Vivian Leah is a 96-year-old woman with a variety of healthcare issues needing attention

Vivian Leah is a 96-year-old woman with a variety of healthcare issues needing attention. Vivian receives hemodialysis treatments three times a week in her home and while she usually experiences an active mind, she reports bouts of confusion and difficulty concentrating just prior to the treatments and on the weekends. Vivian is nearsighted and has limited peripheral vision as a result from high blood pressure, with a measurement of 186/90 the last time she had visited her physician. Her nutrition is poor and has an albumin level of 1.2, which is well below the normal limits, and often experiences nausea and loss of appetite. Vivian lives on her own and although she can not rely on family, her neighbors assist her the best that they can. With her one-bedroom apartment being on the first floor, her only obstacles are the three steps just outside. She experiences difficulty with balance and gait due to skeletal changes and was recently discharged from the hospital for a fall. Upon assessment, she was found to have many bruises and two old rib fractures. Vivian struggles to take care of her home and seemingly herself, which is why community resources would be beneficial in her case for many reasons.
Risk for Injury
Vivian may be vulnerable to physical harm due to unfavorable interaction between internal and external conditions. She is at risk for injury as evidenced by impaired vision, advanced age, a history of falls, and her inability to maintain her home. It was found that about one-third of older adults fall each year. Falls in the elderly can be predicted by visual impairment but may also be correlated to the presence of fall history, a balance/ gait deficit, cognitive impairment, and home hazards (Källstand, 2013). Vivian is a member of the senior citizen community making her vulnerable to age-related health decline such as the visual impairment and difficult gait she is currently experiencing. Because she had a history of falls and is unable to maintain her home, that risk increases in the of her being unaware of her disheveled surrounding and tripping.
As an older adult at fall risk in an unsafe environment, it is important to take steps to reduce the risk for falls including education, fall risk assessments, and the monitoring of vitals, but it could also be beneficial to seek out help to safety-proof her living environment (Güne?, 2018). The Monroe County Opportunity Program (MCOP) of Monroe, Michigan provides a variety of services essential to the older adult community, specifically their Home injury Control for those staying at home. With this, certain safety precautions, such as ramps, grab bars, smoke alarms, safe lighting, and non-skid surfacing are provided. Vivian is already at risk of injury and she would be more likely if she had to put these precautions in place herself and may not be willing to give up what independence she has left. The MCOP is willing to install everything and perform minor repairs so that their clients may remain in the safety of their own home. (Monroe County Opportunity Program, 2018)
Impaired Physical Activity
Vivian is limited in her ability to perform movements purposefully and independently. She has impaired physical mobility as evidence by alteration in cognitive functioning, unsteady gait, and her advanced age. A person’s ability to maintain a steady gait generally depends upon both higher level cognitive processes and sensorimotor processes, both of which Vivian is beginning to lose (Bolandzadeh, 2015). Being confused and unable to maintain balance can make it hard for her to get around the way she would like, it may also result in injury, such as a fall.
Lake Erie Transit is a transportation service that benefit many senior citizens in the area of Monroe County by allowing them to travel safely. Because Vivian is among the senior citizen community, she will qualify for essential services such as door-to-door transportation that includes assistance with steps and additional safety and comfort care prohibiting smoking and other damaging behavior from the vehicle. With impaired mobility, it could be difficult for Vivian to conquer stairs, but with Lake Erie Transit drivers are caring and offer assistance in any way they can. Vivian also requires ongoing hemodialysis treatment with which she will need transportation. She would be able to call in advance, allowing for transportation to arrive in time for scheduled appointments. When visiting their easy to use website, all fixed routes and schedules are provided, as well as a number to call to schedule a pick-up time at home. Large tabs identify specific pages of the site including services, schedules, how to ride, fares, contact info, and even information about other community resources in Monroe County. (Lake Erie Transit, 2017).
Acute Confusion
Vivian often experiences abrupt onset of consciousness and attention disturbances such as acute confusion. She has acute confusion as evidenced by difficult concentration and sudden loss of active alertness. The onset of this confusion usually occurs before hemodialysis treatments and on the weekends, leaving her with a disorganized mindset for five days out the week. Because her cognition is impaired, it may be difficult for to understand, retain, or translate any information given to her including fall prevention teachings (Horner, 2014). It would not be safe for Vivian to live on her own and without the cognition required to take care of herself.
Friends of the Family Home Healthcare in Monroe may be just what Vivian needs in order to remain safe and at home rather than in a senior living setting. This essential service provides assistance to the older community in the comfort of their own homes with activities in daily life. Not only that, but services such as advanced treatment of long-term illnesses non-medically and medically, hemodialysis, as well as check-ins, monitoring, light housekeeping, meal prep, and companionship are included (Kristina, 2018). Vivian has lived in her home on her own for some time and may not like the idea of strangers in her home, if that were the case, she may be open to interviews to determine which healthcare personnel would best meet her needs and standards.
Risk for Frail Elderly Syndrome
Vivian has shown a decline of multiple domains of health such as mental and physical, making her vulnerable to an unbalanced equilibrium. She is at risk of Frail Elderly Syndrome as evidenced by her advanced age, alterations in cognition, impaired balance, and poor nutrition status. Malnutrition is a large factor contributing to Fraility Syndrome, which is prevalent in females aged 65 and older. “Scientists agree that fraility is a geriatric syndrome characterized by the reduction of physiological reserves and resistance to stressors making the elderly vulnerable for adverse health outcomes including dependency and falls” (Jaroch, 2014). Because of this, Vivian’s unsteady gait and confusion may present as a predictor of falls.
Vivian may not be able to remain safe living on her own and without constant observation because of each risk she is predisposed to. Elderly Solutions is a home for senior living that provides 24-hour night and day care in a group home setting including group activities and provided balanced meals. The decision to move into a senior living facility can be a difficult one as for some it might mean that they must accept the fact that they can no longer take care of themselves and live independently. At Elderly Solutions they offer everything they need and more with an atmosphere that promotes the best quality of life. (Elderly Solutions, 2018)
Risk for Electrolyte Imbalance
Vivian is vulnerable to developing an abnormal concentration of electrolytes in her body that could potentially compromise her health. She is at risk for electrolyte imbalance as evidenced by changes in appetite, abnormal lab values, and compromised regulatory mechanisms. Vivian experiences a loss in appetite, nausea, and vomiting which all contribute to an imbalance in nutrition, one that is below her body requirements. She also suffers from renal impairment which effects glomerular filtration and may lead to the accumulation of fluids and electrolytes in the body. This increase in fluid may contribute to her increased blood pressure as well as the decline in the plasma protein Albumin. Her hemodialysis treatment may assist with the removal of fluid from the blood, but it can not replace the function of the kidneys (Debone, 2017). With continuation of treatment and an increase in nutrition, Vivian may be able to increase electrolyte balances and near homeostasis.
Living Independent for Everyone is a part of the meals on wheels service. This community center provides several essential services such as provided meals, transportation, and home delivery. Their website is helpful and easy to use with information about what to expect from each location provided, the terms of service which outlines who qualifies for the service and contact information to further explore the service and schedule a delivery. The website also provides resources at each location to help individuals such as Vivian to decide which location would best benefit her needs (LIFE). If mobility is an obstacle, Vivian is left with two choices: she may decide to join members of the community at the center with the assistance of provided transportation or to remain in the comfort of her own home and having a balanced meal delivered to her.

Risk for Loneliness
Vivian is at risk for experiencing discomfort associated with a desire or need for more contact with others. She is at risk for loneliness as evidenced by independent living, the lack of family, and impaired vision. Loneliness is estimated to be prevalent in older adults as high as 45% because of their susceptibility to age-related changes and losses. Elderly participants in a recent survey mentioned that boredom was a source of loneliness and that any activity, such as interacting with members of the community or simply going for a walk, helped to alleviate the feeling of loneliness (Cohen-Mansfield, 2016). Vivian has impaired vision which may not allow her to be as involved in activities as others, giving her the perception of loneliness.
Monroe Center for Heathy Aging provides a variety of social programs including exercise classes, brain aerobics, internet access, and more. Vivian would be able to join members of her community and even have the chance to meet new companions. The biggest obstacle for participants at the center is mobility difficulties, which Vivian shares (Monroe Center for Healthy Aging) This mobility issue not only prevents them from going out of their homes, but it also presents them with the lack of energy to do so. As mentioned previously, Lake Erie Transit is a wonderful resource for elderly travelers needing transportation and assistance with it (2017).
With her various health issues, Vivian is at risk of several more including injury, Frail Elderly Syndrome, electrolyte imbalance and loneliness. As an older adult, there are all kinds of resources that apply to her specific needs, it is just a matter of her seeking them out and overcoming a few minor obstacles. If she decides to reach out to these resources, she will be provided with the support she needs to live her life happier and healthier.

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