Sunday, March 7, 2010

Complex case QOL

I have had a patient who is very unsafe to return home. She is falling alot and has fallen on the ward numerous times, she often doesnt use her walking frame and she fluctuates between being lucid and being very very confused. She often talks about living in the past with her mother as it is happening presently or will happen in the future. She needs constant direction on the medical ward and she needs 24/7 supervision due to her cognition, and falls risk.

We had a family meeting with the Son and Daughter last week, and we each communicated how concerned we were that they had decided it be best for her to return home. I understand that they want the best for her (i.e. quality of life and the patients wish to not go into a RH). I also know that they are aware of the concerns, but really what can we do? The patient has been deemed incompetent, and the EPA wants her to remain at home. I wonder about her quality of life, and whether the patient can experience a quality life remaining at home and not having any awareness of where she is, what day it is, what year it is and why she was in hospital. She also doesnt show any awareness of how she is managing.

What is a quality life??

I have found a few definitions: and picked out a few key terms...

Quality of life: An important consideration in medical care, quality of life refers to the patient's ability to enjoy normal life activities. Some medical treatments can seriously impair quality of life without providing appreciable benefit, while others greatly enhance quality of life.

The best way of approaching quality of life measurement is to measure the extent to which people's 'happiness requirements' are met - ie those requirements which are a necessary (although not sufficient) condition of anyone's happiness - those 'without which no member of the human race can be happy.'

- McCall, S.: 1975, 'Quality of Life', Social Indicators Research 2, pp 229-248

‘‘Quality of life’’ (QOL) subsumes two distinct domains in gerontological research. One is health-related quality of life (HRQOL); the other, nonhealth or environment-based quality of life (Spilker and Revicki).
This website, discusses these two domains - and i think it helps me understand that perhaps the family of the client
above are thnking of her environment based quality of life and not her health based quality of life. HOwever QOL does mean different
things to different people.

Anyway, the medical and AH team essentially have concerns about the choice the family have made, and the wellbeing of the patient in mind. The SW has put a referral through to elder support to ensure that we have done all we can to protect the wellbeing of the patient. But essentially, all we can do is advise the patient (which we have done) of our concerns and the risks of the patient remaining at home and support them as much as we "can" towards a safe discharge, whilst knowing that the patient is going to fall again and will also most prob end back up in hospital (which we have also discussed with the family).

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