The Pulse

Patient Information: Male, Age 79

Diagnosis: Wallenberg - Stroke / Dysphagia

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services after hospitalization due to a stroke. A feeding tube was placed to address his dysphagia (difficulty swallowing). Prior to the stroke, he lived in his assisted living apartment and was able to eat a regular diet.

What do you do in your free time?  Living in Florida, I just love spending weekends with my family at the beach, watching soccer, or playing music. I started playing the violin at age 5 and guitar at age 7 and it one of my favorite hobbies. But mostly, my time is spent with the entire family as we are involved in the local Hungarian Community. We are members of a performing Hungarian Archery Team – the Hun Archers. We perform all over the Southeast USA at Folk Festivals, Renaissance Festivals, and Hungarian Festivals. Which takes up a lot of my free time but, is so much fun.

Patient Information: Female, Age 91

Diagnosis: Left Hip Pain / Spinal Stenosis / Difficulty Walking

History: This woman, a long-term skilled nursing facility resident, was referred to therapy due to a significant decline in functional mobility including bed mobility, transfers and walking. The decline was preceded by a fall while getting out of the car with her daughter, after which
she experienced increased pain in her left hip and back. Prior to this incident, she required minimal assistance with most functional tasks.

Opioids are commonly prescribed for acute and chronic pain, including after surgeries such as THR, TKR, and ORIF. Opioids have numerous side effects and a high potential for misuse. Over-reliance on opioids for acute and chronic pain management has led to alarming trends across the United States, including a record number of people developing opioid use disorders, overdosing on opioids, and dying from overdoses. From 2015 to 2017, the annual number of opioid-related deaths rose 44% from 33,000 to 47,600.¹

I am often surprised to learn that terms and concepts I use on a regular basis are different than
I thought. A common term that I have misunderstood for many years is “aspiration pneumonia.”
Recent reading has led me to a new understanding of this term.

What do you do in your free time?
I pride myself in being a family man. My wife, 2 boys (ages 1 and 4), and Golden Retriever Nacho, are blessed to have both sets of grandparents nearby to us in New Jersey. As the boys get older, I look forward to getting back into and sharing my love of tennis, basketball, soccer, and movies with them. I love hosting parties and watching everyone enjoy themselves. We make a big deal out of every birthday, anniversary, and milestone, so the house stays busy with positive energy. My favorite time is during the holidays when family, friends, food, and good spirits feels just perfect.

Patient Information: Male, Age 80

Diagnosis: Muscle Weakness / Falls

History: This gentleman, a long-term skilled nursing facility resident, was referred to therapy by nursing due to generalized weakness, risk of falls, and a significant decline in his ability to bathe, dress himself and use the bathroom independently over the previous few weeks. Prior to this decline he was able to walk 100 feet with a rolling walker with close supervision and required minimal (25%) assistance for toileting.

According to the CDC, falls are not only a serious health risk, they carry a high economic burden as well. For older adults in the US, fall mortality rates have increased by 30% from 2007 to 2016. In 2015, the total medical cost for falls was more than $50 billion with Medicare and Medicaid accounting for 75% of these costs. The statistics related to falls are astounding. Each year:¹

• Three million older adults are treated in emergency departments for fall injuries
• 800,000+ patients are hospitalized due to a fall-related injury, most often head injury or hip fracture
• A typical nursing home with 100 residents reports about 100-200 falls
         – 35% of injuries due to falls occur in residents who do not ambulate
• 24% (most common cause) of falls among elderly nursing home residents are due to muscle weakness and gait problems, whereas 16-27%, on average, are due to environmental hazards

Patient Information: Male, Age 94

Diagnosis: Chronic Kidney Disease / Generalized Weakness

History: Following hospitalization related to chronic kidney disease, this gentleman, a long-term skilled nursing facility resident, was referred to occupational therapy to address severely decreased range of motion (ROM) in his right hand which limited his ability to feed himself. Prior to the hospitalization, he was able to feed himself independently.

Patient Information: Male, Age 66

Diagnosis: Fall-Related Trauma / Multiple Fractures

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services after being hospitalized for two and a half months due to a fall at home while climbing a ladder, resulting in multiple fractures to the left side of his body. While in the hospital he suffered respiratory failure due to a pneumothorax (collapsed lung). Prior to his fall he was living at home, independent with all activities, and worked full-time in the field of construction.