Case study – clinical gerontology

Weighting: 40% of total mark
Word Length: 2000-2500 words
Let s consider Fran (who you have known for the past three years in your professional capacity as a health care professional working in the community), a 69 year old widowed lady who lives alone but has a daughter, Kim and a son, Mick who both live nearby and have regular contact. She also has another daughter, Karen, who is estranged from the rest of the family and has had no contact for 15 years. She has a small companion dog called Pippin that she has closely bonded to. You consider Fran to be a vibrant person who is full of life and loves having company, every visit is a joy!
The following is the medical history that you have compiled since you have known her (there is no relevant surgical history and she is taking relevant and best practice medications for each condition “ there is no polypharmacy):
Mild COPD Osteoarthritis
Morbid obesity Hypertension
Asthma Lymphodoema
You are doing some casual work at the local hospital and Fran arrives onto the ward for admission via the emergency department, she has very noisy breathing, sacral and orbital oedema and does not appear to have had her hygiene attended to for sometime “ this is most unusual and uncharacteristic for her. Kim and Mick arrive soon after, they tell you that they had both been away for one week and Kim found her Mum lying on the floor barely conscious and rang the ambulance and Mick straight away. Examination found that Fran has Chronic Heart Failure (CHF) and is treated accordingly.
Fran has improved dramatically and returned home and you have since found out that she had been experiencing the symptoms of CHF for quite some time but had not reported them to you on your regular visits. Her function is not what it was but she has had regular OT input to assist her function at home. She tells you that she got quite a fright and has been talking with her children about what she would like if it or something more serious happens again. She says she wants people to know about this so the right thing can be done in the future .
You have worked very closely with Fran and developed an advance care plan stating her wishes should she become unable to express them. You also broached the idea of Fran completing the relevant documents to ensure medical and financial power of attorney but Fran opted to complete these at a later date with her family. She has been given all relevant information to consider
The years pass and you have noticed a gradual decline in Fran s physical health she has also developed mild cognitive impairment but still lives at home comfortably with the appropriate supports. Eight years later, you are looking for change in your work and decide to move to residential care. You and Fran say your goodbyes..
It s now twelve years later. You have been working in residential care at St Jude s Residential Care Service for the past four years as you were ready to take on the challenges and rewards of residential care. Fran has come to St Jude s after an ACAS assessment determined she was eligible to receive high care. You are shocked at how different she looks and you wouldn t be surprised if she had less than twelve months to live. After some time, initial ACFI assessment shows that her PAS Score indicates moderate cognitive impairment (there is no additional medical history). Her COPD and CHF are now in the advanced stages. You see Kim and Mick again and inquire if anyone has been given legal authority to make decisions on Fran s behalf? Neither Kim nor Mick are aware of anything and you rightly suppose that Fran had not discussed this with her children, they do however, still have the ACP that Fran had drafted many years ago and they both indicated that they knew these were Fran s wishes and that they just want what Mum would want .
Fran s overall condition improves due to the excellent care she is receiving and she enjoys living at St Jude s for three and a half years. During the last six months of her stay, Fran s physical condition deteriorates and everyone agrees that it is likely that she will die soon. Kim and Mick decide to contact Karen and tell them about Fran s condition. Karen arrives and demands invasive procedures and active treatment for Fran but Karen and Mick disagree. Karen then demands that Fran be sent to hospital so they can fix her . A common situation..

Choosing the role of either yourself as a clinician, Fran, Kim, Mick or Karen, critically reflect on this case study paying attention to key challenges (and goals to overcome them) that you identify. Use evidence based literature to support your argument.

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