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Chapter 5 Case Study: Mrs. J

The following case study was modified from the Assessment of Dementia case study downloaded at:

Mrs. J. is a 78-year-old, African American woman who lives in a small southern city. About a year ago, her husband died suddenly of a stroke, leaving Mrs. J. to live alone in her home of 52 years. It was the home where she had raised her three children, all of whom graduated from college, have professional careers, and now live in other parts of the state. Her family is a source of pride, and her home has numerous pictures of her children and grandchildren.

About 3 months ago, Mrs. J.’s oldest daughter, Vanessa, got a call from one of the neighbors. Vanessa lives a 4-hour drive from her mother—a drive that can often be longer in bad weather. The neighbor stated that Mrs. J. had walked to the neighborhood store in her pajamas and slippers. Because Mrs. J. has lived in the community for several years, people have been watching out for her since her husband died, and someone gave her a ride back home. Mrs. J. doesn’t drive, and the temperature was fairly chilly that day.

As a result of the call, Vanessa went to Mrs. J.’s home for a visit. Although she and her siblings had been calling Mrs. J. regularly, no one had been to the family home in about 6 months. Vanessa was shocked at what she saw!

Mrs. J. had been a cook in a school cafeteria earlier in life and always kept her own kitchen spotless. But now the house was in disarray with several dirty pots and pans scattered throughout different rooms. In addition, odd things were in the refrigerator such as a light bulb and several pieces of mail. Many of the food products were out of date, and there was a foul smell in the kitchen. Trash covered the counters and floor.

Vanessa contacted her siblings to ask them if their mother had told any of them that she wasn’t feeling well. Her brother, Anthony, remarked that their mother would often talk about Mr. J. in the present tense—but he thought that it was just her grief about his death. The younger brother, Darius, reported that his wife was typically the one who called their mother—about once a month. He didn’t know if there had been any problems—his wife never said anything about it to him.

Vanessa also contacted the pastor of her church, Rev. M. He stated that Mrs. J. had been walking to church on Sundays, as usual, but he did notice that she left early a few times and other times seemed to come to service late. But like the brother, Anthony, he thought that this behavior was probably a grief reaction to the loss of her husband.

A final shock to Vanessa was when she went through her mother’s mail. There were several overdue bills and one urgent notice that the electricity was going to be cut off if the balance wasn’t paid. She owed several hundred dollars in past due heating, electric, and telephone bills.

Vanessa contacted her mother’s primary care physician (Dr. P.) who said that she had last seen Mrs. J. for her regular checkup 3 months earlier and that she had missed her last appointment a week ago. Dr. P. said that her staff had called to make another appointment but that her mother hadn’t called them back yet. The doctor said that she had written a reminder for the nurse to contact Vanessa the same day that Vanessa called. Mrs. J. is being treated with medication for arthritis, hypertension, and gastroesophogeal reflux (GERD), and all of these were under control at the last visit. Her weight was stable, and her only complaint was some difficulty staying asleep at night. Dr. P. reported that her mother’s mood was sad but had improved some in the month before the last visit. The doctor asked about memory and concentration, but her mother denied having any problems and did not seem to be confused at the time of the last visit. When the doctor heard about the recent problem at the store and Vanessa’s description of her mother’s house, she was very surprised and asked that Mrs. J. be brought in immediately.

Activity #1. Class Discussion

Ask students to assume that they are social workers working with the primary care physician and that they have been asked to see Mrs. J. and her daughter prior to their meeting with Dr. P.

Ask students to consider the following assessment questions:

  • What psychosocial factors are present in the case example that impact Mrs. J.’s physical and mental well-being?
  • What instruments could be used to evaluate the cognitive and mental functioning of Mrs. J.?
  • What instruments could be used to evaluate symptoms of depression?
  • What should be the role of Mrs. J.’s family in care planning? Are there other informal support systems that should be involved?
  • What multicultural issues are present in this case study?
  • What issues are relevant to establishing rapport with Mrs. J. and her family?
  • What type(s) of interventions would be appropriate?
  • How would the interventions be evaluated?
  • What programs or resources might be appropriate for Mrs. J.?
  • What would characterize a culturally competent intervention?
  • What would characterize culturally competent services and programs?
  • What are some gaps in service that Mrs. J. might face?

Activity #2. Role plays

  • Divide students into groups of three.
  • Ask students to go online and download the MMSE.
  • Ask the students to assume the following roles:
    • Mrs. J.
    • Vanessa
    • Social worker

If a particular task only requires two people, the third person becomes an observer and after the task provides the feedback (questions and discussion) to each participant on the following points:

  • What did you do that you liked?
  • What would you do differently next time?
  • This is what you did that I liked…
  • This is what you might consider doing differently next time…
  • If time allows—and if appropriate for the particular students, you may ask the client in the role play to provide feedback to the social worker.
  • This is what you did that I liked…
  • This is how I felt when you...
  • This is what you might try next time…)

Remind students that the case example only provides an outline, they are to improvise additional details as needed. (Be kind to one another. The goal is not to “stump the chump” but to have an opportunity to practice using skills with an older adult and family member.)

Depending on the level and experience of the students, it may be necessary to model the tasks before doing the role plays.

Task #1: Social worker role plays administering an MMSE examination to Mrs. J. (Third student observes.) Score the MMSE. Based on the details of the case study, determine what stage Mrs. J. is on the Global Deterioration Scale. After the role play, the observer provides feedback.

Task #2: Rotate roles. Based on the MMSE score, select either the CSDD or the Short GDS. Social worker introduces the screening and conducts a depression screening with Mrs. J.

  • Obtain the person’s agreement to be screened.
  • Explain the purpose for the screening.
  • Administer and score the depression screening instrument as instructions direct.
  • [If necessary based on the MMSE score, rotate roles and the social worker conducts the CSDD interview with Vanessa.]

Task #3: Rotate roles. Social worker discusses his/her concerns and makes initial treatment referrals for further diagnostic assessment to Dr. P. for possible psychotherapy and antidepressant medication.
Discuss the results of the MMSE, the GDS, and the depression screen with Mrs. J. and Vanessa.

Task #4 (optional): Ask one student to take the role of the social worker and the other to take the role of Dr. P. Social worker presents his/her concerns and the results of the MMSE, the Global Deterioration Scale, and the depression screen to Dr. P. (Remind students that Dr. P’s time is quite limited and that they will need to be concise and focused in their presentation of Mrs. J and her situation.)

Document Date: September 9, 2009
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