BACHELOR OF OCCUPATIONAL THERAPY

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OCC312
Scenario-based Learning 1

Scenario 3:“We just can’t manage her!!!”

STUDENT COPY

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Trigger

You are a second year OT student undertaking fieldwork placement in the

Memory Clinic at King Fahd Hospital. Your supervising OT is Abida. Abida has
received a referral from the doctor, who is requesting an OT home assessment to
review Mrs Yaser who is living alone in her own home. Mrs Yaser’s family and
the doctor are concerned she may no longer be safe living alone at home.

You accompany Abida to Mrs Yaser’s home assessment. Also present at the
assessment is Mrs Yaser’s daughter, Beena. Mrs Yaser is a 76-year-old woman
who has been “difficult to manage at home”, despite the assistance provided
through her family, for the past six months. Several times through the
assessment, Beena states in a somewhat exasperated manner that, “she just
doesn’t belong here, we just can’t manage her here. She needs to be living with
us”.

Instructions
 What are your reactions to this client and this situation?

 What terms are unfamiliar? Any group members may provide an explanation of listed
terms.

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 What previous knowledge/experience do you have that assists you to understand
this problem/situation?

 Identify information about the person/situation from the trigger. What does this tell
you?

 Identify the further information you need to understand this situation.

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More Information
OT meeting with Beena

History of Presenting Illness

Mrs Yaser developed early signs of dementia about eight years ago. She
referred herself to a Memory Clinic because she was concerned about not
remembering conversations and forgetting appointments. Since then, Mrs
Yaser’s memory has steadily declined, as has her capacity to manage her
everyday activities although generally she has remained physically “fit and
healthy”.

Mrs Yaser’s husband (now deceased) cared for Mrs Yaser at home for seven
years post-diagnosis of dementia. During that time he was reluctant to accept
help in caring for his wife but did endeavour to implement all of the strategies
suggested by the Memory Clinic Team. He did accept some assistance from a
personal care worker to help shower his wife, and Mrs Yaser used the shower
rails and hand held hose suggested by the visiting occupational therapist. Mrs
Yaser’s husband passed away one year ago.

Past Medical History

Hypertension, removal of bilateral cataracts, Non-Insulin Dependent Diabetes
Mellitis, osteoporosis, osteoarthritis involving both hands.

Personal/social History
Mrs Yaser has two children. Her children have successful careers. Beena lives
nearby and her other daughter lives in Oman. There are four grandchildren. Mrs
Yaser has no other living relatives.

Mrs Yaser had considerable success in a family butcher business with her
husband. Although she retired in her mid-60’s, she continued to have some
interest in the family business. Mrs Yaser and her husband were known as being
financially generous to both charitable causes and individuals in need of
assistance.

Until seven years ago, Mrs Yaser’s main recreational interests were weekly
gatherings with friends. She has enjoyed reading, cooking and was sociable
throughout her life. She also enjoyed overseas travel and took a trip to Oman two
years ago to visit her daughter and family.

Current situation
In the past six months, Beena has become anxious about Mrs Yaser’s ability to
live alone at home safely. According to Beena and the personal care worker, Mrs
Yaser’s ‘problem behaviours’ include regular agitated phone calls to Beena and
her sister, intrusive behaviour towards her neighbours, and night-time

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disorientation. Mrs Yaser burns food and cooking utensils when cooking. In
addition, Beena have reported Mrs Yaser has lost several kilograms over the
past three months. Mrs Yaser has become disoriented when walking in the local
shopping mall.

One of the personal care workers reports that Mrs Yaser refuses to shower some
days and on occasions has forgotten the worker is coming so has already left the
house by the time the worker arrives. Mrs Yaser is at times incontinent of urine
and cannot manage her own continence pads or washing the bed sheets and the
house is beginning to develop an odour. She had bruises on her arm and
forehead that indicated she may have had a fall. Mrs Yaser experiences difficulty
finding words to express herself. This makes it difficult for others to understand
what she is saying.

Beena has been the family member allocated to purchasing her medications
when the tablets run low. Beena notified the doctor that she has not had to re-fill
any medications for the past two months. Mrs Yaser had been attending a craft
group twice a week. A driver has been pre-arranged by the group for transport.
The Group Co-ordinator told the doctor that Mrs Yaser is now refusing to go in
the car to the craft group. Despite the issues noticed by Beena and others, Mrs
Yaser says she is managing well and gets angry with Beena when she asks
questions or comments about her concerns.

Care Plan
Mrs Yaser receives support from daily personal carers. She had a home
assessment to review the aids needed for safe showering 12 months ago. No
further OT involvement has occurred since this time.

Comprehensive assessments provided by the Memory Clinic, a doctor and the

OT will investigate Mrs Yaser’s problems and help to develop a plan of action to
address her increasing needs.

The mission of OT in the Memory Clinic is to develop programs to support the

occupational performance and well-being of the client. OT’s develop programs in
conjunction with the client, family, Case Manager and personal care workers.
Both trained and untrained staff implement programs developed by the OT, with
support from the OT.

STUDENT TASK: Abida has asked you to consider the key issues that might be
relevant in providing a suitable environment for Mrs Yaser that enhances her
well-being. She asks you to prepare information for an education session for
Beena and for the personal care workers about how to consider Mrs Yaser’s
habits and roles, and how to structure the environment to meet her needs. Abida
expects you to identify key issues for engaging Mrs Yaser in activities at home,
and to provide evidence for your clinical reasoning process for these issues next
week.

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Instructions

 Are there any further terms you don’t understand? Any group members may provide
an explanation of listed terms.

 Using the information presented, brainstorm the broad occupational issues for Mrs
Yaser. Consider the person, occupation and environment in your brainstorming.
Justify your reasoning for choosing these issues.

Person –
Affective –

Cognitive –

Physical –

Spirituality –

Environment –
Physical –

Institutional –

Cultural –

Social –

Occupation –
Self-care –

Productivity –

Leisure –

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 For you to complete the tasks that Abida set and to better understand Mrs Yaser’s
issues, what knowledge and skills do you as an OT student require? Think broadly.
This will form the basis of your learning objectives.

 Develop specific questions related to gaps in your understanding or skills. Evaluate

and prioritise the questions.

 Decide on learning tasks (learning objectives) to be followed up by the group.

 Brainstorm potential information sources.

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Task for Next Session

Abida has asked you to consider the key issues that might be relevant in
providing a suitable environment for Mrs Yaser that enhances her well-being.
She asks you to prepare information for an education session for the family and
for the personal care workers about how to consider Mrs Yaser’s habits and
roles and how to structure the environment to meet her needs. Abida expects
you to identify key issues for engaging Mrs Yaser in activities at home, and to
provide evidence for your clinical reasoning process for these issues next week.

In addition to your general research to address the learning objectives, prepare a

list of the four key points with supporting evidence and justification for their
inclusion that you would include in the education session.

Suggested Resources

Key:

* Reading is in the prescribed textbook (available in college library)

+ Reading is in a recommended textbook (available in college library)
# Reading is accessible via the Saudi Digital Library
^ Reading is available as a pdf

Australian Government Department of Health and Aging. (2011). Dementia: Osborne

Park Hospital guide for occupational therapists in clinical practice. Retrieved from
http://ilc.com.au/resources/2/0000/0415/dementia_osborne_park_hospital_guide.pdf.

*Goodman, G. & Bonder, B. (2014). Preventing occupational dysfunction secondary to

aging. In M. Vining Radomski & C. Trombly Latham (Eds). Occupational therapy for
physical dysfunction (7th ed., pp. 974-1000). Philadelphia, PA: Lippincott Williams &
Wilkins.
*Kielhofner, G. (2008). Habituation: Patterns of daily occupation. In G. Kielhofner. A
model of human occupation: Theory and application (4th ed., pp. 51-67). Baltimore,
MD: Williams and Wilkins. See also case study p 435-439 (use of MOHOST with
person who has Alzheimer’s disease).

*Kielhofner, G. (2008). The environment and human occupation. In G. Kielhofner. A

model of human occupation: Theory and application (4th ed., pp. 85-100), Baltimore,
MD: Williams and Wilkins.

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*Vining Radomski, M. & Giles, G. M. (2014). Optimizing cognitive performance. In M.
Vining Radomski & C. Trombly Latham (Eds). Occupational therapy for physical
dysfunction. (7th ed., pp. 725-752). Philadelphia, PA: Lippincott Williams & Wilkins.

*Vining Radomski, M., & Morrison, M. T. (2014) Assessing abilities and capacities:
Cognition. In M.Vining Radomski & C. Trombly Latham (Eds). Occupational therapy
for physical dysfunction. (7th ed., pp. 121-143). Philadelphia, PA: Lippincott Williams &
Wilkins.

#Wood, W., Harris, M., Snider, M., & Patchel, S. (2005). Activity situations on an
Alzheimer's disease special care unit and resident environmental interactions, time
use and affect. American Journal of Alzheimer's Diseases and Other Dementias,
20(1), 105-118.

Websites
 Ministry of Health Alzheimer’s page
http://www.moh.gov.sa/en/HealthAwareness/EducationalContent/Diseases/Nervous-
system/Pages/Nervous-System-2011-9-20-001.aspx

 Saudi Alzheimer’s Disease Association http://beta.alz.org.sa/beta/index.html

 Alzheimer’s Australia www.alzheimers.org.au, especially Publications &

resources>Help sheets>The environment and dementia
http://www.fightdementia.org.au/understanding-dementia/sextion-9-the-
environment--dementia.aspx

Assessments
^Cooke, D., Gustafsson, L., & Tardiani, D. (2010). Clock drawing from the occupational
therapy adult perceptual screening test: Its correlation with demographic and clinical
factors in the stroke population. Australian Occupational Therapy Journal, 57(3), 183-
9.

^Folstein, M. F., Folstein S.E., & McHugh, P.R. (1975). Mini mental state: A practical
method for grading the cognitive state for the clinician. Journal of Psychiatric
Research. 12, 189-198.

^Galea, M., & Woodward, M. (2005). Mini mental state examination (MMSE). Australian
Journal of Physiotherapy, 51(3), 198.

*O'Toole, G., Ashby, S., & Fussell, M. (2011). Dementia and occupation analysis. In L.
Mackenzie & G. O’Toole (Eds.). Occupation analysis in practice (pp.163-176). United
Kingdom: Blackwell Publishing Ltd.

Additional readings
^Amr, M., Amin, T. T., Al-Rhaddad, D., & Sallam, K. (2013). Prevalence of psychiatric
disorders in older patients attending an Arab tertiary facility. International
Psychogeriatrics, 1(1), 1-2.

Page 9 of 11
^Bennett, S., & Liddle, J. (2008). Community-based occupational therapy improved daily
functioning in people with dementia. Australian Occupational Therapy Journal, 55(1),
73-75.

*Hamilton, T. B. (2010). Occupations and places. In C. Christiansen and E. Townsend

(Eds.). Introduction to occupation: The art and science of living (pp. 251-279). Upper
Saddle River, NJ: Pearson.

^Ogunniyi, A., Daif, A. K., Al-Rajeh, S., AbdulJabbar, M., Al-Tahan, A. R., Al-Bunyan, M.,
& Shamina, A. R. (1998). Dementia in Saudi Arabia: Experience from a university
hospital. Acta Neurologica Scandinavica, 98(2), 116-120.

^Ohman, A, Josephsson, S., & Nygard, L. (2008). Awareness through interaction in

everyday occupations: Experiences of people with Alzheimer’s disease.
Scandinavian Journal of Occupational Therapy, 15(1), 43-51.

^Öhman, A., Nygård, L., & Kottorp, A. (2011). Occupational performance and awareness
of disability in mild cognitive impairment or dementia. Scandinavian Journal of
Occupational Therapy, 18(2), 133-142. doi:10.3109/11038121003645993

^Steultjens, E. (2008). Critically appraised paper: Shared occupations are important for
the wellbeing of persons with dementia and their caregivers. Australian Occupational
Therapy Journal, 55, 74-75

^Wood, W. (2005). Toward developing new occupational science measures: An example

from dementia care research. Journal of Occupational Science, 12(3), 121-129.

Resource Sessions and Skills Classes

 OCC311 Lectures: Caregivers and Community; Introduction to Dementia.
 OCC311 Practical: Cognitive Screening.

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