Case Study Presentation

Click to edit Master subtitle style Fairuz Abdul Rashid

Phase III MBChB University of Aberdeen

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Outline
Medical details Social details Current care details Public health Occupational/Environmental Health The Future

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Patient Details
Mrs JP 2 visits (alone and with pysiotherapist) 87 years old Lives in Inverbervie Diagnosed with Osteoarthritis in 2003

1996 first back pain 2003 knee pain, lower limb stiffness lumbo-sacral facetal joints degeneration 2004 low back pain, right hip stiffness and pain
A few falls and progressive immobility

throughout the years

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Osteoarthri tis
The repair process

cannot compensate localised loss joint failure vary from minimal to severe pain and stiffness No cure exists at present but treatment is available to ease symptoms and reduce the likelihood of the disease progressing Management - a combination of exercise, lifestyle modification, and analgesics (BNF 2011, NICE 2008)
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Symptoms can

Past Medical History

2011 Lung Infection (hospital admission) 2010 Stage 3 Chronic Kidney Disease 2009 Hernia 2001 Pyloric Channel Ulcer 1999 Hypothyroidism 1998 Essential Hypertension Cataracts Seborrhoeic kerotosis Alopecia
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Drug History
Osteoarthritis RCTs - paracetamol Paracetamol Evidences

is efficient in knee osteoarthritis, with less evidence of Aspirin other sites. Past medication
Ibugel Co-codamol (intolerable The long-term safety data onconstipation) due to paracetamol

are reassuring.

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Drug History
Omeprazole Levothyroxine Alendronic acid (as sodium salt) Calcichew Aqueous Cetirizine Furosemide Salbutamol (inhaler) Betamethasone valerate
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Social Details
Lives with a son, in a single storey semi-

detached house
v

three steps at the front and at the back

Husband died in 1998 Parents had bad knees and back pain

possible FH? and feed

Dependent on son and carers to wash, dress Activities of daily living

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Mobility v Zimmer walker inside the house v unconfident to go outside due to limited

mobility

Continence v mobile to toilet, pads for safety v bowel fully continent Sensory v poor vision, loved to read but unable

nowadays v Bilateral deafness hearing aids

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Zimmer walker

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Psychosocial
v

strained relationship with son, no other immediate family nearby a friend from Stonehaven comes to visit once a week social isolation Im just a lonely old lady not getting enough emotional support

v v

Mood and cognition

v

frustrated and irritable with the deterioration of her lower limb ability signs of depression Its my time to go yet Im still here 4/14/12

Current Care Details

son cares for her during weekends

(weekdays working in Stonehaven)

v v

care assistants - twice a day on weekdays

morning get dress, breakfast afternoon meal house keeping and grocery

houseworkers 2 days per week

v

went to nursing home while son was on

holiday

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Primary Healthcare Team

General Practioners
v v

Home visit and treating co-morbidities Referral to other members of the team or appropriate specialities for care Prescribing and medication review

Physiotherapy
v v v

Management for long-term disability Physical methods to promote healing Facilitate patient through remedial exercise
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Occupational Therapy
v

Improve, sustain or restore the highest possible level of independence using specific, purposeful activity Home assessment
v

Rails, level access shower

District/Community Nurses
v

Acute and chronic disease management tailored to the patient's needs Annual geriatric (over 75s) assessment Skin and wound care
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v v

Bathroom

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Optician
v

Carry out sight tests to check the quality of patients vision and eye health Look for signs of eye disease Prescribe and fit glasses

v v

Community Pharmacy
v

Provide information to patient on how to manage her medicines to ensure optimal treatment Prepare Dosette box

Podiatrist
v

Assess, diagnose and treat abnormalities and 4/14/12 diseases of the lower limb

Public Health - Public Implication

8.5 million people in the UK are affected by joint pain

that may be attributed to osteoarthritis (Arthritis Care 2004)

Every year 2 million adults visit their GP in the UK

(Arthritis Research Campaign 2002)

In Scotland, a total estimate of around 80,000 patients

(ISD Scotland 2011)

Over a 1-year period there were 114,500 hospital

admissions in the UK (Arthritis Research Campaign 2002) year (ARMA 2004)

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Total cost estimated as equivalent of 1% of GNP per

Occupational/Environmental Health
Occupational
v v v

Stop driving in 2003 Led an active lifestyle before mobility became limited In 1999/2000, 36 million working days were lost due to osteoarthritis alone, at an estimated cost of 3.2 billion in lost production (ARMA 2004)

Income support
v v

Retirement pensions Sons wages

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The Future
Condition might worsen Well-supported physically but not mentally and

emotionally

Psychiatry evaluation Befriending? Nursing home? Ethics How far should we go to help patients? Where do we go from here?

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References
Arthritis and Musculoskeletal Alliance (ARMA).

Standards of Care for People with Osteoarthritis. London: ARMA; 2004. Care; 2004.

Arthritis Care. OA Nation. London: Arthritis Arthritis Research Campaign (ARC). Arthritis:

The Big Picture. London: ARC; 2002.

ISD Scotland. Statistics on Patient

Consultations in General Practice for Osteoarthritis. Edinburgh: ISD Scotland National Statistics release; 2011. 4/14/12

Thank You!
Questio ns?

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