CASE EXAMPLE

Mrs. James is an 88-year-old woman who recently saw her family physician and complained of fatigue, increased nervousness, pain in her back, and an overall description of “not feeling like myself lately.” She noted increased difficulty with sleep, shortness of breath, and a growing fear that she was forgetting more than usual. Although she is troubled about her symptoms, at times she thinks she is “just acting like a foolish old lady” and noted that her concerns are probably due to “just old age,” and why would anyone care or bother about an older adult feeling poor? Mrs. James is the full-time caregiver for her 90-year-old husband, who was diagnosed with moderate Alzheimer’s dementia a year ago. Although they have family who live locally, she noted apprehension about her oldest son’s visits to the home. She explained that her son did not believe there was anything wrong with his father and sees the older man’s forgetfulness and strange behaviors as a way of gaining attention and remaining “lazy” so that his wife continued to do the majority of the housework.

DISCUSSION QUESTIONS

1. What types of assessment questions might you ask Mrs. James in an intake interview? What additional areas of her life would you want to ask her more about?
2. What types of interventions might you consider for Mrs. James? How might you discuss your ideas with her?
3. How would you conceptualize this case differently if Mrs. James were 68 years old rather than 88? What if she were caring for her lesbian partner rather than her husband? What might you consider if Mrs. James and her husband were African American? Native American? Or any other racial-ethnic minority?