Involving patient and family

On my gerontology placement, one of my patients was a 88 y/o male who was referred for falls. He is relatively dependent on his wife for assistance with ADLs. Therefore, usually attends the appointments with his wife. During the treatment sessions, I have noticed that he usually takes ownership of the treatments when his wife is not around. He responds to the exercises when I explain it to him, he also asks questions and seem more responsive. However, when his wife is with him, he seemed to switch off, leaving the wife to learn from the session/clarify things. One instance was when he attended physio, and reported that he had a fall a few days ago. He was rushing to the toilet and had forgotten to take his WZF, so he slipped while turning the corner. His wife had difficulty assisting the patient to get off the floor. The patient also reported difficulty getting off the floor. So, my treatment session for that day, was to teach them how to get the patient up from the floor in case of another fall. Before I did that education, I was giving the patient new exercises for his HEP. During that, his wife was not in the room. The patient was responding well to instructions and seemed genuinely interested. But during the education, I needed to speak to both the patient and his wife. In that time, the patient was just staring into space and did not participate in the session. (I was just demonstrating the procedure with my supervisor, so the patient did not have to get onto the floor).

In future treatment session, I will direct my questions/education to the patient, so that he feels that he is able to take ownership of his treatments. I also felt that the “get off the floor” education was brought across in such a way that it was mainly the wife’s responsibility. In future, I will tailor it in a way that both the wife/partner and the patient play a part in the patient’s treatment/education. Another thing I can do in future sessions, is to ask the wife to wait in the waiting room during sessions. But, involve the wife, if the patient requires a HEP, or education.