Reference no: EM132825642

Bobby X is a 62-year-old male with a 35-year history of Type 1 Diabetes. Secondary problems include: nephropathy (dialyses for 4 times a week), amputations (Left Below the Knee - LBKA), obesity, hypertension, and neuropathy. Bobby lives alone in a subsidized housing unit in South Surrey. He struggles with low motivation, poor diet, and leads a sedentary lifestyle. He has limited support because he was never married and both of his parents (who he was very close to) have passed away. He has one sister who provides as much support as she can but she works full-time and has a husband with health issues who she provides support to as well. Bobby worked as a parts sales man but has no pension or savings - he is low income and receives some money from the government. Bobby's sister reports that Bobby was "spoiled" as a child - he never had to eat anything he didn't like. Bobby's parents were obese and all of Bobby's siblings are obese.

Bobby's health is deteriorating and his independence is decreasing. He reports he "really loves" living in his own apartment where he is able to "do what I want, go out when I want". Bobby is non-compliant with medication administration, glucose control, following a healthy diet, and regular exercise.

Bobby has a number of recreational interests (photography, getting out to the mall or sightseeing, creating crafts with driftwood, making art cards to sell, swimming, bird watching, listening to his records, watching movies). He has not been active with any of his interests in the past year.

Bobby is deconditioned due to his amputation, lack of compliance, lack of motivation, and lack of physical health (strength, endurance and motor control). The deconditioning impacts all aspects of his life (self-care, leisure and health care treatment - dressing, toileting, washing dishes, tidying his apartment etc.). As his weight increases it makes getting around in his wheel chair and transferring himself to the toilet/bed etc. more difficult. Bobby attends dialysis treatment three days a week, resulting in additional stress on his free time and energy.

Currently Bobby receives meals on wheels 3 times a week at lunch time and goes to the mall for fast food or orders in for his other meals. There is a home support worker who comes in 5 days a week to help with his medications and to assist him with bathing. His apartment is a mess with dirty dishes, laundry etc. his sister comes to visit once a week to help with his house work - but she is frustrated because it is starting to wear her out. Bobby uses Handi-dart and the city bus to get around to appointments etc. He has a Case Manager who connects him to services that he needs and has arranged for an Occupational Therapist to assist him with exercises to help with his new prosthesis for his amputation. Bobby does not do the assigned exercises and is at risk of not being able to walk - he has been using a wheel chair to get around instead. The Case Manager is looking at placing him on a list for an Assisted Living facility to provide him with more structure and support.

Questions

-What are the formal supports and informal supports that Bobby is currently receiving?

-Suggest at least 3 other supports (formal and/or informal) that you think may be helpful to Bobby and his family.

-Provide a brief summary about how obesity poses a challenge for Bobby and his quality of life.

-The benefits of healthy eating and an active lifestyle are clear - what suggestions would you make to Bobby to increase his physical activity and improve his eating habits?

-If you were the Recreation Therapy Assistant providing service where Bobby lived - how would you provide assistance to help motivate Bobby to follow your recommendations?