Reference no: EM134028237

Question

One day a week, Horizons places you as an intern for them at a regional hospital that they subcontract with to provide social work services. You have been called in to the emergency room by a nurse supervisor to talk with Mrs. A., an 80-year-old widow. The nurse, while leaving to respond to another emergency, asks you to "deal with this senile patient." Mrs. A. is sitting in a chair beside her 50-year-old son, Mr. A. Jr., who brought her to the emergency room.

Mr. A. Jr. has been living in his mother's apartment for the past six years, moving in when his wife left him. He has a history of mental illness and heavy drinking. He has been unable to hold a steady job for the past 10 years. Mrs. A. cooks, cleans, cares for his needs, and supplements his income.

Mrs. A. is disheveled and has visible bruises on her face and arms. You learn from a medical school resident that she is waiting to have her broken right wrist set. You greet Mrs. A. and ask her what happened, and Mr. A. Jr. answers for her. He says he found his mother after she had fallen off a chair when trying to change a light bulb. As he describes this, Mrs. A. is silent and unresponsive. Mr. A. Jr. tells you that both the hospital intake worker and emergency room nurse admonished her for climbing on a chair, saying she should know better.

Mrs. A. looks away. She looks confused and tells you that she couldn't find her Medicare card when the intake worker asked for it. She says she can't remember whether she took her purse with her when she left home.

When Mrs. A. is taken into the examining room, Mr. A. Jr. insists on accompanying her. She begins an agitated monologue that does not seem to make sense. Mr. A. Jr. explains to you that her behavior is typical and there is no point in talking with her. He will answer any questions. Mrs. A. becomes increasingly agitated.

While Mrs. A. is being treated, you leave to confer with the intake worker who complains about the rash of older patients who have come to the emergency room in the last six months: "They should be sent to rest homes where someone can watch after them properly. That would make my job a lot easier."

There are many issues that need to be addressed in order to help Mrs. A. In this section, we are going to focus on the macro issues.

- What interventions might be considered on the agency level to better prepare staff to work with older adults?

- What community interventions might promote better services for older adults?