Uncertainty and Social Isolation
Ms. Katsitsanéron Tehya is an 85-year-old woman who has been living on her own in a large urban city since her partner died one-and-a-half years ago. She identifies as Two-Spirit, prefers to be called Katsitsanéron, and her pronouns are she/her. She has no children; however, she has a niece that lives about two hours away. Her niece calls to check in on her aunt twice a week and visits occasionally. Lately, while speaking to Katsitsanéron her niece has noticed some slightly odd behaviours and lapses in her memory. Starting about two weeks ago she noticed a gradual worsening of Katsitsanéron’s ability to remember certain things, forgetting what time of day it was and misplacing items, she also noticed that at times her aunt had difficulty finding words when they would speak. Concerned that these behaviours were progressing, Katsitsanéron’s niece decided to visit her. When she arrived, Katsitsanéron stated that she was surprised to see her niece despite the arrangements they made together. When visiting Katsitsanéron’s niece is surprised to notice that Katsitsanéron appeared as though she has not showered in several days and her home had several dirty dishes including pots with burn marks. In trying to assist her to bathe and change into clean clothes, her niece notices that Katsitsanéron has difficulty changing positions from sitting to standing and walking. Her niece then asked her if she is having pain and she states, “Yes in both of my hips…my arthritis is acting up again…”.
In a medical clinic, you are the nurse registering Katsitsanéron. You complete her initial assessment and document the observation from Katsitsanéron’s niece as the primary presenting concern. Katsitsanéron’s vital signs are as follows: blood pressure 145/69, heart rate 82, temperature 36.7, oxygen saturation 97% on room air, and respiration rate 18. When asking Katsitsanéron about her past medical history she answers, “I am pretty healthy”. Her niece then interjects and states that she has a history of high blood pressure and osteoarthritis. You complete her neurological examination and note that she is alert but disoriented to time. Katsitsanéron is able to tell you her name, however, she is unable to recall her age and states an incorrect birth month initially and then corrects herself. Katsitsanéron has diminished grip strength bilaterally in her hands due to Heberden and Bouchard nodes from her osteoarthritis. The primary care provider orders blood work and a CT scan after assessing Katsitsanéron. When you ask about her social networks, her niece states that Katsitsanéron has been living alone since her partner died and she seemed to be coping well until recently. She also explained that she has no children, two of her close friends recently passed away, and she does not attend any social groups.
After Katsitsanéron’s evaluations were complete, she is diagnosed with both middle-stage Alzheimer’s disease and a flare-up of her osteoarthritis. The primary care provider states that she needs around-the-clock supervision, assistance with daily personal care, and increased social interaction. This can be achieved through a change in her living circumstances and becoming a part of social support groups. Although very conflicted due to her own responsibilities and financial constraints, Katsitsanéron’s niece eventually decides to move Katsitsanéron into her home and assume the role of primary caregiver.
After about a month, during the home visit, the nurse asks Katsitsanéron and her niece, “How are you managing? How are you dealing with daily life?” Katsitsanéron’s niece states, “Everything is generally okay”. The nurse notices that Katsitsanéron’s niece appears uneasy and fatigued, and decides to inquire further and asks: “At this point what do you think we can put in place that would help support you?”. After some encouragement, she states “I need help during the daytime for someone to watch her. My husband works two jobs and I can’t run errands if I need something. The other day I ran to the store to pick up a few items while she was having a nap and when I returned home, I saw her walking down the street in her nightgown…every day I am in constant fear that she will wander, misplace something or fall”. The nurse continues to listen to all of Katsitsanéron’s niece’s concerns and begins to coordinate some support and resources to address each concern.
Case Study Expert Reviewer: Suzanne Ezekiel