In the Christ & Diwan (2008) article, the authors list seven domains that social workers should address in order to fully assess an older client’s needs. Each domain is considered equally important. This comprehensive evaluation fits well with the social work perspective that it is important to not only address the internal concerns of clients but also their environment. Making decisions for older adults without their input occurs often. In society people sometimes treat their elders like children—making decisions for them based on what they think is best rather than from the client’s perspective. While at times this may be well intentioned, the potential for infantilism and, in turn, compromised self-determination, occurs.
For this Discussion, review the program case study for the Petrakis family. You will focus not on Helen, but on her mother-in-law, Magda. What decisions were made about Magda’s treatment without a formal assessment and/or her input? Consider how Christ & Diwan’s (2008) seven domains relate to Magda’s case. Complete an assessment for Magda and identify the choices that were made without her feedback.
Respond by Day 5 to two colleagues and explain how their assessments support the NASW Code of Ethics (2008). Include two values and/or guiding principles to support your explanation. (Be sure to include NASW as reference and 2 other peer reviewed references, be detailed in response and ask question to student to further conversation.
Response to MIchael
Post a summary of your assessment of Magda’s situation that addresses the seven domains. Fill in the gaps in content as necessary.
According to Christ & Diwan (2008), the seven domains to the biopsychosocial framework are: “a) physical well-being; b) psychological well-being and mental health; c) cognitive capacity; d) activity to perform basic ADLs and IADLs; e) social functioning; f) physical environment; and g) assessment of family caregivers” (pg. 4).
When pairing the current evidence or rationale of these domains with Magda’s health, there is quite a bit to be concerned about. In the physical well-being domain, Magda’s broken hip has caused a decrease in her IADL performance (driving, cleaning around her house, and buying food). Although not stated in the scenario, Magda takes medication for either her pain or dementia or both. Seeing on how she broke her hip from a fall, Magda has an increased risk for falling.
In regards to the psychological well-being and cognitive capacity domains, Magda’s dementia symptoms should be part of the assessment. Regarding the cognitive capacity domain, as Magda’s dementia progresses, significant changes occur in memory, language, object recognition, and executive functioning (Christ & Diwan, 2008). Magda’s ability to plan, organize, sequence, and abstract will become marketability diminished. Furthermore, asking the family, and Magda, if there has been any hallucinations, increased agitation, and wondering off for no specified reason that they have noticed will be assessed. Also, Magda’s substance use, the dosage, and frequency of her medication usage would be assessed.
In assessing the ability to perform various ADLs and IADLs, it would be great to have an additional professional opinion from an occupational therapist (OT) regarding Magda’s ability to perform these task independently. Helen is already performing a great deal of these task. However, the task that Helen is performing for Magda, would need to be assessed by Magda performing or not performing the task.
Regarding the social function domain, the scenario does not offer any deficits in social functioning. However, according to Christ & Diwan (2008), “health also affects social functioning because people who are confined to bed or have severely impaired mobility are likely to disengage from social activities” (pg. 7).
Magda’s physical environment would also need to be assessed. Again, OT could provide a comprehensive assessment of the living environment. There are certain contraindications when suffering from a broken hip (height of toilet, bed, crossing of the legs, etc…) that OT would be great at in explaining. In addition to the OTR’s evaluation, the social worker should also document the living conditions from a social workers perspective.
Magda’s support system should also be assessed for any compassion fatigue. Currently, Helen is under a lot of stress regarding being the primary care giver for Magda, being a wife and mom to her family, and working obligations. Assessing the entire family caregiver situation would be part of my assessment.
Describe ways you would have included Magda in the original assessment and treatment plan. Include questions you would have asked Magda and her professional support system (doctors, nurses, etc.) to gain further insight into the situation.
I would have conducted a comprehensive biopsychosocial assessment of Magda prior to allowing Alec do move in. I also would have asked more questions about Alec background since Helen was apprehensive in the beginning. It is one thing to offer help with an ailing relative, but for one that has multiple issues and needs assistance on daily basis might require a lot more attention than previous planned. I would have asked Magda and her nurses what did the discharge plan look like? Seeing on how Magda appears to need quite a bit of assistance, what other interventions are being provided besides medication for pain; what is being done about Magda’s dementia and any follow-ups with her broken hip. OxyContin is very addictive and if Magda is in this much pain, perhaps placement into a skilled nursing facility is indicated because of the pain, dementia, and primary caregiver fatigue. I think unless the husband is willing to step and help his wife with his mother, placement might be the best thing.
Christ, G., & Diwan, S. (2008). Chronic illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from http://www.cswe.org/getattachment/Centers-Initiati…
Response to Hilda
1) Physical well‐being and health
Magda Petrakis is an 81-year-old female of Greek descent who lives alone. Her overall health is deteriorating due to a broken hip and diagnosis of dementia. She is currently taking medicine one of which is a pain medication. She is well groomed and well feed. I would evaluate Magda’s pain by requesting she rate the pain on a scale of 1 to 10. I would ask Magda if she feels she can manage her pain to determine if the pain pills are needed or need to be changed. I would question Magda, her doctors, and her pharmacy to determine with medicines she is taking over the counter, prescribed, and vitamins/supplements. I would also, question them on her medical history, past and present. I would question Magda on her sexual activity. According to Paveza (2013) “This area is often overlooked because of the clinician’s discomfort in seeking this type of information from the older adults” (p.184). I would be very respectful during this part of the questioning.
2) Psychological well‐being and mental health
Magda was self-sufficient until six months ago, and she has been diagnosed with dementia. These life changes can cause mental health issues. I would ask questions to determine if Magda is experiencing depression or anxiety. “ One particular reason for assessing anxiety is the fact that, in older adults, depression and anxiety can present with similar symptoms” (Paveza, 2013, p.185). I would ask her how are you sleeping? Do you feel down or hopeless? How has your energy level been? I would ask her primary caretaker and daughter in law, Helen, the same questions in reference to Magda.
3) Cognitive capacity
Magda’s cognitive ability is deteriorating she is no longer able to clean her house, pay her bills, or track her medication. She is, however, still able to cloth and feed herself. I would ask Helen, the caretaker, if she is seeing a decline in Magda’s ability to complete daily functions.
4) Ability to perform basic ADLs and instrumental activities of daily living (IADLs)
Magda’s daily living drastically decreased when she broke her hip. She is no longer able to drive which has made her non-mobile. She can not complete her shopping or outside actives on her own. She no longer cooks meals, cleans her house, or manages her finances or medications. I would question Magda to find out what additional outside activities she is no longer attending such as church services or community activities. I would question Helen about whether Magda is not able to complete the daily tasks, or is it just quicker for her to do them.
5) Social Functioning
Magda has limited access to community and church activities. She does interact with family, and her part time caretake is a member of her church. I would ask Magda what activities she was attending that she currently is not now. What organizations and group are you affiliated with that you are no longer attending?
6) Physical environment
Magda lives by herself in an apartment. The apartment is well kept, in a safe/clean neighborhood, and overall in good condition. The apartment, however, is not meeting her needs. There are no guard rails in the bathroom. This is of concern because she has already fallen and broken her hip once. The apartment is also not wheel chair accessible. Magda is aware of the access issue and has “negotiated risk” in this area. The concept of a “negotiated risk” allows the elderly client input on their risk taking (Paveza 2013). The access to the kitchen is another issue. Due to this issue Helen or the other caretaker provides all the meals.
7) Assessment of family caregivers
Magda has a combination of family and hired caregivers. The cost of the hired help is a financial burden on the family. Currently they are using their vacation savings to provide caregiver services. Her daughter in law, Helen, is the family primary caretaker. Her grandson Alec was also assisting with her care. Due to theft and missing medicine his assistance was terminated. The termination was in the best interest of Magda. I would ask her questions to determine if abuse or neglect were occurring. Are you happy with the assist being provide to you? Is anyone hurting you in any way? These are examples of questions.
Describe ways you would have included Magda in the original assessment and treatment plan.
I would include Magda’s input on all assessment and treatment areas. I would allow her to negotiate risk on her areas of concern. I would also make sure she agrees to the treatment plan.
Christ, G., & Diwan, S. (2008). Chronic illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from https://www.cswe.org/getattachment/Centers-Initiat…
Paveza, G. (2013). Assessment of Elderly. In M. Holosko, C. Dulmus, & K. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions. (pp. 125–145). Hoboken, NJ: Wiley.
Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD:Laureate International Universities Publishing. [Vital Source e-reader]. The Petrakis Family (pp. 20–22)