Case Study

Occupational Profile

Quinn is a 77-year-old Caucasian man with a diagnosis of dementia. Quinn has a past medical history of congestive heart failure, hypertension, depression, and grout. He is married to his wife Dorothea, and she visits him on Wednesdays and Fridays. She takes him outside to the patio and reads him letters from their grandchildren. Dorothea wants Quinn to remain as mentally capable as possible, when she doesn’t have letters to read, she reads him the local newspaper instead. She also attends all his care plan meetings and frequently speaks as an advocate on his behalf.

Quinn has been a resident at the nursing home for the last 2 years in which his family has planned that Quinn remains at the nursing home indefinitely. He participates minimally in the facility’s activities, responds well to simple comments, and recognizes his wife but sometimes confuses his daughters and grandchildren. He cannot recall the names of staff members but smiles when he sees someone he recognizes. He is also dependent on all his ADLS since he has arrived at the facility and is non-ambulatory.

The nurse realized that Quinn needs more assistance with more help with his meals over the last 3 to 4 weeks and he has been referred to Occupational therapy. The facility staff feels that Quinn is more cognitively impaired than he appears. Quinn is displays short and long term memory. He is able to follow verbal commands and with some visual cues. He is unable to learn new things and information with an attention spam of approximately 5 minutes. Quinn is unable to locate, identify and locate the various utensils, however he is able to demonstrate holding a spoon and fork correctly once placed on his hands. Quinn is unable to scoop food onto the spoon, as he drops the food on his lap also. Quinn is able to drink half of his liquid because he cannot extend his neck.

Framework

In Quinn's case study, I will use the Person-Environment Occupational Performance (PEOP). This model was chosen to guide interventions based on intrinsic and extrinsic factors that contribute to Quinn's professional performance. PEOP guides intervention through the concept of adaptation and modification. This model explores how people, work, and the environment affect Quinn's work performance in tasks. The focus was based on a unit of feeding task to identify cognitive or environmental factors that support his self-eating ability.

Another model that I will be using for this client will be the Allen Cognitive Level Screen (ACLS), which requires a person to do a few short stitching tasks with a string and a needle, which is used to screen for dementia (Scand J 2017). It involves following instructions, fine motor skills, and learning. Allen Cognitive Level Screen is used to determine if a person has the mental and physical ability to safely complete tasks that need to be completed daily. This is called functional cognition.in Quinn’s case, we are determining what level he is on, and what level of independence he has, such as if he can take his medications alone and where his cognitive level is.

Dementia

Dementia is also known in terms of the impairment ability to remember, think, or make decisions that interfere with everyday life activities. Some people with dementia have no control over their emotions and may change their personalities. The severity of dementia varies from the mildest stage, which is just beginning to affect a person's function, to the most severe stage, which is completely dependent on others for basic living activities. Dementia is more common as people grow older, but most adults won’t get dementia. There are various forms of dementia, including Alzheimer's disease. A person's symptoms vary by type.

Dementia is caused by damage to brain cells. This damage affects the ability of brain cells to communicate with each other. Everyone loses some neurons with age, but people with dementia experience much greater loss. For example, some symptoms are Acting impulsively, Not caring about other people’s feelings, losing balance, having problems with movement, Hallucinating, or experiencing delusions or paranoia. Early detection of symptoms is important because several causes can be treated. However, in many cases, the cause of dementia is unknown and cannot be treated. Still, early diagnosis helps manage the condition and plan.

To diagnose dementia, doctors first assess whether a treatable underlying disorder may be associated with cognitive impairment. Physical tests to measure blood pressure and other vital signs, and clinical tests of blood and other fluids to check the levels of various chemicals, hormones, and vitamins to identify or rule out possible causes of symptoms. A person's medical history and family history reviews can provide important clues about the risk of

dementia. Typical questions are whether dementia develops in the family, when and how the symptoms began, whether behavior or personality changes, and specific medications that can cause or exacerbate the symptoms.

Early stage, the person has short-term memory problems, lacks concentration, and experiences mood swings. Middle Stage, the person has orientation problems, is prone to get lost, and has problems with clothing, hygiene, food, and language. Late stage, the person cannot recognize close relatives. In addition, there is a serious language disorder and disorientation is serious. Final Stage, the person becomes completely dependent on all aspects of daily life, is indifferent and unresponsive, and has no meaningful language or memory. In addition, humans do not interact with the environment and their motor function is impaired.

OTPF

Besides feeding, Quinn has many other needs that generally require attention. Therefore, hiring as a nursing home skill can lead to other pursuits of Quinn, such as Quinn's managers (Koch, & Iliffe, 2011). Also, one of Quinn's best intervention sessions is to increase dietary independence by slowly teaching how to hold a spoon and improving motor coordination through exercise. Ideally, this would help him learn how to hold food from his plate without dropping it on his lap. Quinn's wife's role and routine greatly help Quinn's intervention. Taking Quinn out and reading a letter to him plays an important role in improving motor coordination and cognitive ability (Spector, Orrell, & Woods, 2010). Therefore, she can be included in an intervention session designed for her husband.

Research shows that physical exercise plays an important role in helping to protect, maintain, and improve the health and well-being of people in either the pre-clinical or the clinical stages of Dementia (Buchman AS and D Bennett.). Exercises like walking, dancing, and even yoga can be very beneficial to the client. Craft projects, scrapbooking, baking, working with clay, painting, and drawing help those small muscle exercises.

Alzheimer's disease has social implications because increased anxiety, along with memory loss and other problems, is a common symptom of dementia. People who feel anxious are less likely to be social and may even be afraid to interact with others. As a caregiver, you need to promote socialization and at the same time pay attention to the feelings of your loved ones. Make it as easy as possible for you to be with others. Personal beliefs vary from person to person. This includes religious or political beliefs and beliefs cultivated through experience and lessons of life. However, people with dementia can lose the ability to logically think about whether their beliefs are correct. These false beliefs, also known as delusions, can be very strong and anxious.

The routine is changed and sometimes even the environment is changed. This can cause anxiety and confusion. People with dementia struggle to adapt to changes in their environment because of damage to areas of the brain known as 'multiple demand networks', highly evolved areas of the brain that support general intelligence, say scientists at the University of Cambridge.

Problems and Strength list

Performance issues are impairing the ability to successfully participate in feeding and social participation. Deficits are present in orientation to others, short attention span, and decreased overall functioning. Quinn ADLs: Self-feeding, Requires A to set up, and initiate movement to bring the utensil to the mouth, Stabilization of utensils, and Delayed motor coordination. Quinn has an of Positioning: Kyphosis posture. Poor positioning of extremities in w/c Skin sores.

Quinn might have some difficulties, but he also has some strengths. For Example, Quinn can perform automatic responses with prompting, maintains a regular diet, ability to feed himself finger foods, and can hold a cup independently once placed in his hand.

Methods/ Interventions

At Quinn’s stage, the patient's caregiver can intervene and do everything for him. However, patients can still physically help with clues and prompts and should be encouraged to do so. Intervening too much as an OT, family member, or caregiver is one of our greatest frustrations as patients may not be able to continue their daily activities and lose basic self-care skills. The saying, “If you don’t use it, you lose it” really does apply in this case as said by Tepa Snow.

For this reason, most of my time is focused on working with patients in ADL retraining along with balance and functional mobility retraining. Also, explain to all nurses the benefits of working with the patient and taking care of them as much as possible. With this method, I can include increased verbal or visual cues, demonstration, physical guidance, partial physical assistance, and problem-solving to improve the outcome (Beck et al., 1997).

Long-Term Goals and Short-Term Goals

Long-term goal:

The client will engage in self-feeding compensatory strategies with mod assist to eat food off his plate using verbal and physical cues for 2 weeks.

Short-term goal:

• Client will learn the use of a built-up handle spoon/ fork with min assist in 3 days

• Client will learn the proper way to grasp the use of a universal cuff with min assist in 2 days.

• Client will independently practice eating with a plate guard in 2 days.

Long-Term Goal

The client will tolerate a 30- minute social activity in his facility at least once a day for 2 weeks.

Short-Term Goals:

• Client will eat at least one meal each day in the dining hall for increased social engagement independently in 2 days.

• Client will engage in a meal with another patient to increase socialization for 2 days.

• Client will participate with other faculty to maintain interaction for 2 days.

Long-Term Goals

The client will participate in proper upright wheelchair positioning techniques with min assistance to increase engagement in self-feeding within 2 weeks.

Short-term goals:

• Client will learn to use a pillow for proper truck support within 2 days.

• Client will participate in safety awareness when using a wheelchair with min assist in 3 days.

• Client will engage in different angles for proper positioning with min assist in 2 weeks.

Treatment Sessions

2.) The client will participate in a 45-minute treatment session. 10 minutes, I will introduce myself to Quinn, do universal precautions for both of our safety, and I will take his vital signs (blood pressure, pulse, temperature, oxygen level). For 5 minutes I will explain to Quinn the activity for today and make sure he acknowledges it. For 30 minutes we will go to the dining hall so we can eat a prepared meal, and Quinn can learn and demonstrate the purpose of using the adaptive equipment such as a built-up handle spoon/fork, scoop dish, and plate guard. I will also do a patient education on the safety awareness of eating while seated in a wheelchair. Having Quinn eat at the dining hall will increase his socialization interaction with other patients.

Plan

The plan for Quinn is for him to benefit from our treatment plan so he will be able to eat and hold the utensil without having food dropping on him. And proper wheelchair positioning so he won’t extend his neck too much. Along with working with the patient, the family will also be provided with caregiver education. Educating your patient’s family members on your interventions to increase carryover is just as important as what you’re doing with the patient (Schaber, P., & Lieberman, D. (2010). Collaborating with the family and staff as a cohesive team makes a big difference.

Documentation

References

America, D. S. of. (2018, October 14). Dementia can affect motor skills. Dementia Society. Retrieved July 18, 2022, from https://www.dementiasociety.org/post/dementia-can-affect-motor-skills

Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D. Allen Cognitive Level Screen for the classification of subjects treated for addiction. Scand J Occup Ther. 2017

Alexandra, W., & Alexandra, W. (n.d.). Overview of the major types of dementia.