Ajit’s Story
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 whose, primary language is Tamil and he is able to communicate with simple verbal and written English. He escaped to Canada with his family when the war broke out in Sri Lanka and many members of his extended family were killed. Unfortunately, Ajit was driving when he also lost his 10 year old son in a car accident. Not long after the tragic accident, he started drinking which lead to him losing his job. His wife initiated a divorce close to 15 years ago and he has two remaining daughters and one son.
Diagnosis
Aljit lives alone in senior’s social housing and can no longer drive, so has been using public transport. Since his divorce, he has been drinking more and is struggling with his IADLs. He has also been diagnosed with atrial fibrillation, alcoholic dementia, gout, previous MI with stenting, and CRD. Recently Ajit fell, fractured his hip, and consequently spent an extended time in the hospital. Ajit persuaded the doctor and the occupational therapist that he could return home and his son, who had been visiting Ajit in hospital, indicated that he will be able to help after the discharge.
Concerns
In the hospital, Ajit had his right hip pinned, that was further complicated by post-op delirium tremors and pneumonia. He also developed a DVT in his right leg which he is now on warfarin and requires regular blood work. Ajit has significant arthritis in his hands, which makes it difficult to open pill bottles and do actions requiring fine motor skills.
Formal / Informal Supports
Ajit is not close with his two daughters or their children who live out of town and the relationship with his son, Rohit, has been strained for many years with periods when they were not speaking. Rohit has a history of substance use disorder and no permanent address so usually sleeps in his car or crashes on friend’s couch. Ajit has a few friends who check in on him once and a while. There was a referral made when he left the hospital for daily home support to possibly assist him with remembering to take 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?