Biophysical and Psychosocial Processes in Elderly Patients: Case Studies

This article discusses case studies of elderly patients and their biophysical and psychosocial processes. It also covers assessment tools and care priorities for each case. The subjects include hypertension, cognitive decline, social isolation, arthritis, and fall risk.

Running head: CASE STUDY
Case study
Name of the student:
Name of the University:
Author’s note

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Case study 1.
Read Rob’s story, outlined on page 325-326 of your course textbook (Scoot, Shannon & Davies,
2017, p. 325-326).
Discuss the biophysical and psychosocial processes pertinent to the case.
Rob Cameron is an 81 year old retired man who lives with his wife Margaret in coastal
town in rural New Zealand. The review of Rob’s story shows that he has been diagnosed
with hypertension and is becoming increasingly forgetful. Rob also became distracted
while driving a car leading to injuries. Hence, he seems to suffering from cognitive decline
too. Both his health issues are linked to the biophysical process of ageing. This can be said
because hypertension is most commonly found in elderly population and the biophysical
changes associated with ageing increases the risk of hypertension (Rajpura and Nayak
2014). Ageing is a process that results in gradual decline of physiological function of all
organ system and inability to resolve inflammation process during ageing results in
oxidative stress and vascular dysfunction (Buford 2016). Hence, these changes might also
be the reason for increase in systematic vascular resistance and increase in blood
pressure for Rob.
The psychosocial process that is pertinent to the case is that Rob’s forgetfulness and
cognitive decline has affected his ability to do daily task. kazazi et al. (2018) supports the
fact that age associated changes lead to cognitive decline and low level of functioning.
This can affect independence of people and impair health related quality of life. Hence, as
Rob’s symptoms shows risk of dementia, it is necessary for proper assessment and
treatment so that Rob can lead a normal life.
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
The Montreal Cognitive Assessment tool (MoCA) is appropriate for Rob’s case because
assessment of his cognitive function is necessary to reduce risk of injury and other
negative events for Rob. It is a cognitive screening tool used for mild cognitive impairment
and the test is done by brief 3- question test. The tool mainly assesses different type of
cognitive functions such as orientation, short term memory, executive function, attention
and mental state. The scoring range from 0 to 30 and score of 26 and higher is considered

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normal (Debert, Benson and Dukelow, 2013).
Discuss 3 priorities of care for this person.
The three care priorities that is necessary for Rob are:
1. The first care priority is to encourage patient to start taking the prescribed
antihypertensive medication to reduce risk of other health complications. Health
education about hypertension can improve Rob’s attitude towards treatment and
improve adherence to the medication too (Lo et al., 2016).
2. The next care priority is to reduce risk of injury and fall in patient by conducting proper
assessment of patient and evaluating need for support in activities of daily living.
3. As Rob’s failing memory can create many issues for Rob, it is necessary to make
changes in his environment so that he can easily orientate with time and place.
Labelling every item, providing list of activities and maintaining his regular daily
schedule will reduce challenges because of cognitive decline (Jensen & Padilla,
2017).
Discuss any equity, rights and access issues relevant to the case.
While providing the above mentioned intervention to Rob, issue may arise in relation to patient
autonomy. As per ethical principles, maintaining patient’s right and giving them liberty to take
their own decision is important. However, if Rob does not agree to take anti-hypertensive even
after health education, then ethical conflict may arise as it would affect the principle of
beneficence.
Case study 2.
Read Dulcie’s story, outlined on page 370 of your course textbook (Samuelson, Crawford &
Alexander, 2017, p. 370.
Discuss the biophysical and psychosocial processes pertinent to the case.
The review of Dulcie’s case scenario suggests that after the death of her husband, John,
Dulcie has become socially isolated and depressed. She does not like usual activities that
she used to enjoy doing such as cooking meals for her family. She avoids meeting people

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and spends more and more time inside. Hence, loneliness and social isolation is regarding
as psychosocial change in Dulcie’s life which can increase the risk of depression in patient.
Social isolation is common concern in elderly and this can increase functional decline. This
occurs because of several physical, psychological and social role changes in the life of
elderly people (Shankar et al. 2017). In case of Dulcie, lack of close family ties after her
husband’s death and reduced connection with her cultural habits affected her ability to
actively take part in social activities. Hence, managing this change is necessary as Dulcie
can be at risk of depression too if treatment is delayed.
Biophysical issues have also been identified based on review of Dulcie’s story as she is
showing symptoms of failing memory. Change in memory is normal part of ageing.
However, some older people experience greater memory loss which may indicate risk
factor of Alzheimer’s disease (Parikh et al. 2015). This does not mean that dementia is a
consequence of old age. Several genetic and environmental factor increase risk of
dementia in old people (Kravitz, Schmeidler and Beeri 2012). Hence, failing to recall
events and take medications on time can create risk for Dulcie. This change in cognitive
decline needs to be properly assessed.
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
As Dulcie has avoided taking the meals that she enjoyed because of social isolation, she
might be at risk of malnutrition. Hence, the Malnutrition Universal Screening Tool (MUST)
can be used to evaluate nutritional health of client. MUST is based on list of simple
questions that inquire about current weight, changes in weight and any other health
condition that affects food intake. Based on the scores obtained, the person is identified
at risk of low or medium or high risk of malnutrition (Bernoth and Winkler 2016).
Therefore, this tool can help to identify the degree to which Dulcie is malnourished.
Discuss 3 priorities of care for this person.
The following care priorities are necessary for health and well-being of Dulcie:
1. As Dulcie might be at risk of malnutrition as she now finding the normal cooking
process as tiring, it is planned to provide proper nutritional support to her. This
can involving monitoring daily fluid intake and providing access to drinks. Her daily
nutritional requirements must be checked too (Bernoth and Winkler 2016).
2. As Dulcie is socially isolated, reducing her social isolation is necessary to reduce

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risk of ill-health and depression. Engaging her in social activities and physical
exercise is necessary to distract her from her grief and increase her motivation
towards social activity. Engaging in cognitively stimulating activities and group
activities can promote psychological well-being of older clients (Zhang et al. 2018).
3. As Dulcie has been forgetful, this may affect her ability to manage daily activities
and engage in self-care. Hence, it is necessary to make changes in the home
environment of Dulcie so that she is reminded regarding her daily schedule on
time. Providing reminder device and keeping home clutter free can reduce risk of
fall too (Jensen & Padilla, 2017).
Discuss any equity, rights and access issues relevant to the case.
While providing nutritional intervention, issue may arise because of cultural preference towards
food. Not respecting her cultural preference may violate patient’s right to autonomy. Hence, this
needs to be considered.
Case study 3.
Read Betty’s story, outlined on page 389 of your course textbook (Robson 2017, p. 389).
Discuss the biophysical and psychosocial processes pertinent to the case.
The review of Betty’s case revealed fall as the major issue for her. Multiple falls in the last 12
months has affected her ability to engage in household duties. Some of the other physical issues
that have increased her fall risk include feelings of dizziness, arthritis and low vision. The issue of
arthritis is linked to the biophysical process of ageing. Arthritis is regarded as an age related
disease because aging increases the susceptibility to osteoarthritis because of aging of the musco-
skeletal system. This occurs because cartilage becomes more brittle and normal bone structure
loses (van Onna and Boonen 2016). Another issue leading to high risk of fall in Betty is the use of
blood pressure medication. Anti-hypertensive drug is most commonly used in older adults.
However, it is associated with an increased risk of serious fall injuries because of harmful
biophysical effect of the medication. Gait impairment, dizziness and postural hypertension are
common adverse effects of anti-hypertensive medications and as Betty takes this medication too,
it is likely that she is might feeling dizzy because of the blood pressure medication (Tinetti et al.
2014).
The psychosocial issue that is evident in the case is the risk of social isolation because of Betty’s

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inability to move and fear of getting out. Lack of physical activity and social activity can have
detrimental effects on health and increase risk factor of all-cause morbidity and mortality. It can
also increase the risk of cognitive decline and mental health conditions like depression and
dementia (Landeiro et al. 2017).
Identify an assessment tool appropriate for use in this case and discuss key elements of the tool.
As Betty has increased risk of fall, assessment of fall risk is most important to determine whether
the degree of risk and the kind of treatment needed by her. The Peninsula Health Falls Risk
assessment tool (FRAT) can be used for assessment of fall. It is a common tool used during fall
screening where assessment is done on the basis of fall risk status, risk factor checklist and action
plan. The fall risk status is determined by risk scores and risk factor checklist assess whether risk
factors of fall is present in patient or not. The final process is the development of problem list and
appropriate intervention strategies for those problems (Bernoth and Winkler 2016).
Discuss 3 priorities of care for this person.
The three care priorities for Betty are as follows:
1. As Betty suffers from troubled walking due to arthritis, repositioning patient is important
so that pressure on tissue is reduced and circulation is promoted. In addition, increasing
physical activity is necessary as extreme physical inactivity can lead to permanent gair
impairment (Knittle et al. 2015).
2. The second most important care priority is to prevent fall risk by providing walking aid to
patient and supporting patient during activities of daily living.
3. As Betty experiences dizziness because of taking blood pressure, she should be given
education regarding not standing up immediately after taking the medication. She should
also be encouraged to directly report about to physician if dizziness persists for longer
time. Regular monitoring is also important to prevent injuries and future falls for Betty.
Discuss any equity, rights and access issues relevant to the case.
While providing assistance during daily life activities, violation of patient safety and dignity might
arise as Betty needs to be provided physical support during walking. However, as per cultural
consideration, the patient may not like close contact. Hence, support needs to be provided by
taking permission and handling the patient in a professional manner.

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