Instructional Strategies: Case Studies

Case Study 1

An 85-year-old Japanese-American woman has resided in her apartment independently since her husband passed away 10 years ago. She has no children or known relatives. Over the years, her osteoarthritis has limited her abilities to cook and clean her apartment.

The concerned landlord has her seen by the geriatric consultative service at a nearby hospital. In the process of evaluation by the geriatric interdisciplinary team, the geriatric social worker has arranged for a hired Caucasian caregiver to cook and clean for her.

After the first several visits by the hired caregiver, the Japanese-American woman indirectly tells the caregiver that her apartment has been quite clean because of her and that for now she can do well without cooked meals. She tells the caregiver to take a break.

When the Japanese-American woman visits the geriatric clinic in follow-up, she is found to be weak and exhausted, having lost about 5 pounds. She is also noted to have some bruising on her knees.

On further respectful questioning, the Japanese-American woman reveals that she has been having diarrhea since the caregiver started cooking for her. This stopped when she asked the caregiver to take a break. When asked about the bruising of the knees, the Japanese-American woman explained that she has been kneeling to clean the floor but has stopped doing this since the caregiver has taken a break.

	Questions for Discussion
	1. What might explain the gastro-intestinal symptoms, this elder was having? 2. What might have led this elder to clean the floor so much after the caregiver started to come? 3. What are some etiquette issues in the home to consider when visiting a Japanese elder?

Suggestions

One consideration is the possibility of lactose intolerance. Lactose intolerance is prevalent among Japanese. It may be that this elder did not want to offend the caregiver and ate whatever was cooked, even if she did not like the food because traditional Japanese elders avoid offending others. The other consideration is home etiquette when visiting the home. Did the caregiver remove her shoes? Did the Japanese-American elder kneel to try to clean or “purify” her apartment thus sustaining bruised knees, especially if the caregiver “contaminated” the floor with her outside shoes? The elder may not have been able to ask that shoes be removed prior to entering her apartment for fear of offending the caregiver.