Analyzing Fred's Occupational Dysfunction: A Case Study Report

This case study analyzes the occupational dysfunction of Fred, an 84-year-old man, focusing on the impact of osteoarthritis and depression on his daily life. The report explores Fred's challenges after moving to residential care, including physical limitations and mental health issues such as lack of energy, reduced activity, and feelings of isolation. The discussion incorporates the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to diagnose Fred’s depression. The case study further examines the application of occupational therapy models, including the Model of Human Occupation (MOHO) and the Person-Environment-Occupation (PEO) model, to understand and address Fred's occupational performance limitations. The report also considers the Doing, Being, Becoming and Belonging model and the influence of Fred’s brother. The analysis highlights the significance of social interaction, meaningful activities, and environmental factors in supporting Fred's well-being and promoting his engagement in occupational performance.

Running head: CASE-STUDY
Case-study
Name of the student
Name of the university
Author’s name

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Introduction
The following report is a reflection of the case study of Fred who is an 84-year-old man.
This report will discuss symptoms of Osteoarthritis and depression and will describe the life
change experience after shifting to residential care.
Discussion
Osteoarthritis/Physical health
Osteoarthritis is the most frequent form of arthritis which affects millions of individuals
worldwide especially the people above the age group of 50 (Glyn et al. 2015). Evidence suggests
that osteoarthritis occurs when the layer involving the protective cartilage that supports and
covers the ends of the bones starts to disrupt throughout time. Even though having osteoarthritis
can impact any kind of joint, but it especially affects the joints in the wrists, knees, hips and
spine. The term osteoarthritis can be divided into three words osteo – bone; arth – joint; itis –
inflammation (Glyn et al. 2015).
As a matter of fact, the game of cards is played using the palm and the fingers. Thus,
when Fred plays cards, he is likely to face pain in his finger joints along with stiffness in the
affected area.
Pain
The paper by Tekeoglu, Dogan, Ugras and Sag (2017) suggests that during the early
osteoarthritis there is a formation of knobby bony deformity at the smallest joint of the end of the
fingers which is also known as the Heberden's node. The paper also showed that osteoarthritis

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mostly impacts three parts of the hand which are the joint between the thumb and the wrist;
joints which is very much near to the fingertip and the joint in the middle portion of the finger
(Tekeoglu, Dogan, Ugras and Sag 2017).
Evidence has stated that the osteoarthritis and multiple sclerosis have a connection
between them. Thus, when Fred plays cards he needs to move his thumb, fingers, wrist and the
hand, as a result, a stimulus is released which directly goes to the brain and tells that it is hurting
when playing cards or moving the joints (Feinstein, Magalhaes, Richard, Audet and Moore
2014).
Stiffness
Similarly, like the pain, when Fred plays cards, the hand movement gets restricted
because of stiffness. While playing, there is a consciousness running behind the mind which is
unknown to Fred because the brain knows that moving the hand will cause pain and thus, the
brain sends sensory signals to the hand through the central nervous system (CNS) and as a result,
the hand dexterousness, synchronization, and strength gets impacted and get limited and
eventually the hand becomes stiff.
It has also been seen that multiple sclerosis causes limitation of hand movement and
causes stiffness. One of the major indications of the multiple sclerosis is observed as a loss of
hand dexterousness. Fine-motor skills may degenerate or start to fade away. Fred will start
experiencing challenges while doing an occupational performance, for instance, lifting up the
cards or any other object, shuffling the cards, will face difficulty when writing or buttoning
clothing, or may face difficulties when eating using the utensils such as a spoon. Multiple
sclerosis (MS) can also cause pain, weakness in the muscle tissues, tremors, and difficulties with

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hand-eye coordination. Though, when playing the game of cards, Fred may suffer from other
joint pains like in the neck, hip, lower back, knees and other joints.
Depression/Mental health
When a person loses all his abilities to do regular daily activities, it causes a rise in
mental issues. The mental health is described by how a person thinks; feels and acts. Depression
has been considered as the most frequent psychological disorder which hampers the quality of
life (QoL) of several people worldwide. Depression negatively impacted the feelings of Fred thus
he used to miss Albert and eventually it hampered his decision making process and his behavior
(American Psychiatric Association 2015). When people start getting depressed, it makes them
sad and they lose interest from different activities, even from those activities which were their
favorite. Thus, it caused many emotional (moderate depression) and physical challenges
(Osteoarthritis) which limited Fred’s capacity to perform accordingly in the residential care such
as he stopped playing cards and wanted to play the game of cards using his lucky deck of cards
and Albert. Diagnostic and Statistical Manual of Mental Disorders (DSM–5) considers that lack
of energy and reduced activity are the major and most experienced symptoms of depression
(American Psychiatric Association 2015). When the person experiences depression, they start
losing their self-esteem along with which they also feel guilty and lose hope and meaning of life.
As self-confidence gets reduced it eventually decreases self-esteem, decreases inner certainty and
power (Parker 2014).
Lack of energy
Depression can have a serious effect on the quality of life as it disturbs the flow of life
(Sehlo and Kamfar 2015). Because of the lack of energy, Fred was feeling demotivated and lost
all his energy from participating in occupational performance. Due to pain in his joints, his level

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of energy decreased and it gave rise to fatigue in Fred which made him less active both mentally
and physically. Cognitive function and quality of life of Fred were also hampered. He
consistently started missing Albert and his lucky cards, which made him restricted from the other
residents who wanted to play with him. Due to his moderate depression, he lost the energy which
would have helped him in building a healthy relationship with the other members in the
residential care.
Additionally, moderate depression started affecting Fred’s performance in the
occupational performance, as a result, his concentration levels and productivity got hampered.
Hence keeping depression unchecked in one's professional and personal life will trigger several
other implications. That's why looking for support is so critical, not only for relations and
employment but for their purpose.
Reduced activity
In the case study, it was demonstrated that how moderate depression hampered his
occupational performance. Depression in Fred caused him to lose interest from everything which
he used to and also what he used to love to do. Like when Albert used to be around him, Fred
used to play the game of cards using his deck of lucky cards. The behavioural model of late-life
depression demonstrates that cognitive function, loss of interest and changes in the physical
health such as osteoarthritis which was being experienced by Fred cause limitation of activities
or reduced activity (Rodda, Walker and Carter 2011). As a result, the rate of positive outcome
decreases. Additionally, reduced activity started hampering Fred’s performance in the
occupational performance, as a result, he lost interest from his favorite activities such as card
games and also it hampered his productivity.

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Experience at residential care
Resettlement such as going to a residential care home is often a difficult process,
including multiple influential threats including lack of privacy, which could have a significant
impact on the person's life, mainly in terms of the environment and meaningful jobs (Milte,
Shulver, Killington, Bradley, Ratcliffe and Crotty 2016).
According to the push-pull model of relocation, it has been demonstrated that the
decisions or the choices of relocation for the older people to the residential care are imposed
rather than informing them about the decisions (Smetcoren, Donder, Dury, Witte, Kardol and
Verte 2017). Similarly, in the case of Fred, it has been stated that he was moved to residential
care without his willingness since he was not coping with his mental and physical health in the
home. But, since he does not have anybody else other than his brother in the family, he feels
depressed (Reed, Cook, Sullivan and Burridge 2003).
Along with that, it is also seen that people who have been sent to residential care either
forcefully sending them or with informed consent sending them, they often miss their family
members a lot. This makes these people create a gap between the residents of the residential care
and between them. Just like in the case study, Fred was missing Albert since he is his only
brother and only family, and along with that, he used to play a game of cards every time. But
after shifting to the residential care, Albert has not been able to come and meet Fred since Albert
cannot get a direct bus for the nursing home, and he does not have anyone who will take him to
see Fred.

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MOHO
A specific (OT) model that guides OT intervention is the model of human occupation
(MOHO). The Model of Human Occupation (MOHO) tries to demonstrate how people get
encouraged toward activities and choose to do things in their way in everyday life and their
abilities (Maciver et al. 2016). In the MOHO model, integrated elements such as volition, habit,
and output potential are interpreted within relation to the impact on behavior of the physical and
social environments. Volition can be described as the encouragement and reflection of the
occupation, for instance, the interest and values of the people (O’Brien 2017). Habituation can be
described as the procedure by which activities are planned into the daily life routine, and
performance capacity is described as the capability to do things. As a function of the interface
among the individual components (volition, habituation, and performance capacity) and the
environment, skills are utilized; these skills are noticeable and goal-directed actions. According
to the MOHO model, it can be suggested that a better contact should be built between Albert and
Fred or he can be given his lucky deck of cards which would increase his interest and encourage
him to again participate in the game of cards. Using the habituation method, Fred should be
made to join the game of cards which are held on the evening of Friday.
PEO
The Person-Environment-Occupation (PEO) model focusses on different aspects such as
person, environment, and occupation and its impact on the occupational performance. All this
three aspects are dependent on each other. Concerning the PEO model, person can be related to
Albert who was a very close and important person to Fred. Environment can be related to the
residential care and occupation can be related to the card playing game. Thus, the PEO model
states that any of the aspect missing from the whole model can affect the wellbeing of the person.

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In the model there are few intrinsic factors associated with the model (Maclean, Carin-Levy and
Hunter 2018). Such as, the physiological factors are linked the health of the person. The
endurance, flexibility and movement are linked to the physiological factors. Though, in the case
of Fred, it can be seen that he is unable to move because of his osteoarthritis condition. Along
with the physiological factors, there are cognitive factors which are important to communication
and also learning. But, for Fred, his depression and cognitive impairment restricted him from
properly interacting with the residents of the residential care (Maclean, Carin-Levy and Hunter
2018).
Doing, Being, Becoming and Belonging
It is a significant part of life of a person, while completing tasks with different people
within the community. This model has been developed by Ann Wilcock in 1999. It involves four
aspects. Doing, is an important part of being a person. It is usually to produce some end-product.
Like in the case study, playing card games and having fun with the residents was the end product
for Fred. Being refers to the reflection of a person and occupational performance is a reflection
of this. Becoming refers to participating in a task and growing into a person destined to be.
Belonging refers to participate in a task with other members and try to belong in that group to
accomplish the task. Actions of Fred, involving with others during the card games shows what he
is becoming, how well he belongs in the group of residents, and all of this reflects what kind of
being Fred is becoming (Ennals, Fortune, Williams and D'Cruz 2016).
Conclusion
Since Fred has been reluctantly been shifted to the residential care, which is why he is not being
in a mood to do anything. Also, since he is too old and being depressed along with having

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osteoarthritis, he does not feel like participating with others in the card games. He is missing
Albert very badly and wants to play with the lucky pack of cards. Also, since Fred is now in a
stage which is near to the death stage, that is why he does not feel like leaving away from the
things which likes. Thus, it can be concluded MOHO, PEO and Doing, Being, Becoming and
Belonging model is a successful model which will help in enhancing a successful transition of
residents into the residential care setting.

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References
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