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Interdisciplinary Geriatric Assessment:
Mr. Ames

hospital treatment

Eight days ago Mr. Ames was admitted to the hospital for a non-healing foot ulcer. He had driven 800 miles to attend his sister's funeral. When he returned home, his right foot was badly swollen and erythematous. A large blister was evident over the metatarsal plantar aspect of the foot. Upon arrival at the hospital, his temperature was 100.4° and the ulcer was draining green purulent material. He was immediately admitted to the hospital for evaluation and treatment.

Upon admission he was started on antibiotics. In the operating room the infected area of the plantar space of the right foot was incised and drained. Purulent material was collected and submitted for culture.

Culture results: Staph. aureus, Strep. intermedius and Strep. constellatus.

Antibiotic treatment was changed to IV only.

Mr. Ames and his spouse were presented with two treatment options:

1. aggressive debridement, infection control and surgical revascularization
2. amputation of the right leg.

Mr. Ames decided to have his right foot removed. He felt he would be better off without the problem. It was recommended that he have the amputation above the knee but he insisted that it be below.

The right leg was amputated approximately 8 inches (20.3 cm) distal to the knee joint. Large vessels were tied off with silk suture material and a posterior myofascial flap was used to cover the stump. Skin edges were joined with staples. Fluff was used to pad the end of the stump, which was then wrapped with a Kerlix® roll and an Ace® wrap. No intra-operative or post-operative complications were noted.

During his hospitalization, Mr. Ames received acute care services from OT and PT. Initially, he required a maximum assist of 2 persons for transfers postoperatively. But within 3 days he was able to transfer to wheelchair with minimal assist. He was independent in sink activities such as oral care and hair care and washing his upper body. He fed himself independently. He was able to dress his upper body independently but required moderate assistance to dress his lower body due to fatigue from exertion and trunk instability. He required maximum assistance with all other lower body care, e.g. bathing, toileting, and changing the wound dressing. The operation site remained clean and dry and slightly edematous, with the skin pink and cool to the touch. He reported feeling tired following very little exertion such as sitting up on the edge of the bed.

The interdisciplinary geriatric assessment team has been called together a few days before his discharge to develop a plan for his discharge. This meeting should last about 15 minutes. Print the IGA form (pdf). Using it and the information you now have for Mr. Ames, act as the team leader for the virtual team and develop an action plan.

Team members from what services must be involved with these decisions? along with the patient? the patient's family?

Discharge options are as follows: nursing home, rehabilitation facility, or to his home. For each of these options, what medical services will he need to receive? (Refer to discipline descriptions if needed.)

When you have completed the IGA form including the plan of action, compare your filled-out IGA form to the form developed by our team (pdf) and proceed to the rehabilitation treatment page.