Well Elder Interview Paper

Intro
The focus of this paper is to compare and contrast a well elder and a frail elder while using Occupational Therapy Practice Framework language. For this assignment I chose to conduct a semi structured interview using the Canadian Occupational performance Measure (COPM) to gather information about my chosen elders perceived problems and priorities. For this assignment I will be using pseudonyms in order to protect the privacy of both individuals.

Frail Elder:
BM is a 63-year-old women born in St. Joseph Missouri. She sustained a right cerebrovascular accident 3 years ago responsible for her left hemiplegia. Since her stroke BM has not been able to independently live on her own, work or care for herself. Due to her health condition she is completely wheelchair bound and is dependent on the caregivers at the assisted living facility where she resides. BM feels that she has lost her independence since her stroke and it has greatly impacted her ability to

engage in her occupational roles she enjoys, some of which are being a mother, friend, employee and Christian. BM stated that it is important to her to be able to care for herself as much as possible and not be so dependent on others. She wants to be able to independently perform dressing, showering, and other self-care tasks. She would also like to be able to engage in crocheting with friends and attend church again.

BM stated that she has motor functioning of her right extremities, normal vision and cognitive performance skills.

She stated that her physical environment provides her with the most support in participating in activities of daily living. For example she is able to perform grooming, feeding, oral hygiene and wheelchair mobility for short distances using one-handed compensatory techniques. However, BM is unable to physically carry out her occupations daily without the assistance of a caregiver which limits her ability to engage in occupational roles such as attending church and meeting friend to crochet. She stated that she has very limited functional mobility within her left extremities which interferes with her occupational performance in bathing, dressing, toilet hygiene and all transfers. She has difficulty bathing the right side of her body and using her left hand for bilateral tasks such as tying her shoes and putting on socks. She has difficulty performing toileting tasks and requires maximal

assistance.

Well Elder:
JB is a 68-year-old women born in Oregon Missouri. She is a retired school teacher and lives at home with her husband in their two story home. She has three grown children and five grandchildren that live nearby. She was diagnosed with osteoarthritis within the past year. She has pain in both of her hands, especially when doing activities she enjoys such as cooking, gardening, restoring furniture and doing housework. JB feels that her self-care and home management abilities have been impacted by her diagnosis of OA. Her participation in leisure activities have slowly declined within the past few years due to decreased strength, range of motion and pain. She would like to be able to continue living in her home and caring for herself independently.

During an interview using the COPM, Julia stated that it is very important to her to continue her responsibilities in managing household responsibilities and fulfilling her roles as a wife, grandmother and mother. Planning and preparing meals are also very important to her. She expressed frustration with her difficulties completing her morning activities including bathing, dressing and grooming because of her decreased ROM and strength. She has difficulty squeezing bottles, getting out of the bath tub, putting on makeup and her socks and shoes. She is unable to do heavy meal preparation including carrying dishes and cutting foods due to weak grasp, decreased ROM and pain. She also has difficulty manipulating tools for prolonged periods of time during leisure activities such as gardening and restoring furniture due to hand weakness and pain.

Compare and Contrast
BM and JB share many similarities in the obstacles that they each face with their disabilities, mainly in the areas of physical participation in daily activities. BM and JB both experience similar challenges with functional mobility within their physical environments. For example, they both have difficulty transferring to and from bathing positions and putting on socks due to weakness and ROM deficits. Although BM and LB are both impacted by their medical conditions they have differences within their performance and environmental demands.

BM and JB have significant performance differences due to their disabilities. For example, BM faces many obstacles while JB only faces minimal obstacles with their disabilities. BM in unable to physically carry out her occupations daily without the assistance of a caregiver while JB is still able to with some difficulty. They also have differences within their environmental demands. For example, BM lives within an assisted living facility where her environmental demands support her participation in meaningful occupations. The facility is fully accessible with full amenities, transportation, therapy services, educational and recreational activities. JB lives at home where her environmental demands present some barriers to her participation in occupations. For example, her home does not have an accessible bathtub which makes it difficult for her to get in and out to bathe herself in the morning.

Aging Theory
The wear and tear theory would best represent both clients within this case study. Park and Yeo (2013) stated “the wear-and-tear theory proposes that the human body also undergoes aging due to damage from accidents, diseases, radiation, toxic substances, food, and many other harmful substances when it is utilized for a long time”. JB’s osteoarthritis caused destruction in the joints resulting in decreased strength and range of motion so client has difficulty transferring in and out of her bath tub to bathe in the morning. BM stroke caused left sided paralysis so client has difficulty performing bathing tasks such as washing the right side of her body.
Intervention & Support from Literature
Based on the identified issues with BM and JB I would develop individual intervention plans for both. The intervention approach for BM would consist of Constraint-induced movement therapy (CIMT) to promote functional use of the effected upper extremity. It is important to promote functional recovery of the affected limb from the stroke that was caused by wear and tear over time to be able to engage in meaningful occupations such as ADLs. The use of CIMT is supported by evidence based practice for improving motor function in stroke survivors.
There is literature that supports CIMT interventions in stroke rehabilitation. Nilsen, Gillen, Geller, Hreha, Osei, and Saleem (2015) reviewed 20 CIMT articles and the evidence suggested that constraint-induced or modified constraint-induced movement therapy can improve upper-extremity function, balance and mobility, and activity and participation. Based on this article there is a large amount of literature that supports CIMT interventions in stroke rehabilitation. Another study by Koyama, Sano, Tanaka, Hatanaka, and Domen (2007) used modified CIMT with 19 older adults resulting in significant improvements in hand and wrist function of the affected side. BM would benefit from CIMT intervention by improving extremity function of the upper limb so she can independently engage in self-care tasks such as showering.
The intervention approach for JB would consist of a hand exercise program with range of movement and strength exercises. This exercise intervention would progress gradually to help improve grip and pinch strength, hand function and decrease pain. It is important for JB to continue using her hands to improve hand function and decrease stiffness and pain that she experiences from the wear and tear of her joints over the years. The use of an exercise intervention is supported by evidence based practice for improving hand functioning in individuals with hand osteoarthritis.
There is literature that supports therapeutic exercise for individuals with hand osteoarthritis. Perez-Marmol, Ortega-Valdivieso, Peralta-Ramirez, Ickmans, and Aguilar-Ferrandiz (2017) conducted a study using a fine motor skill intervention on 45 older adults with hand osteoarthritis and had significant improvements with manual dexterity and finger and thumb range of motion than the control group. Based on the findings of this study JB would benefit from an intervention such as this to improve her hand function so she can independently engage in meaningful occupations such as getting herself ready in the morning.