything with

anyone outside of the family, which is only occasionally. He said that he visits family once a week at most. This is something we as a family need to address. Home Safety Evaluation I went through my papas house and found a few things that should be addressed. The home is fairly well equipped with adaptations having been made for my grandma before she passed away. There are temperature controls on the water heater, grab bars, a shower chair, and a handheld shower in the walk-in shower. There are no throw rugs in his house. There is a light switch next to his bed that he reports using throughout the night when he gets up to go to the bathroom. It is a rambler style home with three steps and handrails at both entrances. One of the biggest concerns is his dog, which has soiled the carpet throughout the home. Dog feces can be seen in various locations throughout the home which is very unsanitary. Another concern is the family member that is in and out of his home. I thoroughly assessed the pathways throughout the home. There was a pair of shoes in the hallway which I moved, but other than that the pathways were free of clutter and there were no cords or loose carpet. The last concern is the stairs going to the basement. There is a secure handrail on only one side of the stairs. The stairs are too narrow, too high, and the lighting is insufficient. This is where he had his fall and what he says causes his knees to hurt the most. His laundry room is downstairs and so the family has been taking care of the laundry for him. List of Local Resources I made a list prior to going out to my papas house of some local resources that could be beneficial. I highlighted the areas that I thought might be most useful for him. I provided him with a pamphlet from Intermountain Therapy Animals because I went there for my service learning and thought it would be perfect for him. He loves animals, and this would provide him with an outlet to interact with others and to serve the community doing something he loves. I also thought it would

be beneficial to leave him with a Diabetic hotline number for access to any questions regarding his diabetes. I also left him with a fall prevention hand out, list of vendors, information regarding the local senior citizens center, and resources for medical alert systems, and durable medical equipment. Three different Fall Prevention Handouts I found three fall prevention handouts that I really liked. I picked the one from Centers for Disease Control and Prevention/MetLife Foundation because it was easy to read with black on white print. It clarified the most pertinent information on fall prevention. For my papa I thought this one would meet his needs best. It was a little longer, but the script was in larger text and gives a good visual of each area of concern. I chose the handout that I felt would best meet the needs of my grandpa. Impression of Findings In doing this assignment I found that my grandpa does need certain areas addressed. These areas, however, are not perceived by my grandpa as being problematic. He mentioned to me that he had fallen one time, but I believe that number to be higher based on discussions heard by family members. I would recommend avoiding using the stairs to the basement altogether. It may also be a good idea for him to consider utilizing a medical alert system to be able to access emergency assistance if unable to get to a telephone. My papa isnt properly taking his medications; which is what he believes to be the cause of his fall. He would benefit from a pill box with a timer and or locks, for safety concerns. His dog is a significant source of happiness for him, but presents as a fall hazard and contributes to an often times unsanitary environment. He wont let it outside for fear of it running away because its so little it fits under the fence. Unfortunately my grandpas carpet often serves as the dogs grass. My papa, money permitted, would benefit from flooring that could be mopped on a weekly basis, or training for the dog to use a training pad. Although he appears

healthy, a diet based on fast food cannot be healthy. It may be beneficial for him to consider eating lunch at the local senior citizens center. He recognizes his hearing problem to be a major stressor. Although he does use hearing aids, it is important that he has a check-up in order to meet his needs in this area. My papa seems quite lonely despite visits from family members. He can be stubborn, but he may be open to attending senior citizen center activities and lunch which could promote opportunities for socialization. Conclusions I learned a great deal through doing this assignment. I was able to gain experience in the area of conducting an interview with the elderly population. I was able to improve my observation skills, and apply knowledge I have gained from my education to identify needs and provide solutions to those needs. I gained a better understanding of the importance of learning more about an individual in order to take a client-centered approach. I felt as though I knew my papa quite well, but now have a much better understanding of his situation. I was able to discover that clients may not be forthright, or even aware of their needs. As a practitioner, it is crucial to have the skills to identify and address issues that may otherwise remain unnoticed. I have to be careful how I approach this, but I feel a responsibility to talk with my papa and other family members in order to address the needs identified in completing this assignment.

References Centers for Disease control and Prevention., MetLife Foundation.(2005). A fall prevention checklist for older adults. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/pubs/English/booklet_Eng_desktop-a.pdf Harkins, R. (2012). Slips, trips and fall. Retrieved from http://www.rlharkins.com/PDF Docs/Safety Documents/Slips, Trips and Falls/Slips, Trips and Falls Handout in English.pdf Laya, M. (2001-2002). Fall prevention. Retrieved from http://depts.washington.edu/osteoed/handouts.php Padilla, R., Byers-Connon, S., & Lohman, H. (2012). Occupational therapy with elders: Strategies for the cota. (3rd ed., pp. 177-205). Maryland Heights, MO: Elsevier Mosby.

Additional Five Questions 1. Can you tell me about your medications? He said he could tell me all about each of his medications with his list, but when he looked for his list he could find it anywhere. He didnt know which pills were for what just that they were in his pill box so he takes them. 2. When do you take your medications, morning or night? He said he takes them when he remembers, sometimes morning and sometimes at night. 3. Who refills your medications? He said that his two daughters rotate picking up his medications and schedule doctor appointments for him on a regular basis. He is offended by this and thinks that he can take care of his own medications. 4. How do you feel about the safety of your home? He didnt want to answer this question. Simply stated as safe as he could be. This is the biggest area of concern. 5. Will you tell me about some of your favorite social activities? He said he enjoys playing with his cat and dog. He likes to go to golfing. He likes reading the newspaper and talking about the sports section to family if they call or come over.

Ask your doctor or your healthcare provider for an occupational therapy home evaluation in order to help make recommendations for safety and increased independence in the home. Possible modifications: ramps, shower chairs, raised toilet seats, safety bars in bathroom/hallways, chair lifts, adapting tubs/showers, bed safety bars Accessible Homes Foundation P.O. Box 26383 SLC, UT 84126 www.accesshomes.org ASSIST INC. 218 E 500 S SLC, UT 84111 801-355-7085 www.assistutah.org Architectural design for home accessibility as well as financial assistance United Way 211 www.uw.org/211 801.736.8929 Minor home repairs including minor appliances for elderly and disabled persons Utah Independent Living Centers Throughout Utah- SLC branch 3445 S Main Street, SLC, UT 84104 801-466-5565 (Help people live independently in their own communities) Utah Center for Assistive Technology 1595 W 500 S, SLC, UT 802-887-9500 www.usor.utah.gov Disability Home Modification Salt Lake City UT www.servicemagic.com/tloc/Salt-Lake-City-UT/Remodel-to-Accommodate-a-Disability/ Prescreened Remodeling Contractors of Salt Lake City, Seniors Blue Book http://www.seniorsbluebook.com/search/Home-Maintenance-Handyman-Services-301/Utah-125/ Carfit www.car-fit.org 801-585-9522 Better Business Bureau 5673 S. Redwood Road, Suite 22 Salt Lake City, UT 84123 www.bbb.org Pick me Up Medical Transportation 1-888-822-1048

Community Services Council-Lifecare 801-978-2452 Minor repairs for elderly or low income persons including grab bars and door modification Independent Living Centers Throughout Utah Funding for assistive technology Utah Center for Assistive technology 801-887-9500 Utah Division of Services for People with Disabilities 801-538-4200 Utah State Office of Rehabilitation 801-538-7530 Specific to My Grandpa Diabetes Information Hotline 1-800-342-2383 Intermountain Therapy Animals 801-272-3439 Local Fitness Center 580 West 165 South: 801-229-7154/801-229-7156 Senior Friendship Center 93 North 400 East: 801-229-7111 1st Med Alert: 801-417-8077 Active Care: 877-219-6050 www.active.com ADT: 801-364-7694