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Case study
Linda is an 83 year-old woman who was admitted to the rehabilitation hospital following a right cerebral vascular accident (CVA) with left weakness. Upon admission, Linda was identified as a fall risk and required assistance in both ADLs and IADLs. At this time, Linda walks independently with a “toe drag” on the left and is walking throughout the facility using a standard walker. Increased muscle tightness was noted throughout the left upper extremity.
On initial assessment, Linda could feed and groom herself, given set-up. She needs minimum assistance in transfers and moderate assistance in bathing. She uses her right hand for most tasks, and will use the left arm as a gross assist in some activities. Her left shoulder and elbow are weak, with muscles scoring in the “fair” grade of strength. Linda report pain at 5-6/10 during tasks that require her to use her left arm.
Linda has an impaired awareness of light touch on her left body side and she has left visual inattention. Linda is interested in participating more in dressing and cooking tasks, but requires prompting to stay on task and to follow a schedule for task completion.
Goals Linda set for herself in rehabilitation include: “walk like I used to”, “use left hand when I need to” and “pain control. Linda’s husband Bob has visited her daily while she was hospitalized, but has not wanted her discharged to home because he did not feel competent to care for her. Both Bob and Linda will need a lot of support as she transitions back to living in her home.
Linda is being discharged to home today. She and Bob live in a one-story home that has two steps (with no handrail) to enter the house. At home she will have a walker, a lift chair, a shower chair, and grab bars in the bathroom. Linda is unable to dress herself, requiring Bob to assist with both upper-body and lower-body dressing. Linda has home health therapy support and is highly motivated to improve. Because her ADL activities and her therapy activities will take most of the day, both she and Bob are worried that they will have little ability to socialize or maintain their relationships in the community.
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Questions
Integration of core knowledge, scientific knowledge, theoretical knowledge to describe how this client may experience disability in regards to her lifespan development for eg Erikson theory or piaget theory, engagement in social activities, self-care, driving, cooking, stroke symptoms, values, beliefs and spirituality and quality of life
Client-centered identification of barriers consider: Client factors; psychosocial; socioeconomical and sociocultural factors. Troubleshooting ideas to work around barriers
Answer
Linda, being at the age of 83 is bound experience some major challenges in regards to her lifespan development. Erickson (Cote and Levine, 1987) has discussed eight psychological stages and the one that is most relevant here is the Ego Integrity vs. Despair. At this stage individuals feel integrity if they have proud over their accomplishments. On the other hand, they will feel despair if they do not think they have accomplished something in their lives. Based on this understanding, it can be stated that Linda might feel integrity considering her style of adopting things and actions. Moreover, it can be observed from the case that the Linda prefers doing most of her work on her own. Along with that, she is also worried about her inability to be social when back home. These elements show that the Linda was independent throughout her life and stayed social. Now at present, these elements will reduce from her life, it can make her life challenging. She might view these two elements as the major threat to her life.
Erickson (Kidwell et al, 1995) has mentioned another important aspect which is intimacy and isolation. As per the case, Linda seems to be oriented towards the intimacy throughout her life. However, now as she has gone old, she will be relying on the isolation which may seem challenging for Linda. She might not view staying isolated as the good part of her life. Linda seems to have engaged social life which is going to reduce. Therefore, the reduction in the engagement in social activities might bring in despair for her. The major challenge she can consider is her growing inability to take care of herself. However, these changes are not likely to impact the values and beliefs she has gained throughout her life, as she still has Bob with her to help. Her orientation towards spirituality might seem challenging as she can question her new poor state of life if she fails to do what she could have.
The solutions that can be suggested to Linda in such situation is that she needs to accept the current situation as new phase in life. It is obvious that the hard embedded beliefs and values cannot be rooted out within few days’ time. This is the same with Linda. Despite the suggestion to accept the new life and change the preference towards isolation, Linda will face difficulty in accepting this life of disability. Her experience with this disability does not seem to be appreciable. As stated earlier, that Linda seems more to be social animal rather than lone survivor, it can be suggested here that keeping her in an environment where she can have the opportunity to engage with other people can be satisfying for her.
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Cote, J. E., & Levine, C. (1987). A formulation of Erikson's theory of ego identity formation. Developmental Review, 7(4), 273-325.
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Kidwell, J. S., Dunham, R. M., Bacho, R. A., Pastorino, E., & Portes, P. R. (1995). Adolescent identity exploration: A test of Erikson's theory of transitional crisis. Adolescence, 30(120), 785.
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Lennartsson, C., & Silverstein, M. (2001). Does engagement with life enhance survival of elderly people in Sweden? The role of social and leisure activities. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(6), S335-S342.
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