Elderly

Read the three cases and answer the three questions after each case. No outside sources! Use Table 5.2 below.

Case 5.1 Mrs. Ellyn Townsend

Mrs. Ellyn Townsend is an 87-year-old widow who lives alone with her cat in a modest apartment in the center of a large city. She has lived alone for 20 years, following the death of her husband of 40 years from a fatal stroke. She has lived in this neighborhood since she and Mr. Townsend first married. They raised four children in the apartment Mrs. Townsend still occupies. The neighborhood is not as safe as it once was, but many older people have stayed in the area because of its convenient proximity to the downtown shopping area. Recently, the neighbors called Mrs. Townsend’s daughter, Theresa, to tell her that Mrs. Townsend was wandering around the neighborhood looking for her husband. Mrs. Townsend expressed concern that he was late getting home from work. When reminded that Mr. Townsend died 20 years ago, she became very agitated and argumentative. She accused the neighbors of misunderstanding her and trying to make fun of her. Although her concern about the rising crime rate in her neighborhood is warranted, she has become hypervigilant about locking doors and windows.

Mrs. Townsend has various health problems, including heart disease and circulation problems attributed to her late-onset diabetes. She is on almost a dozen different prescription medicines, although it is obvious to Theresa that she does not understand when and how to take them. She becomes irritated when Theresa asks her about her medications, insisting she is taking them as required and can prove it. Mrs. Townsend is a retired nurse and until recently was very skilled in monitoring her blood sugar and giving herself insulin. She needs to be reminded how to do this now.

Theresa has noticed recently that the house smells of urine and feces, and she has found soiled clothes stuffed in drawers and under the bed. Her mother denies there is a problem, refusing to consider she might need an adult hygiene product. The cat runs away frequently, and Theresa suspects that this is because her mother is either not feeding the cat or has become abusive.

1.
What symptoms does Ellyn Townsend exhibit that suggest she might have depression dementia, or delirium? Which symptoms are clearly a change from what her daughter has seen in her mother over the years?

2.
What immediate issues should the social worker address for Ellyn’s safety and well-being?

3.
What might be the next step in developing an intervention for her? Who else does the social worker need to involve in the diagnostic process?

Case 5.2 Mr. Charles Curry

Charles Curry is a 78-year-old widowed man who has lived alone for the past 2 years, following the death of his wife of 50 years. His suburban home is in good condition although in need of minor repairs and painting. The place has taken on a cluttered look since his wife’s death, with dishes piled in the sink, flower beds overrun with weeds, and papers scattered about the living room. Mr. Curry served as his wife’s caretaker prior to her death and did a wonderful job, according to Tom Curry, his eldest son. Mrs. Curry had a prolonged illness from cancer but was able to stay at home with hospice support until the time of her death. Hospice maintained contact with Mr. Curry for about a year after her death, but then he requested that they no longer visit him.

Mr. Curry used to be active in the local men’s club, the Sons of Hibernia, a social and service organization for those of Irish descent. He went to the club three times a week to play cards with other retirees. His friends at the club describe him as having been a jovial, outgoing, friendly guy since his retirement at age 65. He is a retired postal carrier, so he knew everyone along his route and seemed to enjoy visiting with lifelong friends and neighbors. He stopped going to the club when his wife became ill and has not indicated any interest in returning there since her death. He says the club is too far away and that he is too tired to attend any social activities.

Tom Curry has expressed concern about his father’s unwillingness to get out of bed. Mr. Curry says he is always tired after not sleeping very well. As a result, he spends much of the day going back and forth from the couch to the bed, sleeping off and on. At night, he goes to bed at 7:00 p.m. and is up wandering around the house or trying to watch television from midnight on. Tom claims his father appears to be very lethargic and preoccupied. He has trouble remembering whether or not he has eaten but does not express hunger or thirst. He answers “I don’t know” to many questions, not seeming to take the time to think about the answer. He frequently expresses a desire to die and join his wife, although he has not indicated he has any specific plans to take his life. Tom does not think his father has seen a health-care provider for over 2 years, but Mr. Curry refuses to go because he feels okay. He has lost weight since his wife’s death; he does not enjoy cooking and prefers to snack on convenience foods. He has not engaged in any inappropriate behavior, and when he concentrates, he appears to be oriented to time, location, and individual.

1.
What symptoms does Mr. Curry exhibit that suggest he has depression, dementia, or delirium?

2.
What risk factors support a diagnosis of one of those conditions?

3.
How can the social worker get Mr. Curry, his son, and other collaterals involved in a plan to address the condition? Might this require hospitalization?

Case 5.3 Ms. Rosa Mateo

Karen Kline works for Elder Services in a midsize city in the southwestern part of the United States. She has been working with Rosa Mateo, age 80, for 5 years, helping her to obtain light housekeeping assistance and secure a visiting nurse to monitor blood pressure and medications, as well as providing other components of general case management. Karen has not seen Rosa in 2 weeks, but when she comes to her apartment, Rosa refuses to let her in, accusing her of trying to steal her Social Security check. Karen soothes her fears, reminding Rosa that she is her case manager and not the individual who has been victimizing older adults in the neighborhood. Rosa appears to settle down and lets her in. For almost an hour, they discuss Rosa’s concern about a recent respiratory ailment and the spiraling cost of antibiotics. Karen suspects that Rosa supplements her medication with a healthy dose of vodka on a regular basis and perhaps chooses to purchase alcohol rather than food with her limited income. Today, Karen notices Rosa seems unusually distracted and agitated. She gets up and walks around, glancing furtively out the window every time she passes it. When Karen asks her what she is looking at, Rosa begins to cry and expresses concerns about some man who has been looking in her window. She begs Karen to take her out of the apartment and place her somewhere where the man cannot find her. When Karen goes to comfort Rosa, she becomes verbally and physically abusive.

1.
What symptoms does Ms. Mateo exhibit that suggest she has depression, dementia, or delirium?

2.
What risk factors support a diagnosis of one of those conditions?

3.
What is the next step for the social worker in this case?

Table 5.2 Differentiating Characteristics of Depression, Dementia, and Delirium