Reference no: EM133528582

Case Study:

Older Adult Suicide Cassandra is 69 years old, married, with one grown daughter. She consults a primary care physician because of a gradual decline in health over the past year and a half. She has come at the insistence of her daughter, who accompanies her to her appointment. She remarks that she is simply there for a check-up and perhaps some laboratory work to explain why she has been "feeling off." Her daughter tells the nurse, "My mother's not well. She's home alone, doesn't get enough sleep, and won't eat right. She complains about her stomach and thinks she has food allergies; she has tried special diets, supplements, and herbal remedies and claims she's getting better, but she's not." Cassandra is petite and well-groomed. She tells the physician, "I'll be okay, but I do want to be sure I'm not anemic or have a thyroid problem. "She gives a history of chronic, recurrent abdominal discomfort, bloating, periodic constipation, and intolerance to many foods. As a young woman, she was told she has irritable bowel syndrome and was given trials of medication, but she reports being unable to take these medications because she has always been "very sensitive to prescription medication." She reports having lost about 10 pounds in the past year. Her examination is unremarkable, except that she is noticeably under-weight. Over the course of the interview, she appears tired and to have a slightly blunted affect. The doctor ordered comprehensive lab tests, including a complete blood count, chemistry profile, vitamin D and B12 levels, and thyroid function tests. She is given an appointment to return in five days to discuss the results and plan a course of treatment. Five days after the initial visit, in preparation for the follow-up appointment later that day, the physician reviews Cassandra's laboratory results, all of which are normal. However, Cassandra does not come in for her appointment. He reaches out to you, the social worker at the primary care center, and explains the situation and asks you to contact her to "check in." When you call, Cassandra's daughter answers the phone and expresses a mix of concern and relief. She states, "I'm really worried about my mother. She seems very confused at times, is really down, and says we'd all be better off if she just went to sleep and didn't wake up. . . . I didn't mention it last week, but she and my dad are not doing well. He's busy, on the road a lot, and I get the feeling she thinks he's unfaithful to her." She continues to explain that her parents have lived largely separate lives due to the travel required for his job, but it had never previously been an issue. Lately, however, her mother has been expressing feeling lonely and uncared for and saddened that she doesn't have a closer relationship with her husband. At your recommendation, the daughter agrees to bring her mother back for a debrief with the doctor regarding her exam results and to speak with you afterward. Cassandra arrives at the office with her daughter. She appears withdrawn and preoccupied, this time with a visibly sad affect. Cassandra asks her daughter to leave the room and reveals to you that she has been unhappy for "a very long time." She adds that she sleeps poorly and is tired all the time; she has lost interest in what was previously an active social life and rarely "goes out." She cannot recall the last time she saw a friend or had a meaningful phone conversation with anyone other than her daughter. She adds that when it comes to her daughter, she tries to pretend that everything is fine so as not to worry her or put her in the middle. There is a good deal of psychic stress and pain attached to the relationship with her husband, and a sense of hopelessness has been building for months. In recent weeks, she has gone for days at a time without sleeping at all or eating much and has periods of confusion. She wishes not to be a burden to those closest to her and has "thought often of ending her life." Recently, she has been thinking about just how to do this, the options available to her, and how it might be done so as to mask her intent. She has resisted these thoughts until now "solely out of fear that it won't work.

Read the attached case study. Answer the following:

1. What warning signs are present in the case?

2. What risk factors are present in the case?

3. What protective factors are present in the case?

4. Based on this preliminary information, what level of risk does the client represent (low, moderate, severe)? Explain your answer.