The patient's capacity for self-care: advocating for a predischarge assessment.

摘要

Mary McCarthy is an 86-year-old widow with hypertension and heart failure NYHA Class III who was admitted after she slipped stepping out of the bathtub, hit her head on the sink, and fell to the floor, fracturing her right wrist. The patient has 2 adult children, a daughter who lives 2400 miles away and can't afford to visit and a son who lives nearby but contacts her only occasionally and very briefly. Unbeknown to her children, Mrs McCarthy's mobility is now limited to a few steps because of advanced osteoarthritis; her visual acuity has diminished owing to cataracts; her meals consist chiefly of cereal and the few foods in containers that she can open; and her cognitive function has eroded to where she often fails to take her medications, to make regular medical appointments, and to recognize her accumulatingfunctional deficits. Now that she is cleared for discharge and her son arrives to drive her to her apartment, how well do you anticipate Mrs McCarthy will care for herself at home?