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Interdisciplinary Geriatric Assessment:
Mr. Fine

Family, Social, & Medical History

Henry Fine is a 95-year-old retired mechanical engineer. His lifetime hobbies have been astronomy and photography. He and his spouse raised two children in their home he built in Illinois. His son now lives in Missouri and his daughter lives in Georgia. His son reports an unremarkable medical history until Mr. Fine underwent angioplasty approximately 9 years ago. At that time he and his spouse gave POA to their children, so if one became incapacitated the children would be able to assist the remaining spouse with making decisions.

Mr. Fine and his spouse lived independently in their home in Illinois until an automobile accident 5 years ago, which she did not survive. Following two weeks of hospitalization and rehabilitation, he was discharged to his home with a cane and walker. He continued with outpatient PT for two months, taking the bus to and from the sessions, using the cane only. For the next year Mr. Fine lived alone and used his three-wheeled bicycle for transportation. Five years ago while on his three-wheel bicycle (not wearing his helmet) he was hit by a car.

Following the bicycle accident, he remained in his home for one more year with his neighbors providing him with assistance and transportation as needed. He then started to look into assisted living apartments in Illinois. Having made the decision to move from his home, his son in Columbia, Missouri asked him to look into apartments near him.

Mr. Fine, using a cane, took the train and looked at apartments near his son and together they decided he would relocate to Missouri.

After the move, his new family practice physician suspected Parkinson's Disease and referred him to a specialist, who confirmed the diagnosis. Mr. Fine was 91 years old. His medication dosage was quickly increased to the maximum and Mr. Fine managed his medications by using a check sheet devised by his son. Due to increasing problems with balance, Mr. Fine resumed use of his walker when away from his apartment. Using his walker, he ambulated without assistance to and from the dining room (approx. 300 ft) and used the elevator for his morning and evening meals. To maximize safety, he began receiving assistance with bathing 2x/week. Mr. Fine oversaw procurement and installation of grab bars for his shower/tub combination. He also obtained a handheld shower head and a tub seat. Grab bars were added near his bed and in the hallway in his apartment.

He enrolled as a participant in an Aging in Place research grant which allowed him to be followed by a registered nurse, with contact at least once every three months. Mr. Fine explored the exercise groups at his apartment complex and found them not to his liking, as he did not think they offered enough challenge. From a family friend he learned of a T'ai Chi group which met 1x / week away from his apartment complex and he enrolled. Mr. Fine's son accompanied him to these sessions whenever possible. If his son was not available he would be transported to the sessions via the apartment van. At this time his posture was stooped as he used the walker and his gait was shuffling. However, he was able to do the standing postures with someone at his side and with a table and/or sturdy chair for one or two-handed support. The T'ai Chi class provided a social outlet for him.

After participating in T'ai Chi for approximately 3 months, Mr. Fine began experiencing frequent problems with diarrhea resulting in occasional bowel incontinence. He was scheduled for a colonscopy. His son was out of town and the apartment complex van provided transportation for the test. When they returned to the apartment complex, the driver informed Mr. Fine he would not be available to transport him after that date, as he was too difficult to transfer in and out of the van. Mr. Fine stopped attending the T'ai Chi class.

At this time, Mr. Fine's macular degeneration was also progressing to a point where it was limiting his visual capabilities. Two months later, when checked on in the morning by the apartment complex staff, he was found to be "dazed" and "incoherent." Concerned that he had suffered a stroke, they called 911 and Mr. Fine was transported to the hospital. He remained in the hospital for three days for treatment of dehydration and was discharged to a nursing home for rehabilitation.

Mr. Fine was ambulating with a walker when he entered the nursing home. His son would walk with him to and from the dining room and questioned if he was being encouraged to ambulate by the staff, as he appeared to be spending most of his time in a wheelchair. He experienced a sharp decline in his voice volume and speech clarity and was not always understood by the staff. In addition, his cough was noted to be weak and his breathing was rather shallow. His son describes his "therapy" at the facility as being "not very aggressive" and oriented toward maintenance and Mr. Fine remaining at the nursing home. Mr. Fine and his family were planning on him returning to his apartment and were very disappointed with the lack of support for more aggressive therapy. Mr. Fine's son contacted the RN who had been following him with the research project prior to his hospitalization and together they arranged for Mr. Fine to return to his apartment.

Starting the day following his discharge from the nursing home, Mr. Fine received personal care assistance 5 mornings a week from a home health agency, and private assistance from 4-6:30pm 5x / week. With stand-by assistance he was walking with his walker to and from the dining room for breakfast and dinner. He retrieved food for his noon meal from the refrigerator. On weekends his son and daughter-in-law were staying with him during the day and assisting him as needed. A condition for his returning to his apartment was that he wear a Lifeline button on a chain around his neck to push to summon emergency assistance, if needed.