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					Caregiving and Alzheimer’s Disease: Case Study Arkansas State University
This case study raises issues of who is the client, the importance of assessment of the caregiver as well as the care recipient, and meeting the needs of the caregiving dyad as a unit. It could be infused in foundation practice or Human Behavior and Social Environment classes. Presenting Problem: John, age 82, is anxious and worried about the care needs of his wife Mary, age 80. He has difficulty accepting in-home care providers, although he is unable to meet Mary’s needs without assistance. John also expresses concern regarding what would happen to his wife if “something” happened to him. He denies suicidal intentions at this time. Medical Diagnosis: John’s current diagnoses include hypertension, acid reflux disease, high cholesterol, arthritis, depression, and hyperglycemia. He is taking the following medications: Avalide 12.5 mg/day; Prevacid 15 mg/day; Effexor 75 mg/day; Lipitor 10 mg/day; Lorazepam .5 mg/day; Vioxx 25 mg/day Mary’s current diagnoses include Alzheimer’s disease, depression, arthritis, and diarrhea. Her medications: Aricept 10 mg/day/PM; Ultam 1 q. 6 hrs.; Vioxx 25 mg/day, AM; Antidiarrheal, 1/AM, 1/PM Psychosocial History: This couple has been married for over 50 years. They raised three daughters from Mary’s first marriage as well as their son. The daughters live out of state. They maintain regular contact but are not directly involved in Mary’s care. John reports that they lived with their son in a nearby town until two years ago when they moved to their current residence because the son “couldn’t handle” the changes in Mary’s behavior resulting from Alzheimer’s. John also disclosed that they had loaned their son a sizeable amount of money, which has not been repaid as expected. He attributes their current financial strain to this situation. Mary’s behavior is consistent with the second stage of AD. She is disoriented to time, place, and person. Her short-term memory is profoundly impaired. She is often agitated and restless and is at risk for wandering. She requires assistance with eating, dressing, toileting, and personal hygiene. John acknowledges his feelings of frustration, anger, and guilt. He is committed to caring for Mary as long as he can, but does not rule out the possibility of nursing home placement in the future. For example, John shared a story about a neighbor who “beat” his wife who also had AD. He states that he will put Mary in a nursing home before “it comes to that”. 1

The couple currently receives homemaker and home health aid services under the Medicaid In-home Waiver program. However, John is frequently in conflict with care providers regarding the quality of care available to his wife. He has very high expectations and is often disappointed due to staff turnover and scheduling changes. Possible questions to guide students:     If you were working with John and Mary, who would you define as the primary “client?” What are the most pressing problems faced by the primary and secondary “clients?” What other factors might you want to assess? What kind of intervention would you develop for both the primary and second “client?”

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posted:11/8/2009
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