Ajit’s Story
scroll down
Aricept 5 mg po OD
Tylenol Arthritis po BID
Warfarin (dosage dependent on INR)
Metoprolol 10 mg po BID
Plavix 75 mg po OD
Allopurinol 200 mg po OD
Tylenol Arthritis po BID
Warfarin (dosage dependent on INR)
Metoprolol 10 mg po BID
Plavix 75 mg po OD
Allopurinol 200 mg po OD
Background
Ajit is a 72 year old man who escaped to Canada from Sri Lanka after war broke out in the country. Although his primary language is Tamil Ajit is able to communicate with simple verbal and written English. Ajit has few surviving relatives as many of his extended family were killed in the war. Additionally, Ajit was behind the wheel when a car accident took the life of his 10 year old son. The tragedy prompted him to start drinking which lead to him losing his job and his wife, who initiated a divorce close to 15 years ago. He has two remaining daughters and one son.
Diagnosis
Ajit lives alone in seniors’ social housing and relies on public transportation. Since his divorce, Ajit has been struggling with his IADLs due to increased drinking. He has also been diagnosed with atrial fibrillation, alcoholic dementia, gout, previous MI with stenting, and CRD. Recently Ajit was hospitalized for an extended period of time after a fracturing his hip due to a fall. Ajit persuaded his doctor and occupational therapist that he could return home and his son, who had been visiting Ajit in hospital, indicated that he will assist his father after the discharge.
Concerns
In the hospital Ajit had his right hip pinned but faced complications due to post-op delirium tremors and pneumonia. He also developed a DVT in his right leg which is being treated with Warfarin and requires regular blood work. In addition, Ajit has significant arthritis in his hands, which makes it difficult to open pill bottles and perform actions requiring fine motor skills.
Formal / Informal Supports
Ajit is not close with his daughters or their children who live out of town and the relationship with his son has been strained for many years with periods when they were on non-speaking terms. His son, Rohit, has a history of substance use disorder and has no permanent address, opting to either sleep in his car or couch surf amongst friends. Outside of family, Ajit has a few friends who check in once and a while. A referral was made when Ajit left the hospital for daily home support to assist him in taking his medications.
Initial Visit
Ajit is orientated to his name and date of birth. He knows he is at home but not sure of the address and does not know the date. You ask if he has pain and he says yes but is unable to quantify the pain. Ajit said he tripped last night and fell. He has a large bruise on his left eye and a skin tear to his left arm. He wasn’t sure when he last ate but states he is not hungry and you note there is minimal food in the fridge. There are dishes in the sink, an empty bottle of whisky on the table and medication bottles scattered on his the table. His clothes are wrinkled, dirty and appeared too big for him. There is a strong smell of urine in the house. Ajit indicates that his son Rohit has gone to the bank for him.
Reflection
01
What are some of the determinents of health with this situation?
02
What from Ajit’s situation may lead you to suspect he has experienced trauma?
03
What strategies might you use to approach a person with dementia?
04
What might you ask Ajit to contribute to your holistic assessment of his health and situation?
05
How might you engage with Ajit and Rohit to support the care needs they identify?
06
What are some potential resources or other people that could be accessed to support Ajit?
07
What might be involved in co-creating a care plan for this family?