Page 1

Running head: OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

Occupational Profile and Analysis: Anita Casey Walker

Touro University Nevada

1


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

2

Occupational Profile and Analysis: Anita Anita is a 77 year old woman that is a resident at the Merrill Gardens Assisted Living Facility for older adults. She is the mother of four grown children, two boys and two girls, three of which live in the Las Vegas valley and assist her with her needs. She is divorced and lives alone on a one bedroom plus a den apartment at the facility. Anita has dry macular degeneration, is borderline diabetic, has Parkinson’s Disease (PD), and suffers from a chronic low back injury. The combination of the conditions has pushed Anita to seek occupational therapy services and hire a personal care assistant. Anita’s PD is at an early stage, is well managed by medications, and does not cause much impairment in function. The chronic low back injury causes a significant amount of pain which causes fatigue in many activities and will sometimes exacerbate the PD tremors. For the most part, Anita is good about resting adequately and utilizing a walker or a cane for functional mobility in efforts to conserve energy. Anita has concerns regarding independence in her meal preparation, home management, financial management, medication management, social participation, and leisure activity participation. Currently, Anita is struggling in all of these areas and is not achieving success in any of these areas independently. All of these activities of daily living (ADL) and instrumental activities of daily living (IADL) are important areas of weakness and concern for Anita. Currently, Anita is trying to regain control of her weight so that she can avoid becoming diabetic. To accomplish this goal, Anita acknowledges that she must avoid eating in the dining room at the assisted living facility because she is unable to resist the additional breads and desserts provided. She noticed that when she prepared meals at home she was more successful in her weight loss goals; however, she is restricted in her cooking due to her severe vision impairment. Her macular degeneration has resulted in complete central vision loss, decreased


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

3

visual acuity, and inability to read which makes it difficult to read the directions on a recipe or TV- Dinner and see which settings on the microwave she is pressing. In addition to her meal and nutrition management, Anita has concerns about maintaining her home and care for her two cats. She has expressed that although the facility she lives in will provide more home maintenance, she wishes to be more independent, especially to save money. The more services that she requests the more monthly charges she will owe. The main chores that she struggles to complete are starting the dishwasher, the washer, and the dryer because she is unable to see the setting options and choose the right ones. Also, she takes care of her two cats by feeding them and giving them water. If she is tired or sore she has her son takes care of the litter box duties. She has expressed that this really bothers her because she wants to enjoy her son’s visit and not ask him to complete her household chores and it would make her happy to do all of these on her own. Next, her financial management is currently being taken care of by a personal care assistant (PCA). Anita has concerns about the cost of this hired help to come in a write her checks and read her mail to her. She would like to find inexpensive large print checks or a reading device that would assist her in being independent with these tasks and save her the ongoing cost of $20 per hour for the PCA. Furthermore, Anita’s deteriorating eye sight has caused safety concerns when taking her medications. She is unable to read the labels on the medication bottles. She has previously had her son write in large letters on the top of the bottle an abbreviated name for the medication but she can’t always read that either. Since she has pain medication for her back and a variety of Parkinson’s medications that need to be taken at a specific time, it is imperative that she does not


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

4

mix the medications up or forget to take one. Fortunately, this has not caused any major safety issues but this is a significant safety risk that she would like to have addressed. Last, but not least, Anita expresses some concern with her level of social participation and leisure activity enjoyment. She is in a signing group called Trouble Makers that she started 10 years ago. She adores meeting up and singing with the ladies each week. She is having a progressively more difficult time reading the music and during practices she is discouraged that she can’t follow along. She has been recording the music during practice and memorizing it so that she can still participate. At this point, Anita is happy she can join in the group but feels uncomfortable like she is keeping the group behind. Living in an assisted living facility such as Merrill Gardens, provides many different activities, although her inability to read the calendar prevents her from participating in many of the things that she would like to. Also, her vision impairment has made playing games more frustrating than fun. The facility hold an auction once a month that she would love to be a part of but her vision holds her back because she can’t see what is for auction. It is evident that these have caused Anita to be depressed. Despite the previously listed problem areas, Anita is very successful in many area of occupation. Anita is able to independently bathe and shower; however, it is important that her call button be nearby in case of a fall. Her significant vision impairments put her at an increased risk for falls. Anita is independent in bowel and bladder management, dressing, eating, feeding, personal hygiene and grooming, and toilet hygiene. Moreover, Anita is able to manage her communication with her Jitterbug telephone, arranges her own rides to get around the community when she needs to, participates in all the religious observances she wants, knows and practices safety and emergency maintenance in the facility. Anita does not complain of any


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

5

issues with rest and sleep preparation or participation, is retired and does not wish to be more involved with the community in terms of volunteer involvement. There are a few additional areas of occupations that are problem areas for Anita. They include personal device care. If a device that Anita is dependent upon breaks, she needs assistance to fix it because she struggles to see the device and the instructions. Since reading the instructions is not feasible, being able to fix or get personal devices running initially is something Anita needs help with. Next, Anita requires some assistance in the care of her pets since she is not always able to change the litter box by herself. She has found her children will help her with this task, although she doesn’t like to ask. As previously described, she is unhappy with her abilities to manage her health, prepare meals, and keep up her home establishment. She has been utilizing compensatory strategies as she can to get by but she would like services to assist her performance in these areas. Shopping is another area of struggling for Anita since she is unable to see the product labels and prices. She is determined to continue participating in her own shopping for as long as possible and goes once a week with her son. Her son is happy to help her pick out what she needs, read her the labels, and drive her to and from the stores. Last, leisure participation is a struggle for Anita because so many activities are based upon the visual system and visual input. For the most part, the assisted living facility that Anita is currently living in is very supportive to participation and engagement in desired occupations. There are a few inhibitory components of the facility that make it difficult to participate. These include the small writing on the monthly calendar of events and the small text written on the daily agenda that is sent out to all residents. These are too difficult for Anita to read which impacts her ability to participate in as many activities as she’d like to. Also, there are very few activities that are geared toward


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

6

visually impaired residents which make participating in the activities difficult. The facility has provided large versions of games but often times it is still too difficult to see. Anita has a history of working with special education services as a secretary for over 14 years. She then worked for 13 years in the education center as an administrative assistant. She remembers fondly working with the physical therapists, occupational therapists, and reading research to find adaptive strategies for physical education for the school district she worked for. She raised two boys and two girls that she is still very close with. She was divorced after 13 years of marriage due to abuse and prides herself on her independence. It is evident that her work meant a lot to her because it was a means to provide a life for her family after her divorce and she is most proud of the children she raised. Singing has always been her favorite leisure activity and she has been a part of singing groups throughout her life. Anita’s priorities and desired outcomes are to increase her independence and performance in some of the activities she does daily. She really wants to be able to prepare her own meals, even if they are microwavable dinners, tidy up her home, do the dishes, do the laundry, and clean up after her two cats. She would like to be able to balance her checkbook, pay her bills, and read her mail on her own so she doesn’t have to pay the PCA any longer. Although less of a priority for Anita, her medication management techniques should be improved to provide more safety. Lastly, her social participation in leisure activities is something very important to keep a part of her life. She expressed fear that she would not be able to keep up with her singing group and it is important for her because singing is her favorite thing to do.


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

7

Occupational Analysis After observing Anita tidy up her kitchen and try to start her dishwasher, it was apparent that the visual impairments caused by macular degeneration were causing her difficulty in choosing the settings. Fortunately, Anita’s mental, cardiovascular, and respiratory systems are all working very well. Anita struggles with some neuromuscular-skeletal and movement-related tasks due to her back pain and PD but it does not impede with her ability to complete the task, only sometimes slows her down a little. Anita has full sensory function and sometimes is held back from pain but during this activity exhibited no signs of pain. The activity demands for Anita to tidy up her kitchen, fill her dishwasher, and start the dishwasher were mild. The required skills and actions include opening the dishwasher, grasping the dishes that were mainly cups and bowls of light weights, and placing them in the dishwasher. Next it is necessary to put the detergent in the dishwasher, close the dishwasher until it clicks locked, choose a setting, and press start. There is a necessary sequence and timing to complete this task since it would not be completed successfully if not done in this order; however, Anita did not struggle with that aspect. Anita successfully completed all of the gross motor components of the activity and only struggled to find the setting and start buttons she wanted. Being able to clean-up her home and start the dishwasher is an important function for Anita. Over the years, this has become a habit of hers after each large meal and is a part of her role as the head of her house. These performance patterns are an important part in one’s confidence as an independent individual. The performance skills that are necessary for the task completion are primarily motor and praxis skills as it takes coordination to ben and reach to grab the dishes and manipulating to organize and arrange them in the dishwasher. Anita did not struggle with this aspect mainly because her body has compensated with more dependency on her sensory-


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

8

perceptual skills due to her lack of vision. She has a keen sense of touch and great stereognosis. This helps her to know how to manipulate the dishes and where to place them. The emotional regulation skills for this activity are to remain calm, stay persistent, and to not get overwhelmed. The cognitive skills necessary are sequencing the tasks in order to achieve success and selecting the correct tools to complete the task such as the correct settings and detergent. Anita was able to do all of these cognitively but needed assistance identifying where the settings she wanted were located on the dishwasher. Performance of this intervention would primarily affect Anita’s cultural and physical context. It is evident that she prides herself on keeping a neat and tidy home which is a part of an American culture. This clean physical environment also enables Anita to find peace and serenity in her home. Problem List Client is unable to prepare her own meals independently due to lack of visual acuity and visual field deficits to identify the instructions for microwave time and choosing the microwave setting. Client is unable to safely manage her medications due to lack of visual acuity and visual field deficits to read the labels on the medication bottles. Client is unable to engage in leisure activities because unable to read music during singing group due to visual impairments. Client is unable to participate in household management tasks including washing dishes and doing laundry due to the inability to choose the appropriate settings on the appliances secondary to visual impairments.


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

9

Client is unable to independently manage finances due to visual acuity and visual field deficits. Since Anita’s goals and priorities are obtaining the skills to function independently and successfully in meal preparation to control weight and health management, this is the first problem to be addressed. Secondly, but almost nearly as important, is the safety risk of the deficits in medication management. It is imperative that the mediation management be addressed to ensure Anita’s safety and disease management. Next, addressing Anita’s fear about losing her leisure activities is significant in maintaining her mental health and fighting depression that is often associated with social withdrawal in the older adult population. Furthermore, Anita’s ability to participate in her household chores is very important to her to fulfill her role as the head of her house and her self-esteem as an independent woman. These chores are a part of her routine and have significant meaning in maintaining a level of independence, and sequentially, pride. The financial management is addressed last because it is already being taken care of by the PCA and Anita has addressed this as a concern low on her priority list in comparison to the other concerns she is having. Overall, this problem list is a compilation of Anita’s priorities and goals with the clinical reasoning and safety considerations from a therapeutic standpoint.


OCCUPATIONAL PROFILE AND ANALYSIS: ANITA

10

Reference American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and Process (2nd ed.). Baltimore, MD: AOTA Press.

651- Occupational Profile and Analysis- Anita  

651- Occupational Profile and Analysis