AC6746: Madam Yeo a retired Kindergarten teacher is an 80-year-old lady who lives with her husband in a 2 roomed HDB: Nursing Older People with Complex Needs, Case Study

Case Study 3: Madam Yeo

Background: Madam Yeo a retired Kindergarten teacher is an 80-year-old lady who lives with her husband in a 2 roomed HDB. apartment. Madam and Mr Yeo have both been relatively healthy and have lived an active life, they have one son who lives in Australia and a daughter Emily who lives nearby. Madam Yeo has recently had a few near falls, she fell two days ago when she tripped on a step and fell since then shas been experiencing worsening pain in her right hip. She had initially refused to go to hospital as she thought it was a worsening of her arthritis. The pain got worse, and she was finding it difficult to move around, she asked her daughter to take her to the hospital.

Emily worries about her parents, and she had been wanting to employ a domestic worker to assist them with cleaning and cooking for a while as she felt that they have not been taking care of themselves and she now wants this to be in place for when her mother comes home. Emily has a good job and has two teenaged children.

Physical Health: Prior to this hospital admission Madam Yeo had, had a few near falls before this one but had ignored these as just being one of those things. She has osteoarthritis in both her hips, and hypothyroidism and takes thyroxine and cholesterol lowering medications, she wears glasses and has a hearing aid.

Whilst at the hospital Madam Yeo underwent a series of investigations (including pelvic and hip x-rays and blood tests), which identified a right fractured neck of femur.  She was subsequently admitted to an orthopaedic ward and commenced on the hip fracture care pathway and underwent surgery for a right hip arthroplasty.  Post surgery Madam Yeo underwent further tests and bone mineral density identified that she had osteoporosis. The care pathway takes a multidisciplinary approach to aid surgical recovery, a rehabilitation programme was developed for Madam Yeo, but rehabilitation staff reported that they found it difficult to motivate her to engage with the programme.

Mr. Yeo has recently been found to have angina, but he is managing well with medication and has had no recent episodes of chest pain. He had been worried about his wife and her ‘stumbles’ but had not wanted to make a fuss.

Medication Management: Calcium and Vitamin D, Thyroxine, Simvastatin, Tramadol and Paracetamol

Socially Madame and Mr. Yeo were avid attenders at the elder day centre in their neighbourhood, but over the past few months Mr. Yeo has been going alone as his wife had not felt like going. Madame Yeo had been spending more time watching TV or doing her crafts although these did not seem to be progressing. They both love seeing the grandchildren and were very proud of them.

Psychologically Madam Yeo was always very bright and was the person in the family who always knew everything and remembered all key events. However there had been a change over the past few months where she had to refer to her book.

Discussions are starting to take place about options for longer term rehabilitation. Madam Yeo wants to go home she says she cannot sleep in the hospital; Emily is concerned how her father will manage and does not want a strain on his health, Mr. Yeo wants to please his wife. The MDT the Doctors say she is ready to move onto alternative rehabilitation, the Occupational

Therapist and Physiotherapist state there is some progress but that constant prompting is required, the nurse says Madam Yeo’s wound is healing well, she does need someone to put on her antiembolism stockings, Madam Yeo is still in pain especially on movement and is requiring regular Tramadol and Paracetamol, she requires assistance to walk to the toilet and has been asking for a commode rather than walking. Some of the staff have been concerned that she has only been eating very small amounts of her meals and is not finishing her drinks, when asked about this she says it is because she does not want to have to go to the toilet.

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