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Struggling to cope at home

Medicine > Medicine of older adult

Differential Diagnosis Schema 🧠

Physical Health Issues

  • Mobility problems: Conditions such as osteoarthritis, stroke, or Parkinson’s disease leading to reduced mobility and difficulty performing activities of daily living (ADLs).
  • Chronic pain: Conditions like fibromyalgia, chronic back pain, or diabetic neuropathy causing difficulty in managing day-to-day tasks.
  • Visual or hearing impairment: Difficulty in coping due to sensory deficits, leading to isolation and reduced ability to manage at home.
  • Respiratory or cardiac conditions: Conditions such as COPD or heart failure that limit physical exertion, leading to breathlessness and fatigue when performing ADLs.
  • Cognitive decline: Dementia or mild cognitive impairment causing difficulties with memory, planning, and executing daily activities.
  • Malnutrition: Poor dietary intake due to physical or psychological conditions, leading to frailty and reduced capacity to cope.

Mental Health Issues

  • Depression: Low mood, anhedonia, and fatigue, leading to loss of motivation and ability to manage at home.
  • Anxiety disorders: Excessive worry, panic attacks, or generalized anxiety leading to avoidance of tasks or social isolation.
  • Psychosis: Delusions or hallucinations impairing the ability to function independently and manage daily responsibilities.
  • Substance use disorders: Alcohol or drug dependency leading to neglect of self-care, financial difficulties, and social withdrawal.
  • Burnout or caregiver stress: Emotional and physical exhaustion from prolonged caregiving responsibilities, leading to reduced ability to cope.

Social and Environmental Factors

  • Social isolation: Lack of support network, loneliness, and reduced social interactions leading to difficulty in managing daily tasks.
  • Financial difficulties: Inability to afford basic needs such as food, heating, or necessary healthcare leading to declining health and inability to cope.
  • Inadequate housing: Living in unsuitable conditions, such as poor heating, structural issues, or lack of access to essential facilities.
  • Lack of access to care services: Difficulty accessing community support, home care, or medical services that are essential for managing health and daily living.
  • Recent bereavement: Loss of a close family member or friend leading to emotional distress and reduced ability to cope.
  • Family conflict or domestic abuse: Strain from interpersonal relationships at home that may lead to emotional and physical strain.

Key Points in History 🥼

Physical and Mental Health History

  • Chronic illnesses: Document any long-standing conditions such as diabetes, cardiovascular disease, or arthritis that may impact daily functioning.
  • Recent health changes: Sudden deterioration in health, recent hospital admissions, or new diagnoses that may have triggered difficulties in coping.
  • Mental health history: Previous or current history of depression, anxiety, or other mental health conditions, and any treatment or interventions.
  • Substance use: Enquire about alcohol, tobacco, or drug use and its impact on daily life and health.
  • Medications: Review current medications, including adherence, potential side effects, and any issues with obtaining or managing them.

Social and Environmental Context

  • Living situation: Details of current housing, including any issues with access, safety, or comfort.
  • Support network: Enquire about family, friends, or community support, and any recent changes in the availability of this support.
  • Daily activities: Assess ability to perform activities of daily living (ADLs) such as bathing, dressing, cooking, and managing finances.
  • Economic status: Financial stability, including income, benefits, and any recent financial stressors.
  • Access to services: Identify any barriers to accessing healthcare, home care services, or community resources.
  • Recent life events: Bereavement, relationship breakdown, or other significant stressors that may have contributed to current difficulties.

Possible Investigations 🌡️

Physical Health Assessments

  • Blood tests: Basic metabolic panel, full blood count, liver function tests, and thyroid function to rule out metabolic causes of fatigue or weakness.
  • ECG: To assess cardiac function, particularly if there are symptoms of breathlessness or chest pain.
  • Cognitive assessment: Tools like the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) to screen for cognitive impairment.
  • Mobility assessment: Gait analysis, timed up and go (TUG) test, or physiotherapy assessment to evaluate physical functioning.
  • Nutritional assessment: Weight, BMI, and dietary history to assess for malnutrition or weight loss.

Mental Health Assessments

  • Depression and anxiety screening: Use of validated tools like PHQ-9 for depression or GAD-7 for anxiety.
  • Substance use assessment: Tools such as AUDIT-C for alcohol use or DAST for drug use to identify problematic substance use.
  • Social work assessment: To evaluate the need for additional support services, home modifications, or financial assistance.
  • Functional assessment: Occupational therapy assessment to evaluate the ability to perform ADLs and identify areas where support is needed.
  • Crisis intervention: Immediate referral to crisis teams or psychiatric services if there is evidence of severe mental health issues or risk of harm.

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Medicine of older adult