Occupational Therapist Summary and Recommendations

Summary

78 y/o female (Margaret Vance, DOB: 14/05/1946, URN: 4829104) assessed at home following recent hospital admission for L NOF # (status post hemiarthroplasty on 02/10/2024). Presents with reduced functional mobility, high falls risk, and decreased independence in PADLs and DADLs. Requires AT and minor home modifications to remain safely in the community.

Social

• Lives alone in a privately owned single-storey brick unit in Subiaco, WA; 2 steps at front entrance, 1 step at rear patio.
• Daughter (Sarah) lives 15 mins away; visits 3x/week to assist with heavy tasks and shopping.
• Previously attended local senior citizens' bowls club weekly; currently housebound post-surgery.

Medical

• L NOF # (hemiarthroplasty 02/10/2024), bilateral knee OA, HTN, T2DM, mild presbycusis. Current analgesia: paracetamol 1,000 mg PO QID.

Ambulation

• Mobilises indoors with 4WW; uses SPS for tight spaces (bathroom/toilet) against PT advice.
• Antalgic gait, reduced L stance phase, shuffling turn, dynamic balance impaired on uneven surfaces.
• 2 falls in past 6 months (most recent resulted in L NOF # after tripping on living room rug).
• Wearing personal alarm pendant (MePACS); nocturnal hallway sensor lights installed.

Personal Care ADL

• Independent with upper body dressing seated; requires long-handled aids or min assist x1 for lower limb dressing and footwear due to reduced hip flexion and pain. Showering over bath currently unsafe; strip washing at basin.
• Independent bladder/bowel continence; struggles with sit-to-stand from low standard toilet pan (400 mm height), pulling on sink vanity for leverage.

Domestic ADL

• Light meal prep (tea, toast) managed independently; relies on pre-packaged meals (Meals on Wheels) and daughter for main meals and heavy cleaning/laundry.
• Fatigues quickly (after 5 mins standing) and unable to safely carry hot items whilst using 4WW.

Community ADL

• Non-driver (surrendered licence 2022).
• Daughter provides transport for medical appointments; eligible for taxi subsidy scheme.

Cognition

• A&O x3, RUDAS score 27/30, intact short-term recall and insight into physical limitations.
• Safe to remain alone during the day and overnight with personal alarm in situ.
• Requires assistance with complex online banking/bill management (managed by daughter).

Main Concerns

1. High falls risk during bathroom transfers (stepping over bath hob to shower).
2. Difficulty with toilet transfers due to low pan height and lack of bilateral support.
3. Inability to safely transport food/drinks from kitchen to dining area while using 4WW.
4. Front access steps lack bilateral handrail support, limiting safe community egress.

OT Recommendations

1. Equipment:

   • Over-toilet aid (OTA) height-adjustable to 500 mm.
   • Kitchen trolley (height-adjustable) for safe meal transport.
   • Long-handled dressing stick, sock aid, and shoe horn for lower limb PADLs.

2. Home modifications:

   • Install vertical grab rail (600 mm) adjacent to toilet on RHS wall.
   • Install galvanised steel handrail to LHS of front entrance steps.
   • Remove bath and convert to hobless shower recess (interim: supply transfer bench).

Home is generally uncluttered with good natural lighting. Scatter rugs in hallway and lounge have been removed by daughter. Existing sliding door to rear patio has a 40 mm lip requiring a small threshold ramp in future.

Client consented to My Aged Care (MAC) referral for CHSP domestic assistance and home modifications, as well as community physiotherapy follow-up.

Plan

1. Order and deliver OTA, transfer bench, kitchen trolley, and small dressing aids via equipment loan pool by 18/10/2024.
2. Submit MAC referral for CHSP minor home modifications (grab rails) and ongoing domestic assistance.
3. Conduct home visit on 22/10/2024 to fit equipment and review transfer technique.

Liam O'Connor

Occupational Therapist(s)