Learning Activity 3: Case Study

Dementia in an Oklahoma Choctaw Woman

You have been called to make a home visit. In so doing, you find the situation described below—

Mrs. Mary Maytubbee (pseudonym) is extremely angry and yelling at her husband to stop having sex with that African-American woman right in the living room in front of everyone. Her granddaughter assures her grandfather by saving, “That’s not her,” meaning that normally his wife would not talk to him like that. Another granddaughter will not visit the house again because the grandmother had noticed her entry to the room and then loudly asked, “Who’s that Jersey cow over there?”


Mrs. Maytubbee lives in a remote part of Oklahoma where the greatest density of monolingual Choctaw speakers reside. This community is a holdover from the early 1800’s when the Choctaws were forced from Mississippi to Indian Territory. The more acculturated Choctaws settled along river basins and farmed while those with less integration with whites went to the remote mountains of eastern Oklahoma.
As you drove through the community, you see that it is marked by two wood- framed stores with a gas pump in front of one. The pavement from the main road stopped a mile back, leaving the front of the store’s opening onto dirt streets. On your last visit to “town” there were three horses being ridden and two cars (one was yours). Yet, for all its pristine isolation, there are satellite TVs and VCRs everywhere. The Choctaw Nation’s only hospital is one hour and fifteen minutes from her house.

Mrs. Maytubbee lives with her husband in a two-bedroom house. The husband is generally well with a good functional status. He does not work any longer. However, he does not respond well to his wife’s condition. He says that any time he tries to help her, she screams at him and is always upset with him. Her social network consists of mainly her husband and her granddaughter who is an IHS community health worker (CHR) for that area. Another granddaughter is estranged from her. Both granddaughters live on adjacent parcels of the family’s allotment lands. There are great grandchildren, but they are very young.