Treatment Plan and Follow-Up Monitoring

A “treatment” plan for Mr. Bynum would involve increasing his mobility and endurance, along with ensuring that he is able to maintain or improve his ability to engage in meaningful occupations. Specific goals include:

• Provision of on-going health education to facilitate healthful behaviors that might prevent worsening of his high blood pressure.
• Ensuring accurate and adequate maintenance of medical recommendations for medication, diet, and other factors to prevent future health problems.

• Assessment and discussion regarding his social network and engagement in meaningful activities.
• Monitoring of social and family issues.
  

Both OT and PT should be involved in working with Mr. Bynum. The role of Physical Therapy is to ensure that Mr. Bynum has the mobility, balance, and postural correction of his forward head posture. Thus, the PT could work with him on strength training, range of motion, effective use of mobility aids including the wheelchair and the walker, and, on a regular basis, monitor his muscle strength, flexibility, gait, balance, and other mobility issues.  Mr. Bynum needs to continue gait training with verbal cueing and instruction regarding appropriate step length with steady gait sequence to improve his dynamic standing balance.  It is also important to instruct him in a home exercise program using elastic bands to improve postural deficits.

The occupational therapist should discuss with Mr. Bynum any issues related to his activities and social network. He or she can work with Mr. Bynum on energy saving home management strategies, medication management, any potential issues regarding other self-care tasks, and safety. He or she can also provide Mr. Bynum with opportunities to try new activities that might introduce him to people he would enjoy and activities that would broaden his horizons.

The best way to monitor his progress at present is through his participation at the Eliza Bryant Village. Because he stays there, staff can attend to any deterioration in his hygiene and grooming, his interaction with others, and his participation in activities. Change in appearance, participation, or attendance might signal a health or performance problem that can then be investigated.

In summary, Mr. Bynum’s behavior is very typical of an older adult who has had a major health episode and has recovered reasonably well but not entirely. One trend for elders is a “stair-step” downward trend in function and health. While this is, at some point in aging, inevitable, engagement in meaningful activities that support physical function and encourage cognitive and social engagement can slow decline and increase life satisfaction. Although Mr. Bynum has significant health problems, he also has many strengths, including a great sense of humor and an ability to find enjoyment in his current circumstances. Coupled with appropriate interventions from OT and PT, he should be able to continue for some time to come to live a life that he finds satisfying.