Meredith is a 76-year-old woman who lives in her own home with her husband. She has a diagnosis of type 1 diabetes, for which she has been taking insulin since she was a teenager. As a teen, she was very focused on managing her diabetes and on how that condition impacted her ability to engage in social and recreational activities. She has managed her diabetes successfully for many years and has been successful in her chosen adult roles of spouse, mother, homemaker, and church leader. Now, after her children have left home, Meredith has been spending more time with her church group. At this time, she also has some long-term complications of this condition, including severe visual impairment due to diabetic retinopathy and coronary artery disease. Meredith is an elder in her church, and she and Darrel (her husband) are active participants in their church’s senior activity program. Meredith typically spends 10 to 12 hours a week in church-related activities. At home Darrell is “sometimes confused” and relies on her to manage and direct their daily activities. Because of increasing “dizzy spells,” Meredith sought medical attention. At this time, she was admitted to the hospital where tests revealed an infarction of the right middle cerebral artery and evidence of several past small strokes (partially reversible ischemic neurological deficits). Within 24 hours, the transient ischemic attack (TIA) symptoms had stabilized and Meredith was referred to a skilled nursing facility (SNF) for rehabilitation and further assessment. In the SNF, Meredith walks independently but has poor endurance and is unable to sustain physical activity during self-care routines, needing frequent rests. 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. She has only gross movement and control of her distal arm. Meredith wants to return home. She says that she is able to function far better at home, where she knows where things are and how they work. Things such as eating and personal hygiene, which she manages independently at home, require assistance now, because of her poor vision. She also needs moderate physical assistance with showering/bathing, lower extremity dressing, and hair care. She would prefer to get rehabilitation and support at home. Meredith has made many accommodations for her poor vision at home, and feels that in that environment she is fully functional. Also, Meredith sees herself as Darrell’s caregiver and has been worried about leaving him at home alone. Darrell has been receiving meals-on-wheels since Meredith has been in the hospital. He has never done housework before, and, according to his pastor (who has visited him at home), he is just letting things pile up. Meredith’s diabetes greatly impacts her ability to perform activities of daily living in the rehabilitation setting. Because this condition has developed gradually, Meredith had been able to plan for and accommodate this condition in her home environment. Until her recent TIA events, Meredith has been able to participate fully in her home and community activities, in spite of serious chronic health conditions. Meredith’s focus is not on her condition, but on her valued life roles, including her roles of caregiver, homemaker, and church leader. Some questions to consider: 1. How can you apply the concepts of the life course health development model to Meredith’s case from adolescence to late adulthood? 2. Meredith has problems with walking due to weakness and fatigue. Can you apply the terms of sys- tems theory to her motor skills, using any selected task, such as climbing stairs or doing laundry? 3. How does the concept of cumulative impact discussed in the chapter apply to Meredith? 4. Using the ICF model presented in Chapter 1, work through Meredith’s health status before and after her stroke. 5. Discuss with your peers how you, as a health professional, can apply the life span theories and perspectives presented in this chapter to Meredith’s case
Meredith is a 76-year-old woman who lives in her own home with her husband. She has a diagnosis of type 1 diabetes, for which she has been taking insulin since she was a teenager. As a teen, she was very focused on managing her diabetes and on how that condition impacted her ability to engage in social and recreational activities. She has managed her diabetes successfully for many years and has been successful in her chosen adult roles of spouse, mother, homemaker, and church leader. Now, after her children have left home, Meredith has been spending more time with her church group. At this time, she also has some long-term complications of this condition, including severe visual impairment due to diabetic retinopathy and coronary artery disease.
Meredith is an elder in her church, and she and Darrel (her husband) are active participants in their church’s senior activity program. Meredith typically spends 10 to 12 hours a week in church-related activities. At home Darrell is “sometimes confused” and relies on her to manage and direct their daily activities.
Because of increasing “dizzy spells,” Meredith sought medical attention. At this time, she was admitted to the hospital where tests revealed an infarction of the right middle cerebral artery and evidence of several past small strokes (partially reversible ischemic neurological deficits). Within 24 hours, the transient ischemic attack (TIA) symptoms had stabilized and Meredith was referred to a skilled nursing facility (SNF) for rehabilitation and further assessment. In the SNF, Meredith walks independently but has poor endurance and is unable to sustain physical activity during self-care routines, needing frequent rests. 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. She has only gross movement and control of her distal arm.
Meredith wants to return home. She says that she is able to function far better at home, where she knows where things are and how they work. Things such as eating and personal hygiene, which she manages independently at home, require assistance now, because of her poor vision. She also needs moderate physical assistance with showering/bathing, lower extremity dressing, and hair care. She would prefer to get rehabilitation and support at home. Meredith has made many accommodations for her poor vision at home, and feels that in that environment she is fully functional. Also, Meredith sees herself as Darrell’s caregiver and has been worried about leaving him at home alone. Darrell has been receiving meals-on-wheels since Meredith has been in the hospital. He has never done housework before, and, according to his pastor (who has visited him at home), he is just letting things pile up.
Meredith’s diabetes greatly impacts her ability to perform activities of daily living in the rehabilitation setting. Because this condition has developed gradually, Meredith had been able to plan for and accommodate this condition in her home environment. Until her recent TIA events, Meredith has been able to participate fully in her home and community activities, in spite of serious chronic health conditions. Meredith’s focus is not on her condition, but on her valued life roles, including her roles of caregiver, homemaker, and church leader.
Some questions to consider:
1. How can you apply the concepts of the life course health development model to Meredith’s case from adolescence to late adulthood?
2. Meredith has problems with walking due to weakness and fatigue. Can you apply the terms of sys-
tems theory to her motor skills, using any selected task, such as climbing stairs or doing laundry?
3. How does the concept of cumulative impact discussed in the chapter apply to Meredith?
4. Using the ICF model presented in Chapter 1, work through Meredith’s health status before and after her stroke.
5. Discuss with your peers how you, as a health professional, can apply the life span theories and perspectives presented in this chapter to Meredith’s case.
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