Paper details Matching Theory Case Study Unsettling Transition Mrs. Elizabeth Cuthbert is an 81 year old Caucasian woman. She has been diagnosed with syncope (fainting spells), hypertension, and chronic obstructive pulmonary disease. For the last four months she has resided in a nursing facility and receives skilled nursing services. Mrs. Cuthbert’s move to the facility occurred as a result of repeated syncope and falls. Her condition has been exacerbated by the recent development of a foot drop, a weakening of the structures in her ankle that allows the foot to dangle when walking. This ailment has increased her risk of falling. Mrs.Cuthbert has been fitted with an ankle foot orthosis (AFO) and provided with a walker, but she claims these aids make her feel “weak.” Mrs. Cuthburt receives physical therapy for her balance and occupational therapy for her tasks of daily living. Her discharge plan involves placement in an assisted living apartment once she has developed the safety and ambulation skills that will allow her to live without constant monitoring. Mrs.Cuthbert’s medications for the last six months include therapeutic aspirin, blood pressure medication,and Tylenol for pain relief from her fall and osteoarthritis.
She is compliant with her medications. Mrs.Cuthbert was widowed 20 years ago and has lived alone in her home of 35 years since that time. Her immediate family includes two adult children, who live in the area, and three grandchildren, who visit and send her letters. Family members visit frequently, at least twice a week. Mrs.Cuthbert Expresses a negative attitude toward the aged in comments during unrelated discussions. For instance, when the social worker intern first met her, she cast aspersions on an“old dog” who lived in the unit, and then went on to make negative comments about her own appearance, saying she looked like “an old hag.” She received the social workers supportive comments positively, but the change in attitude appears transitory. The results of a mini-mental status examination conducted on Mrs.Cuthbert indicated that she was aware of person, time, and place. Mrs.Cuthbert was also evaluated using a mood scale to determine her risk for depression. She scored 7 out of 15 (a score higher than 5 is indicative of depression). Her response to the mood-scale questions revealed feelings of worthlessness, low energy, insomnia, and diminished interest in pleasurable activities. Mrs. Cuthbert evidences no symptoms of mania. Mrs.Cuthbert is undergoing significant change in her social support system as a result of her move to the nursing facility. She no longer has the neighbors whom she visited each day as she went about retrieving her newspaper, checking on her garden, and watering her outdoor plants. She has lost the use of her car and feels that she should give up driving permanently to prevent possible accidents. She also no longer has the option of walking to her place of worship because of her current condition. An additional problem for Mrs.Cuthbert is her reluctance to make safety changes that will allow her to move to an assisted living apartment in a nearby community where several lifelong friends reside. She has been very reluctant to adopt the walker or the AFO and has been refusing the majority of her physical and occupational therapy treatments because she is “tired.” During her care plan meeting, Mrs. Cuthbert expressed surprise that the entire interdisciplinary team had gathered to discuss her case with her and her family. She asked, “Why are all of you interested in me?” She stated that she wanted to move to assisted living because she would be able to visit with her friends there once she did so. When told that she could not move until she addressed the safety and ambulation deficits she is experiencing, she expressed interest in cooperating with the various therapists and counselors. According to Mrs. Cuthbert’s daughter, Barbara, until her current health problems and the move to the nursing facility, her mother was a relatively contented person. She crocheted,enjoyed crossword puzzles, called on friends, assisted two shut-ins whom she has known for years, and had her grandchildren over for weekend visits. Since her admission to the nursing home, it has become difficult for Mrs. Cuthbert to accomplish several of her old activities, and simply not feasible to continue others. However, she has also discontinued the activities that were appropriate for her while at the nursing home, except for doing crossword puzzles. Barbara noted that her mother was not interested in going out for meals as she had been before fall. Her daughter speculated that her mother might not want to be seen in public with the AFO and walker, but noted that she also refused take-out meals offered as well. When asked, Barbara was unaware of any history of mood disorders or other mental illness in her mother’s background, but said that her mother wouldn’t typically speak of such things anyway. Mrs. Cuthbert financial situation is sound. She owns her own house and collects pensions from both her own employment as a secretary and her husband’s work.