These free educational modules were created to be incorporated into your new or existing geriatric curriculum. Each module is designed to be used with one of the three assignment options below them, along with the general questions.
Educational Module 1:
The Case of Mrs. Burgess
Mrs. Burgess is an 85 year old Caucasian woman. She is 5 foot 4 and weighs 140 pounds. She takes a daily vitamin and medicine for her high blood pressure. Until now she has been relatively healthy with no other significant medical issues. Her hearing is excellent but her vision is poor and prevents her from driving. She smokes a pack of cigarettes a day which she enjoys with her nightly 2-3 glasses on red wine. Two weeks ago she fell and broke her hip. After being transported to the emergency room, she survived hip replacement surgery and is now in a rehabilitation unit, but will soon be discharged.
She became a widow ten years ago with the death of her husband of 50 years. He died of cancer after many years of treatments during which time she learned to run the household. She lives in a rural area with few neighbors and no access to home deliveries of medication or groceries. She and her husband built their home just after their marriage and lived a happy middle income lifestyle. She never worked outside the home. She raised her family of 3 children there and wishes to return.
She lost her only child living locally, a daughter, in a car accident 5 years ago. Her other two children, both sons, live in another State and are only able to make it home for Christmas. She has a very good relationship with only one of them and the other relationship has been strained over the death of the daughter/sister. One is a successful Attorney with a family of his own and the other a divorced Social Worker with little means and no children. She has no living will or power of attorney. She does not have a funded prearranged funeral.
She is active in her church and gets a ride there and back home every Sunday from a supportive member of the congregation. Membership in their Women’s club and sewing group has not been possible since the death of her husband who provided transportation for those events. She drove up until the age of 70 when her vision and her eye doctor forced her to surrender her license.
The value of her rural home is not determined but she does own it with no mortgage. She has Medicare and a Bankers Life Policy. She has managed to save $20,000.00 and has a valuable collection of silver and jewelry she inherited from her Great Aunt.
Educational Module 2:
The Case of Mr. and Mrs. Marino
Mr. and Mrs. Marino live in a high rise low income apartment building in an urban area. Mr. Marino is 95 and Mrs. Marino is 90. Mr. is starting to have some mobility issues around the apartment along with diabetes, incontinence, and hearing loss. She remains nimble but is often confused. Her vision is poor due to cataracts. They have never seen a physician for a full evaluation. They both take prescription medications but are not always taking them properly. They take public transportation to mass once a week and enjoy interacting with each other and watching movies on television. They live on social security and have a small savings account from the sale of their house which has been depleted to $10,000.00 over the years. They both have prepaid funeral arrangements. Mr. Marino was a wonderful cook in a local Italian restaurant for 40 years while she raised the children and took care of their home.
The Marino family had 9 children, 4 girls and 5 boys. They now range in age from 60 to 70 and are all college educated and retired from successful careers. They are scattered across the country and all maintain a good relationship with their parents, but not with each other. The closest sibling is over 100 miles away.
Yesterday their eldest son, who is the Power of Attorney, received a call from the building manager because Mrs. Marino was found in the lobby of the apartment building waiting for the bus to go to mass at 3:00 A.M. by another resident. When the manager visited their apartment to check on her he found concerning conditions including a strong urine odor, food out on the table that appeared to be from the day before, and the stove top burner on. The building manager expressed concern related to their safety and well- being living independently. The son called on a Geriatric Care Manager in the area and contracted with her privately to work with other professional if needed to manage his parent’s needs. She works with a team on such cases.
Educational Module 3:
The Case of Mr. Williams
Mr. Williams is a 65 year old African American man who made his living as a musician with some of the top bands in the country. Partially due to his heavy travel schedule he never married. He had an active social life and accumulated liquid assets of over 1 million dollars. He lived on the road and never invested in real estate but settled in an Independent Apartment in an upscale senior community when he retried from his music career and has enjoyed living there for 3 years.
He reported no known relatives as his parents and older sister died many years ago. Mr. Williams was popular in the Community because he often played music for the other residents and had many friends. He struggled with his personal belonging hoarding boxes and boxes of lifelong possession. He did not want to sort or get rid of the treasures and had traveled with them for many years. This habit caused him to live in a cluttered environment with a single pathway to the bathroom and bedroom.
Recently and suddenly the staff and residents began to see a change in Mr. Williams. He irrupted in anger when the wrong kind of juice was served at breakfast screaming and bounding the table demanding he be served orange juice immediately. Again, when he felt the elevator was taking too long he started crying and shaking his fist in the air. With 6 such incidents of uncharacteristic behavior in the last month the staff reported it to the Community Director who presented the concerns to her team.
Educational Module 4:
The Case of Sam
A man who appeared to be in his late 80s presented at the emergency room of the local hospital at 10:00 P.M. He needed a haircut, his clothes were dirty and loose fitting. He did not have insurance cards or identification with him. He reported that his name was Sam and that he lived in a house not too far away. He walked there because he didn’t feel good and could not reach his sister on the phone. He reported that his throat hurt and he was coughing. An examination was initiated and a social worker contacted.
The hospital social worker through interviewing Sam learned that he lived alone and relied on his older sister to help him. When he was younger he reported he lived with friends in a group home but his sister helped him get his own place with money from the estate after their parents died. He reported that he lived there for a long time. He stated she came to see him “EVERYDAY”. As the interview continued Sam shared that lately his sister didn’t always answer the phone and didn’t call him back. This time he had not been able to reach her for a week. He felt scared and sometimes he didn’t even have food. He pulled a letter out of his pocket and shared it. It was a 2nd late notice from the electric company dated 3 months ago.
At the end of the physical examination it was determined that he had a common cold and one other medical concern that caused him to be admitted to the hospital that evening.
Educational Module 5:
The Case of Amar and Ema
Amar and Ema are husband and wife and just arrived in town as refugees from Bosnia. Amar was an Attorney and Ema a teacher. His brother now a citizen of the United States and has been living in town for 5 years. All of their other relatives remain in Bosnia.
Amar and Ema do not speak English. They are in their early 60’s and have been in good health. They enjoy a good family social life and have adequate food and housing for now in the home of their brother.
Last week their brother Ivan took them shopping and while traveling together in his car had a violent car accident at a busy intersection. All three were rushed to the local trauma center and have been hospitalized for several days with a variety of injuries including broken bones. The Hospitalist does not feel they can return to living in the house without services until they heal and have some rehabilitation, however, it is time to release them from the hospital tomorrow.
Educational Module 6:
The Case of Frank Sr. and Frank Jr.
Frank Sr. is a 99 year old retired plumber. He lost his wife of 70 years 2 years ago. They had one son, Frank Jr. now 65 years old. Frank Jr. never married or held a job for more than one year. He skipped from apartment to apartment, sometimes living with friends, and sometimes staying with his parents. Frank Sr., while disappointed in his son, always welcomed him home and helped him when he could.
After his wife died, Frank Sr. allowed Frank Jr. to move in permanently for company and mutual support. They both went to the local day care center each day for a meal and activities. The Day Program offered regular Health Fairs for their members with various screening and services available. After one particular Health Fair, but before the members left the building, two of the health care professionals approached the Director of the center with concerns regarding Frank Sr. One health care professional was concerned because Frank Sr., who typically maintained a normal weight, lost 20 pounds in a month. The other was concerned because during another screening she notice burn marks on Frank Sr. arms and unexplained bruises on his neck and back. When questioned about the marks Frank Sr. would not answer directly. The Director quickly gathered the team she works with on Center concerns to discuss the case.
Assignment Option 1:
Assign individual students a case and ask them to develop a written care plan explaining the role and specific actions required of each interdisciplinary team member related to the case and their proposed care plan. Include a Physician, Social Worker, Dietician, Physical Therapist, Occupational Therapist, Recreation Therapist, Nurse, and Specialists. Require that they explain why their proposed plan is the best possible care plan for the individual.
Assignment Option 2:
In class team assignment
An Interdisciplinary team typically consists of a Physician, Social Worker, Dietician, Physical Therapist, Occupational Therapist, Recreation Therapist, Nurse, and Specialists. As a class exercise, assign one or more students to play each role. Select a module and give all students a copy of the case, their role on the team, and a week to research. Hold a mock Interdisciplinary Team Meeting in class and develop a care plan for the individual/s.
Assignment Option 3:
College/University wide exercise
An Interdisciplinary team typically consists of a Physician, Social Worker, Dietician, Physical Therapist, Occupational Therapist, Recreation Therapist, Nurse, and Specialists. Invite students from related majors across the College/University to participate in an exercise on a given day and location. If your College/University doesn’t host a particular major, students in any area of study may fill in for the role play. Conduct a mock Interdisciplinary Meeting. Require the students to write a reflection paper on the experience.
Questions for consideration
What do you still need to know about the patient and how will you discover it?
What are the community resources available?
What are the concerns?
What are the key action steps you might take to assist with a successful future experience for the patient?
Who would you approach with recommendations?
What services might you recommend?
How might you involve the family?
How might you involve a social network?
What legal financial recommendations would you make?
What medical recommendations should be made?
How would you present the patient with their options?
How would you support the patient choices?
How would you learn about the resources in his/her city or town?
What education would you provide?
How would you follow up?