Measuring outcomes in aged persons MHS

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Measuring outcomes in aged persons MHS
Training Vignette 3 Mr Alloy
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Case scenario

• Mr Alloy is a 77-year old wheat farmer living in
  western Victoria. He has a seven-year history of
  vascular dementia and at least five documented
  collapses.

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Case scenario (continued)

• Mr Alloy lives in a small, purpose-built cottage
  on his and his sons large property 36 kilometres
  out of town. His son Thom and daughter-in-law
  Shedra and their three daughters live 800 metres
  away in the main house.

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Case scenario (continued)

• Mr Alloy has always been up early and a
  seven-day-a-week farmer. He has a collection of
  guns, having established the local gun club and
  has used the guns to shoot the massive flocks of
  cockatoos that can destroy the fields of wheat.

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Case scenario (continued)

• Thom has removed most of the ammunition from the
  cottage but is reluctant to take Mr Alloys
  beloved gun collection.

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Case scenario (continued)

• Shedra cooks, cleans and takes Mr Alloy to all
  the necessary appointments which she makes sure
  are early in the mornings because as she
  describes, Mr Alloy is too damn irritable after
  lunch.

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Case scenario (continued)

• Shedra had arranged for home help through the
  local council but Mr Alloy chased the woman out
  of the cottage threatening to shoot her.

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Case scenario (continued)

• Shedra is afraid of Mr Alloy and always makes one
  of her daughters accompany her when she has to
  deal with him. Mr Alloy has often mistaken her
  for his deceased wife and tried to kiss and
  cuddle her and there are other times when he
  becomes uncontrollably angry and threatens to
  shoot everyone he sees.

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Case scenario (continued)

• There are times when Shedra is convinced Mr Alloy
  knows exactly what is happening, who she is and
  she knows he is putting it all on.

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Case scenario (continued)

• She has had enough and has given Thom an
  ultimatum of either making Mr Alloy have home
  help and have all the guns removed from the house
  or she will make sure he is locked up in an old
  folks home. It has placed their relationship
  under a lot of strain.

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Case scenario (continued)

• Currently Thom showers his father three times a
  week.

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Case scenario (continued)

• Mr Alloy is physically fit except for a very high
  BP. He is on an antihypertensive and some
  aspirin. His GP had prescribed Haloperidol but
  Thom threw it out after Mr Alloy had had trouble
  walking and eating.

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Case scenario (continued)

• Mr Alloy naps throughout the day but, as far as
  Thom and Shedra know, he sleeps through the
  night.

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Part 2 three weeks on

• Thom does not remove all of the guns from the
  cottage as promised to the Aged Persons Mental
  Health Team Case Manager and Mr Alloy fires a
  weapon at Shedra.
• Mr Alloy was admitted to the Acute Admission Unit
  for assessment three weeks ago.
• Mr. Alloy is now disoriented in the unit and
  becomes lost easily.

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• He is placid and compliant but he refuses to
  shower, although he can be coaxed into a wash. He
  has been urinating in the hand basin.
• His BP is very high and he has fallen twice. He
  has skin tears to his left arm and a severely
  bruised face.
• Since his last fall, Mr Alloy is fearful of
  walking and will not move without full assist.

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Case scenario (continued)

• He sleeps most of the night and naps through the
  day.
• Mr. Alloy also requires a soft diet as his
  dentures are causing him pain since the injury to
  his face.

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Three weeks later

• He does not appear to recognise Shedra, Thom or
  the grandchildren.
• Thom is very worried about his father being
  unwell enough to make it back home and Shedra is
  blaming herself for the situation as she knows if
  she had left well enough alone and the psychiatry
  team hadnt interfered, things would have gone
  along the same way.

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