69

Introduction

Cognition involves perceiving, making sense of, and using information. There are three cognitive components involved in cognition: attention, memory, and executive function. Memory is employed throughout everyday activities whether individuals are aware of it or not. Older individuals may have difficulty with memory functions due to age and may have difficulties with tasks they were once able to complete with ease. These individuals may benefit from compensatory thinking strategies (Brown, 2011).

Case Study

Gloria a 75 year old refugee from Venezuela who escaped to the United States 50 years ago with only the clothes on her and her infant daughter’s back and the stress of someone who had lived years longer then she had. Her husband, Juan, had been brutally murdered by the cartel and she only escaped because of a tip from her best friend. She would find out later that the cartel killed her best friend as well. Now 50 years later, Gloria lives with her daughter, Yolanda, and her three grandchildren. Her daughter has brought Gloria to us because she is worried about the safety of her children and her mom. Gloria has been in charge of watching the kids while Yolanda works, but more frequently she has been coming home to find the stove left on, the door to the house unlocked, and even on one occasion, Gloria had forgotten to pick up the kids after school. At first Yolanda thought they were just isolated incidents but now that they are happening with increasing frequency. Yolanda is worried about the safety of her kids with this decline in her mother’s memory.

Theory

The Person Environment Occupational Performance (PEOP) frame of reference believes that intrinsic and extrinsic factors affect occupational performance. Memory loss (cognition) is an intrinsic factor that can interfere with activities of daily living (ADL). PEOP describes adaptation as the process used to meet challenges in ADL’s and by providing compensatory strategies to address memory loss, occupational performance can improve.

Evidence

According to Kempermann, Gast and Gage (2002), new neurons are continually forming throughout life. However, as an individual ages, neurogenesis declines. Kempermann, Gast and Gage (2002) believe than an enriched environment can lead to a great increase in new neurons which then improves behavioral performance. An active lifestyle can promote cellular plasticity which improves learning parameters, exploratory behavior, and locomotor activity.

Intervention Plan

Problem Statement

Client’s safety awareness in everyday tasks is being inhibited secondary to age related memory loss.

Short Term Goals

1. Client will be able to identify 3 compensatory strategies for memory loss, to increase safety awareness in the home environment in 2 weeks.
2. Client will be able to verbalize consequences of safety errors in the home environment to increase safety awareness in 2 weeks.

Long Term Goals

1. Client will incorporate 2 compensatory strategies while cooking a meal given visual cues to increase safety awareness in the home environment in 4 weeks.
2. Client will complete a safety checklist everyday before she leaves her home in 4 weeks.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist at her home for 30 minutes 2x/week for 4 weeks.

Supplies

Notebook and pen/pencil

Agenda

• Meet Gloria and develop a rapport to establish trust (2 mins)
• Converse with Gloria about the safety concerns her daughter identified and analyze her insight into the effects this can have (5 mins)
• Have Gloria write down strategies she thinks she can implement into her everyday life (1 min)
• Develop a safety checklist with Gloria that can be incorporated into her daily routine (15 min)
  • Allow Gloria time to ask questions (2 min)
• Provide a summary of the discussion and explain take home activity (5 min)

Documentation

S: Client’s daughter reported that Gloria has forgotten to pick up her grandchildren from school on many occasions. Gloria’s daughter also reported that she has come home to find the stove left on. Also, last week, Gloria, forgot which bus to take to get home. These instances has Gloria’s daughter greatly worried about Gloria’s safety due to her declining memory.

O: Client participated in a 30 minute session that focused on compensatory strategies to promote safety awareness. Client developed a list of of strategies she could use to aid her to become more aware safety in her home environment. With the help of the therapist, the client created a safety checklist with Gloria that can be incorporated into her daily routine.

A: Client’s ability to identify the effects of her memory loss demonstrates her cognitive awareness of the potential safety hazards. Clients participation in creating a safety checklist indicates that she is willing to use compensatory strategies in her daily routine.

P: Client will continue with OT sessions for 30 mins, 2x/week for 4 weeks focusing on reinforcing activities identified as compensatory strategies for memory and practice demonstrating them in order to increase safety.

References

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A. Davis

Kempermann, G., Gast, D. and Gage, F. H. (2002), Neuroplasticity in old age: Sustained fivefold induction of hippocampal neurogenesis by long-term environmental enrichment. Ann Neurol., 52: 135–143. doi:10.1002/ana.10262