Group Assignment: (due by 1700 on November 29)

This group exercise covers two vulnerable populations: the elderly and the chronically ill.  There is a lot of material to cover in this last unit, so please plan ahead.

Individual portion: If you are not a facilitator for this assignment, you will complete the exercise individually before sharing it with your group. After you have completed your individual assignment, share it by posting it in the group discussion area designated for your group on the discussion board. All individual portions of the assignment must be posted by three days prior to the due date for the group assignment. Your unit 6 group summary assignment is due by 1700 on 11/29/06. This means you will need to have your individual responses posted on the discussion board by 1200 on 11/26/06.

IMPORTANT: Individual work posted after the individual response deadline will not be incorporated into the group assignment summary, therefore, the individual student will receive a zero for that group assignment.  At the discretion of the faculty, individual work posted after the individual response due date but before the group summary assignment due date may be considered for partial credit not to exceed half of the assignment points. 

Facilitator portion: Your group facilitator for this assignment will be responsible for summarizing your groups' individual contributions and posting a summary on the discussion board in the area designated for your group. The facilitator is not required to post an individual response, although it is encouraged in order to assure thoughtful and participatory interaction with the group. The facilitator may pose questions for clarification to individual members, so it is very important that all group members remain active participants in the group's sections on the discussion board until the group summary is completed and posted. The group summary is what will be graded.  Please indicate group contributors and non-contributors on your submitted group summary work.

Vulnerable Populations: The Elderly and the Chronically Ill Populations

Case Study

Frail elders have multiple complex problems that put them at risk for institutionalization. Frail elders are more likely to: be over 75, be hospitalized within the last 3 months, have abnormal lab values, require assistance with ambulation, be malnourished, and require multiple medications. Frail elders require a holistic assessment, not just a complete physical assessment. Using the information provided in your readings and the case study provided below, respond to the questions at the end of the case. 

Mrs. Smith

Mrs. Smith an 82-year-old widow, was referred to a home health agency following hospitalization for her congestive heart failure. The referral information included the following diagnoses: congestive heart failure, hypertension, insulin-dependent diabetes, retinopathy, and periods of dizziness and confusion related to transient ischemic attacks. The physician’s referral requests teaching related to medication changes.

The home health professional (HHP) arrives the day after Mrs. Smith was discharged from the hospital. She arrives at 12:30 to find Mrs. Smith in her nightgown. The HHP enters to find an extremely cluttered home. The HHP has difficulty walking around the living room, kitchen, and bedroom because of the clutter. There are numerous prescription medication bottles everywhere: on the coffee table in the living room, on the bedside table in the bedroom, on the kitchen table, and in the medicine cabinet. Mrs. Smith is legally blind and says, "Oh, I know which pill to take, I knows by the color. I don’t want to get rid of any of my medicine -- it is too expensive -- I keep it in case my doctor changes my medicine again." Mrs. Smith is unable to name any of the medications that she is taking. When asked which one is her Lasix she replies, "Oh, I think it is the little blue pill."

The HHP also discovers dirty dishes piled on the kitchen counter and in the sink. She discovers that the gas stove has been left on -- Mrs. Smith forgot to turn the burner off after cooking breakfast. There are cockroaches everywhere. There are water stains on the living room wall and ceiling from the last storm. The steps into Mrs. Smith’s home are in disrepair. There is a broken window that Mrs. Smith has covered with plastic bags.

A physical exam indicates that Mrs. Smith has a blood sugar of 165. Her blood pressure is 185/110. She has an infected toenail on her left foot. She says she hurt her foot when she fell last week.

Mrs. Smith has a nephew that lives 45 minutes away and comes by once a week. He buys her groceries and fills her insulin syringes. She has no other family. Lifelong neighbors who used to help her have recently moved to an assisted living facility.

Case Study Questions:

Using the Ecology of Human Performance Model answer the questions below. Be specific as to your plan and include all of your considerations.:

1. What other information might you wish to know about Mrs. Smith? 
    
2. What factors are influencing the health and well-being of Mrs. Smith?
    
3. What suggestions do you have for the care of Mrs. Smith?  List 3 primary, secondary, and tertiary interventions for Mrs. Smith.
    
4. What community services would be helpful in this situation?
    
5. To what agencies or services would you refer Mrs. Smith to obtain the desired outcomes of care?
    
6. Will she likely follow-up on these referrals?
    
7. How can you facilitate follow-up to be certain that she receives the care you recommend?

Population Case - Elderly

Mrs. Smith recently moved into a high rise apartment building that is home to 185 elders. You are a public health professional responsible for the health promotion and disease prevention needs of the residents of this high rise. How would knowing the leading chronic conditions and leading causes of death affect your practice? What other considerations should influence a health professional's approach to chronic disease management or health maintenance in the elder population? How would you assess this elderly population in the high rise to determine their health risks? How would their health risks or conditions affect the elders' satisfactory life participation? Describe some primary and secondary prevention interventions that you would consider implementing with this population. 

Population Case - Chronic Health Problems (younger adults or children)

Chronic health problems include disease entities, injuries with lasting consequences, and other enduring abnormalities that affect people across the lifespan. Children and younger adults may develop the diseases of asthma, diabetes, or arthritis; chronic disability due to motor vehicle accidents, or a mental health problem such as chronic depression.

As a group, select a chronic health problem of your choice that affects a population of children or younger adults.  Using the Dimensions Model of Community Health, answer the following questions:

    a. What are some of the personal effects and population effects of your selected chronic health problem?

    b. What are some of the biophysical, psychological, physical, environmental, socio-cultural, behavioral, and health system factors that influence the development of your selected chronic health problem?

    c. Write two objectives or health outcomes targeting your populations' selected chronic health problem.

    d. Identify at least one primary, secondary, and tertiary activity or intervention that might be appropriate in dealing with your selected chronic health problem.

    e. How would you evaluate the outcome of your interventions for this population?