The Role of Community on Health

Case Study 2

Harry and Gladys are an older nuclear family with four grown children. The couple currently lives in an upscale community.

Harry (Father and spouse) – Harry is a retired lawyer who is 86 years old. Both of Harry’s parents died from Alzheimer’s disease. Harry retired from a career as a criminal defense lawyer for the city of San Diego, having served in that position for almost 50 years. Harry is currently suffering from late-stage Alzheimer’s disease. Harry has been known to wander away from home and has had two recent incidents where the police had to be called to find him. He has also had one incident of agitation where he threw a chair through a glass window about two weeks ago. He no longer drives and is dependent on his wife for care including all activities of daily living.

Gladys (Mother and spouse) – Gladys is a retired nurse who is 93 years old. She is in good health but does suffer from mild hypertension and depression. She still drives but has had declining vision over the past six months. She provides total care for her husband and feels it is her total responsibility to care for him as “he was such a loving husband and excellent provider to her and their children.” She does not like outside help with what she sees as her responsibilities. She has only recently allowed her husband to go to a four-hour (morning) adult day care center two days a week so she can run family errands and take care of her other responsibilities. Her father died of a stroke at age 57 and her mother died of natural causes at the age of 102.

Jim (Son) – Jim is a 57-year-old male who lives in New York. He is a lawyer, divorced, and has one child who lives with his former wife. He speaks with his mom and dad every two weeks by phone and came home for a visit about three years ago. He is a workaholic and is devoted to being the best lawyer he can be. He is in good health.

Tim (Son) – Tim is a 64-year-old male with a wife and older children. He is a physician with a busy oncology practice in Maine. He admits to not seeing his parents in over five years but tries to call them when he can. He doesn’t like to visit his parents as he finds it depressing to see his vibrant dad in his current state of mental confusion. He is in good health.

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Mabel (Daughter) – Mabel is a 56-year-old female who lives in North Carolina with her husband. They don’t have children. She is a dentist. She too rarely sees her parents but tries to call them at Christmas. She has suffered from depression since the death of her identical twin sister, Marly. Marly died five years ago in a traffic accident as a passenger in Mabel’s car.

Marly (Daughter) – The identical twin sister of Mabel who died five years ago in a traffic accident when Mabel unintentionally ran a red light.

Harry and Gladys are Catholic. They used to go to church on a regular basis but have not attended church in years due to Harry’s Alzheimer’s disease and mental confusion.

They own a newer car and Gladys drives the couple where they need to go. Gladys suffers from declining vision and has had two recent incidents where she hit parked cars while driving and was not aware that she had done so.

They live in an expensive home in an upper-class neighborhood and have adequate financial resources and savings to maintain their current lifestyle. They have health and dental insurance and go to the doctor on a regular basis.

Gladys does all the housework but they do have a gardener that keeps up the yard and pool services to maintain their large backyard pool (which does not have a fence around it). Gladys also handles all the other family affairs, pays bills, purchases groceries, and cleans their large home. There are no in-home support services for the family, but Gladys has recently begun to take Harry to an adult day care center two days a week for four hours. Gladys admits she is stressed about caring for her husband and since he does not sleep well she does not sleep well. She states she is always very tired.

Their extended family and children live on the East Coast and rarely visit them. Gladys likes to play bridge with her friends, but it is getting more and more difficult due to Harry’s mental confusion and the fact that she is his primary caregiver. Other than Gladys’s friends, they have no other social support system in the area.

The family eats a healthy diet with lots of chicken and fish (low sugar, low salt, and low fat), which Gladys prepares. Harry is at his ideal body weight. Gladys is underweight and states she just doesn’t have time to eat, with all her other responsibilities.