Case Study: COPD, CHF, Elder Abuse

TJ is a 74-year-old Caucasian female, retired factory worker and waitress, widow, who lives in her own home with adult son and one other adult male “friend” (not a significant other). She has a complicated medical history including O2 dependent COPD, CHG, renal insufficiency, hypothyroidism, PVD, peptic ulcer disease. During the last year she has had multiple hospital admissions for COPD/CHF complications, and has been discharged to several different nursing homes and then to home on numerous occasions. She is very dependent on her son and friend for her physical cares. She was readmitted to Nursing Home on 12/29/95 after an abusive altercation with her son, who brought her to the Emergency Room and said he could no longer take care of her at home. Code status: FULL CODE.


Psychosocial issues
Pt. continues to be discharged to home environment that is not conducive to maximum disease management. Vulnerable adult status, such as son is under care of psychiatry clinic at XYZ Medical Center and has on several occasions pushed, grabbed pt. Home environment was poor for pt.'s existing physical condition. Pt. is almost totally dependent on others for her physical cares, but is most likely functionally able to do more than she does. Her son and friend do all the housework and cooking in addition to assisting her with her personal needs including dressing, bathing, taking pills. Home health care workers come in twice a week. Last altercation with son reported to Vulnerable Adult office upon ER admission. Caseworker was assigned.

Past History
General state of health: For past several years health has been poor to fair. Currently, fair.

Childhood illnesses:
Pt. remembers having severe Scarlet Fever as child and thinks she had mumps, measles and chicken pox.

Adult illnesses:
Pt. is poor historian regarding time line; medical histories in chart are also poor.

Accidents and injuries:
None.

Operations:
Pt states several hernia operations -year unknown, not documented on chart. Cataract surgery, Left eye-year unknown.

Allergies:
Penicillin -breaks out in rash.

Use of safety measures:
Uses wheelchair at home. Uses commode.

Exercise and leisure activities:
Watches television. Exercise restricted R/T COPD.

Diet:
Previous to admission had Meals on Wheels. No special diet.

Tobacco:
Non-smoker for about 6 years, 45-90 packs a year before that.

Alcohol use:
Admits to drinking an "occasional beer" non-specific as to exact quantity.

Family History Children
Has one son of indeterminate age. Chart states he is 25 years old, patient says he is in his forties but cannot recall what year he was born in or how old she was when she had him. Thinks she was in her late 20s. Healthy but mentally slow and has other mental health problems. Pt. states he had a "nervous breakdown" after his father died.

Siblings
Pt. is one of 13 children, 10 boys, and 3 girls. 3 are deceased from unknown causes. Pt. is only in occasional contact with one brother who is fairly healthy. Does not know about others. Parents are deceased -causes unknown.

Home situation:
See problem list. Care conference held on 1/9/96. Neither son nor friend attended. Pt. did not attend due to nausea. Pt. has had 2 home health visits per week while at home.

Significant others:
Just son, who is occasionally abusive.

Daily life:
Wheelchair bound, goes out in summer but not in winter, watches TV. Is Lutheran, but religion does not play a big role in life and is not a source of support.

Outlook on future:
Feels everything will be all right if she can go back home. Wishes she would "get better" physically.     Table 4: What assessment data is RELEVANT that must be recognized as clinically significant?