A Case Study of a 72 year old man living alone in a nearby city

In this case study we will discuss about chronic ailments and below are the summaries point:- Mr. XYZ is a 72-year-old man who lives alone. He suffers from obesity (BMI of 32), diabetes, and osteoarthritis, which limits his mobility. He has poor health literacy, often forgets to take his medication, and avoids using his glucometer. He feels depressed and has withdrawn from society, feeling incapable of participating in social gatherings. He only seeks help from his neighbor and social worker when he feels the need. He believes his general practitioner cannot help him and has lost confidence in himself. Poor health literacy level, which affects his ability to navigate the healthcare system and understand self-care and chronic disorder management. Poor accessibility to primary healthcare services, including geographic availability and trust in healthcare providers.

Running head: CHRONIC AILMENTS
CHRONIC AILMENTS
Name of the student:
Name of the university:
Author note:

1
CHRONIC AILMENTS
Introduction of the interviewee:
The patient named Mr. XYZ is 72 year old and resides alone in his house. His wife had
died few years back and all his sons and daughter live in separate cities due to their job
requirements. One of his daughters lives in the next community and has 5 children. However, as
she is working, she gets very little time to visit her father as most of her time is spent on the
children or on her job demands. Mr. X is currently suffering from obesity with BMI of 32 that
had resulted him to feel restricted in huge number of daily activities for last fifteen years. He has
been suffering from diabetes for five years and miserably fails in managing his disorder. He is
often seen to forget taking of his medication. Moreover, he often gets confused while using the
glucometer and therefore often tries to avoid using the equipment. Moreover, he is also suffering
from osteoarthritis for last two years and suffers from restricted mobility. His pains often
exacerbate on certain days and he lies on bed throughout those days in excruciating pain. He had
fallen twice – once in his bathroom and once in his room. However, in such times, he had called
to his neighbor loudly who had come to help and helped him to get up. He does not have a
primary healthcare center in his community and need to drive to the nearby primary healthcare
center in the next community. However, his poor eyesight and restricted mobility had made him
lose his confidence. Recently, he had withdrawn himself completely from the society as he feels
that he is not capable enough to participate in social gathering. He feels that his days had become
restricted and that he would soon die.
When his conditions become worse, he requests his neighbor to drive him to the general
practitioner. He is the only person whom he goes for help as he feels that no one can help him
now as his conditions are worse. However, he complains that his general practitioner tells him
the same think of taking medication on time and attending him monthly. He believes that he can

2
CHRONIC AILMENTS
no longer help him. Another support he often seeks for is the social care worker. However, he
has felt that presence of social worker makes him feel dependent and that affects his ego and
self-respect. Therefore, he only calls her whenever he feels in need. He is found to be highly
depressed in his life and he does not want to live anymore.
Two barriers:
One of the main barriers that can be identified is the poor health literacy level within the
patient. Health literacy level can be defined as the degree to which individuals have the capacity
in obtaining, processing as well as understanding the basic information as well as the services
required for making appropriate health disorders (Batterham et al., 2016). Studies opine that
health literacy level can affect the ability of the people to navigate the healthcare system. This
may include filling out of complex forms and locating various services and providers
(Greenhalgh, 2015). It also helps individuals in sharing their personal information like that of the
health history with providers. Engagement in self-care as well as chronic disorder management
and even understanding mathematical concepts like that of probability and risk are not also
understood by them (Porter et al., 2016).
While interacting with the patient, several important instances were noticed that showed
poor health literacy level of the patient. It was seen that he was quite casual about his missing of
medications. It is also seen that he is completely unaware about why he is having the
medications and how the medications work. His low level of health literacy is also reflected on
the fact that he has no idea about how the glucometer works and even thinks that the glucometer
cannot help him in any way to prevent to manage his diabetes.

3
CHRONIC AILMENTS
Another barrier in his management of chronic healthcare disorders is his poor
accessibility to the primary healthcare services. Studies are of the opinion that access to
comprehensive as well as quality healthcare services is extremely important is promoting as well
as maintaining health, prevention and even management of the disorders. This helps in reduction
of the unnecessary disability as well as premature death and achieving health equity (Neutens,
2015). One of the studies had defined access to healthcare services as “the timely utilization of
the personal healthcare services for achieving the best health outcomes”. Three important steps
are found to be intricately associated with gaining successful access to quality healthcare
services. This includes gaining of the entry into the healthcare systems like that through the
insurance coverage and accessing a location where the needed healthcare services are available
like as in geographic availability (Mohammed et al., 2016). Moreover, finding a healthcare
provider whom the patient trusts and can communicate effectively through the development of
personal relationships is also found to be extremely important. It has been found that access to
healthcare services have an overall positive impact on physical, social as well as mental health
status and quality of life of the patient (Fransen et al., 2015).
In case of Mr. X, it was found that his main barrier was improper access to healthcare
services one of whose reason was the geographic availability. There was no primary healthcare
center in his locality which could provide him good care service delivery meeting all his needs.
Asking for help from neighbor to drive him the next community healthcare centre to the next
locality affected his ego and self-respect. He had to travel long distances to reach the primary
healthcare center and this became one of the most important barrier in accessing care. He had
restricted mobility and could not drive himself. Hence, this affected his health to a large extent.

4
CHRONIC AILMENTS
Societal and individual support:
The patient had the support of his general practitioner. The clinic only comprised of a
simple general practitioner who had no aiding professionals. He had to care for larger number of
patients in the locality and so the care provided lacked quality. The practitioner could not
communicate with the patients in details. He did not try to develop any therapeutic relationship
with the patient for which Mr. X could not develop trust and mutual bond with the professional.
Studies opine that therapeutic communication helps in developing strong bonds based on mutual
trust that increase patient satisfaction (Riley, 2015). Effective communication along with
empathy and compassion increases patient satisfaction (Hiller et al., 2015). Researchers also
opine that effective communication helps in development of therapeutic relationship with
patients. This helps to increase adherence of the patient with the treatment helping the patient to
develop self-care management ideas and motivation (O’Toole, 2016). Moreover, he only
managed his biological determinants of health rather than providing holistic care services.
Present day researchers are of the opinion that healthcare professionals need to manage and care
for not only biological determinants but also the various psychological and social determinants
of health as well following bio-psycho-social model of care (Neutens, 2015). Lack of this
approach prevented him from developing better quality of life.
Another of the social support that Mr. X also receives is the service of the social worker.
Public health social workers help people who are diagnosed with chronic ailments. The services
of such workers help by advising the family care givers, providing patients with health education
and counseling, making referrals to other services, case management interventions, organizing

5
CHRONIC AILMENTS
support groups as well as planning hospital discharges (McCoyd et al., 2016). However,
although the social workers of the patient named Mr. X provide him the above mentioned service
but cannot help in developing the quality of his life successfully. He believes that he needs the
service of good healthcare experts to manage his chronic conditions successfully.
Role of healthcare team members and personal reflection:
Mr. X required the help of expertise healthcare team of a primary healthcare center where
each of the members need to be provide specific care services to meet his needs and
requirements. One of the most important healthcare professionals who would be providing care
to him is the nursing professionals. She would need to develop health literacy level in patients
and this would help patients in adhering to medications and proper glucometer use. She would
need to assess his lifestyle factors like diet and his physical activities and accordingly proposes
interventions for him. One of the most important initiatives that nurses need to take is to develop
motivational interviewing. Motivational interviewing helps patients to identify their negative
lifestyle habits and accordingly help the, to develop motivation to modify them to positive health
habits (Korner et al., 2016). Following this, the nurses need to consult with dieticians and
develop proper food plan for the patients (van Dongen et al., 2016). This would help to control
the calorie gain of the patient and help him in losing weight. Development of health physical
activities and exercises plan would also help in developing the health condition of Mr. X.
Another member of the healthcare team would be the physiotherapist. Such experts help patients
in treating joint pains suffered by osteoarthritis patients through the application of different
therapies (Fotokian et al., 2017).Mr. X would be relieved from his joint pain and he would
gradually develop his mobility. Nursing professionals also need to assess his environmental
conditions of the home and accordingly modify it to prevent fall chances through effective fall

6
CHRONIC AILMENTS
risk assessment. Another healthcare professional who would also be appointed is occupational
therapist. Such therapists help people on overcoming various mental and physical constraints that
result from disabilities, ageing, illness or injuries. They provide practical advices as well as
solutions and thereby enable people in living satisfying, full as well as independent lives (Körner
et al., 2016). This would help Mr. X to gradually overcome the barriers he faces in his daily life
activities so that he can overcome them and live independent lives. Another important
professional would be a counselor. He seems to suffer from mild depression which might
aggravate if not treated successfully. Cognitive behavioral therapies, pet therapy, music therapy
as well as art therapies can be applied as they help patients in overcoming depression (Harris et
al., 2016).
I have realized that it is extremely important for professionals to provide holistic and
comprehensive care services that would meet biological, social and psychological needs of
patients. This can only help old people to live better quality lives. Development of effective
communication and therapeutic realstionship with patients is important. Nurses need to earn trust
of the patient and ensure maintaining his dignity and autonomy while providing care. This
ensures patient satisfaction. Moreover, only developing treatment plan is not sufficient as nurses
also need to educate patients and develop health literacy. This would help in developing
confidence and motivation among the patient that would help in self-care management (Riley,
2015).

7
CHRONIC AILMENTS
References:
Batterham, R. W., Hawkins, M., Collins, P. A., Buchbinder, R., & Osborne, R. H. (2016). Health
literacy: applying current concepts to improve health services and reduce health
inequalities. Public health, 132, 3-12.
Fotokian, Z., Shahboulaghi, F. M., Fallahi-Khoshknab, M., & Pourhabib, A. (2017). The
empowerment of elderly patients with chronic obstructive pulmonary disease: managing
life with the disease. PloS one, 12(4), e0174028.
Fransen, K., Neutens, T., Farber, S., De Maeyer, P., Deruyter, G., & Witlox, F. (2015).
Identifying public transport gaps using time-dependent accessibility levels. Journal of
Transport Geography, 48, 176-187.
Greenhalgh, T. (2015). Health literacy: towards system level solutions. BMJ: British Medical
Journal (Online), 350.
Harris, M. F., Advocat, J., Crabtree, B. F., Levesque, J. F., Miller, W. L., Gunn, J. M., ... &
Russell, G. M. (2016). Interprofessional teamwork innovations for primary health care
practices and practitioners: evidence from a comparison of reform in three
countries. Journal of multidisciplinary healthcare, 9, 35.
Hiller, A., Guillemin, M., & Delany, C. (2015). Exploring healthcare communication models in
private physiotherapy practice. Patient education and counseling, 98(10), 1222-1228.

8
CHRONIC AILMENTS
Körner, M., Bütof, S., Müller, C., Zimmermann, L., Becker, S., & Bengel, J. (2016).
Interprofessional teamwork and team interventions in chronic care: a systematic
review. Journal of interprofessional care, 30(1), 15-28.
Körner, M., Lippenberger, C., Becker, S., Reichler, L., Müller, C., Zimmermann, L., ... &
Baumeister, H. (2016). Knowledge integration, teamwork and performance in health
care. Journal of health organization and management, 30(2), 227-243.
McCoyd, J. L., & Kerson, T. S. (2016). Social work in health settings: Practice in context.
Routledge.
Mohammed, K., Nolan, M. B., Rajjo, T., Shah, N. D., Prokop, L. J., Varkey, P., & Murad, M. H.
(2016). Creating a patient-centered health care delivery system: a systematic review of
health care quality from the patient perspective. American Journal of Medical
Quality, 31(1), 12-21.
Neutens, T. (2015). Accessibility, equity and health care: review and research directions for
transport geographers. Journal of Transport Geography, 43, 14-27.
O'Toole, G. (2016). Communication-eBook: Core Interpersonal Skills for Health Professionals.
Elsevier Health Sciences.
Porter, K., Chen, Y., Estabrooks, P., Noel, L., Bailey, A., & Zoellner, J. (2016). Using teach-
back to understand participant behavioral self-monitoring skills across health literacy
level and behavioral condition. Journal of nutrition education and behavior, 48(1), 20-
26.
Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.

9
CHRONIC AILMENTS
van Dongen, J. J. J., Lenzen, S. A., van Bokhoven, M. A., Daniëls, R., van der Weijden, T., &
Beurskens, A. (2016). Interprofessional collaboration regarding patients’ care plans in
primary care: a focus group study into influential factors. BMC family practice, 17(1), 58.
Appendix:
Interview transcript:
Nurse (N), patient (Mr. X)
N: Hi Mr. X. How are you doing today?
Mr. X: Nothing special, the same old life
N: I have checked your reports. You seem to have high blood glucose level. You even
complained of tremendous joint pain. How long are you suffering from these disorder?
Mr. X: Well I was diagnosed with diabetes five years ago after passing away of my wife. I am
also suffering from osteoarthritis for about two years. I only have the idea that obesity is the
main reason for the disorders but I hardly can understand what my body weight has to do with
these ailments. Strange!
N: It is really sad to know how much suffering you are going through these years. What are the
main barriers that you have faced while managing for your disorder.
Mr. X: I don’t know… I often feel demotivated. I do not know what the medications are for and
why I am taking the medications. I often get confused…I tend to forget them someday and then i
feel not getting up and taking them again. And that glucometer… I even do not know how that
works….If I do not know about them, how can I manage taking them? And yes…. The

10
CHRONIC AILMENTS
community care center is too far. It is not in the community and then I have to request my
neighbor to drive me there. I do not like disturbing people. And again, I cannot drive. My legs do
not work properly and even my eyes….Oh god! It’s high time for me to leave earth.
N: I really feel bad Mr. X. don’t you reach out for support services to aide you in your
difficulties
Mr. X: yeah yeah. I visit the GP. However, he is of very little use. I don’t like him even. He has
no time for me and completes my check up within 5 minutes. And every time he repeats the
same thing of taking medications. I don’t think he can help me in any way. And I take the help of
social workers. However, he also told me i need good care treatment planning to overcome my
suffering.
N: okay, what role does the healthcare team play in your disorder management?
Mr. X: until now I have not approached anyone. However,. My neighbor says that i would need
the support of full healthcare teams. He tells that since I have huge number of health issues, I can
be only helped my efficient healthcare teams. Can you help in getting me in touch with one?
N: sure! In what way do you think a healthcare team might help you?
Mr. X: I am not sure. I need to develop a better quality life. I need someone who can help me
overcome all my issues so that I can gain back my independence. I need them to provide me a
comprehensive treatment that not only develops my chronic health conditions but also make me
live better quality life.