Case Study of an Elderly Rehab Patient at Kings College Hospital

1. Case Study of an Elderly Rehab Patient at Kings College Hospital 16/4/07-10/5/07 Sarah Hart Student No’s 0604985

2. Introduction • A retired 81 year old female • BIBA with acute confusion by LAS. • Had previously been admitted into hospital over past 3 months

3. PC Diagnosed with cellulitis (bilaterally) Acute confused state bought on by a UTI (Urinary Tract Infection) Acute/ Chronic renal failure. Pain bilaterally in LL’s over the past 3-4 days. Swelling and tenderness especially in the calves. Aggravated by movement. HPC History of falls, episodes of falls over the previous 3 months. History over previous 3 months of continence problems. Cognition Scores- MMES- 13/30 and AMT- 5/10, the scores reveal there maybe in impairment with cognition. Presenting Condition

4. PMH Chronic renal failure Recent admission (23/3/07) for multiple gastric ulcers and oesophagitis Severe osteoarthritis Anaemia High Cholesterol Diventricular disease Type II diabetes –Insulin treated Past Medical History

5. Social History • SH • Pt lives on a ground floor flat which she rents. • Because of her prior admission she has a care package with Southwark S/S • Daily home help with personal care and domestic chores.

6. Objective Assessment • Pain in knees bilaterally and tightness around the knee joint. Reduction in knee extension bilaterally. • Referred pain to hip bilaterally during AROM of extension.

7. Upper Limb Ax

8. Lower Limb Ax

9. Ax Bed mobility- I Sit< >Lying- I Sitting balance- Good Lying< >Sit- I Sit< >Stand c r/f Standing- Good Bed< >Chair- I Chair< >Bed- I Gait TUAG (Timed Up And Go) Stairs Upper limb Ax Able to :- Put hands behind their head :- Put hands above their head :- Both hands to head I=Independent Functional Assessment,using the Elderly Mobility Scale EMS

10. Reduced dorsi/ plantar flexion. Reduced exercise tolerance. Reduced balance. Reduced mobility (stiffness in knees) Pain in LL’s Slow walking pace which could increase the chances of falls. Cognition issues (?) Problem List

11. Plan • Reduce pain. • Increase LL functional ability. • Increase ROM. • Increase exercise tolerance.

12. Goals • When working with older patients with complex problems the goals list when appropriate must be agreed with the patient. These goals target:- • Differential (prevention goals) • Improvement (intervention goals) • External environment (adaptation goals) (Pickles 95) • Goals should follow the S.M.A.R.T. plan Specific, Measurable, Achievable, Realistic and Timely

13. Short term goals To transfer independently with good safety awareness. Improve mobility in the ankles Improving strength in the thighs, Mid term goals Continues with the short-term goals Increase exercise tolerance by increasing the distance walked. Taking the patient to the gym Practise walking using a stick rather than an r/f Short and mid term goals

14. Long term goals • Physiotherapy- long term goals for the patient to be mobile and independent with ADL’s using supported discharge S/D. • S/D- The MDT (Consultant, SHO, Nurses, Physiotherapist, Occupational Therapists and Social Workers collaborate and discuss the best care package for the patient on a individual basis. • For this patient it was decided:- • Home-based physiotherapy • Progress from the r/f to a stick • Falls prevention exercises/classes

15. Current condition • Recently the patient became medically unwell • Short of breath on exertion to shortness of breath in sitting. • Further investigations are needed • Haematology • Echocardiogram • Only after further investigation are carried out and the patient is no longer medically unwell, the patient would need to be reassessed then with possible adaptations to the care package go home with S/D

16. Reference list • Pickles. B., 1995, Physiotherapy with older people, London : Saunders • Cycle of pain picture http://www.relaxandrenewmassage.com/images/pain_cycle.png