Assessment

Mrs. Alice Kingson is a 76-year-old African American woman who lives with her husband of 55 years, Charles, in their home, a modest bungalow. She was referred to Elder Services, with her permission, by the hospital discharge planner following her hospitalization at Memorial Hospital for a stroke. The mild stroke left her with a pronounced weakness on her right side and some speech deficits. Although her husband is currently providing personal care and preparing all meals for Mrs. Kingson, this is not a long-term solution. Mr. Kingson has his own health problems and is simply overwhelmed by the demands of his wife’s care.

Mrs. Kingson has four grown children, all of whom live within five miles of her. She has seven grandchildren and two great-grandchildren she used to see almost every Sunday when they came for dinner at the Kingson home. Mrs. Kingson stayed home to raise her children until the youngest child was in school; she then returned to full-time work as a children’s librarian. She continued working until 10 years ago, when she retired along with her husband. She was volunteering two days a week at a local school until she became ill.

Physical Health

Mrs. Kingson is a petite, attractive older woman who looks much younger than her age. When she is sitting down, it is difficult to see the physical damage from the stroke. She is able to walk, although she appears unsteady on her feet and drags her right leg. Her face droops on the right side from the stroke, but she has lively eyes and an easy smile. Her speech is slurred, but if she speaks slowly and methodically, she can easily be understood. Although Mrs. Kingson has always been under a physician’s care for high blood pressure, she considered her health quite good until her recent “episode,” as she describes her stroke. She is under regular medical care by an internist. She has arthritis in her hands and shoulders but claims that this has never interfered with her ability to take care of her grandchildren, do her housework, or be as active as she wants to be. Mrs. Kingson has a minor hearing loss for which she does not have (nor want) a hearing aid. She wears glasses for reading and close work but has not had any problems with glaucoma or cataracts. She has no attention deficits and is able to answer all questions if she has a little more time to get her words out. Considering her speech limitations, she is very articulate. She is appropriately dressed but is wearing a sweater despite the warmth of the home.

Prior to her stroke, Mrs. Kingson was on Atenylol to control her high blood pressure but is now on medication to lower her cholesterol (Lipitor) and a low dose of Paxil to treat what she calls “her nerves.” She receives the medications in a “blister pack” that shows her what medications should be taken at what time of the day. She clearly knows what each of the medications is for and when it should be taken. Mr. Kingson prepares both breakfast and lunch for the couple. Their daughter has been bringing the couple dinner every night. Mrs. Kingson appears adequately nourished. There are no apparent signs of either abuse or neglect.

Competence in the Activities of Daily Living

Mrs. Kingson’s greatest limitations are apparent in her functioning in the ADLs, as she needs some assistance in bathing, dressing, and ambulation. She hates having to be dependent on her husband but she simply does not have the strength on her right side to do these things without help. She is able to use the phone and take her medication independently but is unable to prepare meals, do any housework, or transport herself independently. Mrs. Kingson’s assessment of her own abilities seems to be consistent with the worker’s observations. This appears to be the area where she will need the greatest amount of assistance.

Psychological Health

Mrs. Kingson is a delightful woman with an engaging personality and a good sense of humor, despite the damage from the stroke. Her reaction to her stroke was mainly one of confusion. She was feeling good, walking for about half an hour every day with her husband and taking her medication regularly. She has difficulty understanding how this could happen to her and is eager for things to “get back to normal around here” as soon as possible. Even while being interviewed, Mrs. Kingson was flexing her right hand with a rubber ball to improve manual strength, as suggested by her physical therapist in the hospital.

Once an avid reader, Mrs. Kingson has problems reading now because holding a book is difficult, and her eyesight has been slightly affected by the stroke. Her physician feels the sight will return to normal after the swelling from the stroke has completely subsided, so she is hopeful she will be able to return to reading. She is getting very bored just watching television. Mrs. Kingson admits to being slightly depressed (score 10 on the Geriatric Depression Scale, which is strong reason to believe the older adult is depressed), but she attributes her “blue mood” to her frustration about physical limitations and her speech problems. She is much more concerned about her husband’s reaction to her illness. He is extremely nervous and vigilant, never allowing her to be alone. He has curtailed all his activities with friends and family to take full-time care of her. When asked if she had ever considered ending her own life, she laughed and replied, “Honey, it’s not that bad!” She gives no other indications of suicidal ideation.

Her long-term memory is excellent, and short-term memory is good. She is oriented to time, space, and person.

Social Functioning

It is obvious from the interview that the couple is used to much more social contact with family and friends than has been possible since her stroke. The family has not come for dinner on Sundays since her illness, although the adult children call and stop over frequently. Mrs. Kingson misses her friends from church and the weekly bingo games she was used to attending. Although the doctor has given her permission to go to church and do what she feels she can, she has difficulty getting into the couple’s car due to the weaknesses from the stroke. She has been able to walk the block in front of the couple’s home but only for short distances. This allows her to see her neighbors on days when the weather is nice. Once again, she expressed concerns about how isolated her husband has become since her illness. He used to see friends from his old job (he is a retired teacher) for coffee a couple of times a week and would go to a local barbershop to hang around and visit with friends. She cannot convince him that she is fine for short periods of time alone.

The Kingsons’ adult children and grandchildren are the best source of instrumental support for the couple. In addition to bringing their evening meal, their oldest daughter helps with the laundry and cleaning. The adult children run errands as needed but have limited time available due to full-time jobs and busy families. However, Mrs. Kingson does not believe it is appropriate to voice her concerns about Mr. Kingson with her adult children. She sees this as the couple’s business only. She responds to the worker’s questions with, “They don’t ask, and I don’t tell!” When asked how she deals with these concerns, she sighs and replies, “I pray a lot. We have been through tougher times than this.”

Spiritual Assessment

Mrs. Kingson is a deeply religious and spiritual woman who has relied on her faith throughout her life to help her in difficult times. She is an active member of Sacred Heart Parish, which is a large, culturally diverse congregation. Until her illness, she attended mass and a Bible study group regularly. She believes her life has been deeply blessed with a loving husband and family. However, she also struggles with social justice issues such as racial discrimination, which she experienced firsthand as a young Black woman attending college in the late 1940s. She worked hard to instill a sense of pride and dignity in her own children about their racial heritage, encouraging them to become active in community activities that work to make educational and employment opportunities available to all races. She sees this philosophy as the real expression of her spirituality.

Financial Resources

The couple is receiving modest pensions from their years of working in the school system in addition to Social Security payments. Mr. and Mrs. Kingson have health insurance through Medicare and are able to purchase a supplementary health insurance policy through the retired teachers’ organization. They have adequate resources to maintain a comfortable, although not extravagant, lifestyle. However, the cost of purchasing support services to help Mrs. Kingson stay in her home may strain their finances.

Sexual Functioning

Mrs. Kingson is definitely interested in resuming regular sexual relations with her husband, although she admits she hasn’t felt well enough since the stroke to “be much fun.” She laughed when she said that she thinks her husband is more nervous about making love than she is. He is treating her like a “fragile doll,” but she does understand his concerns about her health. The couple appears to be very affectionate and comfortable with each other.

Environmental Safety Issues

The home appears to be well maintained, and there are no obvious hazards in the living areas. Photos of family members are everywhere in the home, and Mrs. Kingson is eager to identify everyone in the photographs. It is a one-story home, so both the bedrooms and bathroom are on the first floor.