A 74-year-old lady, Mrs Nanda Kiran* was brought to our Centre by her husband and daughter-in-law, with chief complaints of difficulty in swallowing food and water, regurgitating food particles, reduced speech, decreased social interaction, reduced expressions/reactions, reduced interest in activities of daily living and a shuffling gait. She had a past history of Stroke and was a known case of Parkinson’s Disease and Vascular Dementia.
At the Centre, she was observed to refuse food and if insisted upon, her face would convey pain in swallowing. Medical investigations conducted revealed no physiological reasons for pain or regurgitation of food particles. Thus, motivation and distraction techniques were employed to shift her focus from the process of swallowing and increase her food intake. Post meals, she would be engaged in brief time-limited cognitive/motor activities (for e.g. number cancellation/grain segregation tasks, etc.) to keep her occupied and reduce/prevent regurgitation. She was also introduced in various social situations (meeting new people, making requests, etc.). Hints/cues were provided during interactions to aid and increase her participation. The case was incontinent, for which a toilet schedule was created with her being taken to the toilet every 3 hours. Moreover, a daily schedule was created, to provide a sense of order and purpose. Various cognitive, social and recreational based activities were conducted during the day, to stimulate her on different levels. Physiotherapy interventions were introduced for improving her gait pattern and increasing her upper and lower limb strength.
Post interventions, the case was able to eat meals without any difficulty. Her food intake increased, with her weight increasing by 5.5 kgs. She started going for formal dinners and would choose her food of preference. Her interactions improved significantly. She started independently interacting with people of different age-groups. As her interactions increased, so did her reactivity, with her even using humour. Although she couldn’t be taken off diapers permanently, towards her end of time with us, she was able to communicate her need to use the toilet most of the time. She would look forward to attending the Centre and would remind the staff about her daily activities. Post physiotherapy interventions, she resumed her evening walks and occasional dances with her husband, although she needed constant reminders to take longer steps.
The above case highlights the need for more Centres that can provide rehabilitation in a holistic and integrated manner, by offering not just medical but also physical and psychosocial rehabilitation to seniors under one roof. Currently, most places offer medical and physical rehabilitation to seniors, ignoring their and their families’ psychosocial needs. As professionals working in the field of geriatric health, it is important for us to work towards improving the senior’s health in a holistic manner.
*Name changed to maintain confidentiality.
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