Reference no: EM133565993

Mr. and Mrs. Brown are 92 and 89 years of age, respectively. They live in their own apartment, with the occasional services of a housekeeper and a visiting nurse. Their adult children and grandchildren live within easy commuting distance. Mr. Brown has osteoarthritis, most significantly in his spine, hands, hips, and knees. He has hypertension that is controlled with hydrochlorothiazide, 25 mg, po, daily; and lisinopril, 20 mg, po, daily. He takes acetaminophen, 1,000 mg, po, tid for his osteoarthritis, and it is moderately effective in controlling his pain. Mrs. Brown had a CVA 3 months ago. She has no motor deficits, and her speech is intact. Since the CVA, Mrs. Brown has had marked disinhibition, but no other health problems. She does not take routine medications, but has a prescription for Ambien, 10 mg, po, hs, PRN. At the completion of a home visit, Mr. Brown follows the visiting nurse to the front door of the apartment and asks for a word in private. He appears quite anxious, looks over his shoulder frequently at Mrs. Brown, lowers his voice, and says, "Nurse, I've got a problem. I think my wife is oversexed." Upon calm, deliberative questioning from the nurse, Mr. Brown reveals that shortly after her CVA, Mrs. Brown began to initiate sexual activity with Mr. Brown every night, sometimes several times a night. Her preferred sexual activity is intercourse. She becomes quite angry when Mr. Brown cannot achieve an erection and has frequently accused him of "fooling around with other women," although Mr. Brown vehemently denies this. Mr. Brown's feelings are hurt by Mrs. Brown's accusations. In addition, sexual intercourse makes his arthritic joints very painful, and he is not getting enough sleep due to nightly intercourse. Mr. Brown loves his wife very much and is concerned about "not satisfying her" as well as "living with a pervert." Mr. Brown tried to discuss this matter with his wife's physician, who told Mr. Brown that he had "never heard of anything as abnormal as an 89-year-old woman wanting sex." Mr. Brown has become increasingly desperate and admits to sometimes giving Mrs. Brown two Ambien tablets "just to keep her from attacking me in the middle of the night." He finishes his tale by poignantly saying, "Fifty years ago she always had a headache, now I'm getting a headache"

Discuss potential bias to the Brown's situation. How do these biases get developed? Did the physician have any bias toward Mrs. Brown? How can the nurse provide appropriate care to both Mr. and Mrs. Brown?