Case Study 2

Case Study 2: Mrs. T.M.

Mrs. T.M., an Alaska Native patient/client in her early 80s was referred to the Primary Care Physician for a health assessment. She recently relocated to an Assisted Living Home away from her village in St. Paul Island where she was born and raised due to a lack of local resources in her community.

It is customary for a community member to accompany elders from St. Paul when they are sent to Anchorage. In Mrs. T.M.’s case, she has extended family members who live in the Anchorage area who support her. Other than the forced relocation during WWII, she has only been away from St. Paul for medical check ups. She can speak English but is more comfortable speaking Aleut, her native language. Mrs. T.M has been married for 55 years, but because of her husband’s poor health, he cannot travel with her.

It is considered customary not to separate older adult couples. The Assisted Living staff reports that she has been mostly silent, refuses to eat, and does not make sense because she talks off the subject. She was recently diagnosed with advanced heart disease. When being examined, she does not look directly at the physician, stealing only quick glances, and holds her arms tightly around her upper torso.

Questions for Discussion

1. What do you think may be affecting Mrs. T.M.’s communication patterns? What could be impacting her attitude and demeanor toward the physician? 2. What strategies might the primary care physician use to develop rapport and trust and enable Mrs. T.M. to participate in planning her care at the facility? 3. What strategies might the physician use to talk about the severity of her condition and end of life issues, such as having an advance directive? 4. In addition to Mrs. T.M.’s health history, what other relevant information would you wish to include in the geriatric assessment? 5. If you were a clinician on Mrs. T.M.’s unit, what would you include in the care plan to reduce cultural isolation?