Driving and Community Mobility

The driving and community mobility lecture provided me with a new way to assess and design interventions for those needing to enhance their driving and community mobility skills. Just because someone has not had a car wreck does not mean that they are driving safely. However, you must convey that in a caring manner. Approach the subject of driving sensitively and respectfully because no one wants to hear that they should not be driving. That is usually a person’s only way to get out of their home and provides them with a sense of independence. Additionally, do not limit your scope of driving interventions to driving a typical motor vehicle. Individuals may have interests and occupations involving other means of driving, such as a golf cart or a tractor. Another consideration is all of the components you must assess when evaluating a client to drive, some including the ability to transfer, ability sequence, visual processing abilities, physical limitations, and positioning needs.

         One intervention that came to mind while discussing the impact of a stroke on an individual’s ability to drive was compensating for left neglect. This intervention could be implemented in a one-on-one setting. To increase a client’s awareness of their left side, you could assist a client in creating a habit or routine of checking their left side to enable them to check the left when driving and needing the switch lanes, back out of a parking spot, or check for pedestrians. This could be implemented using a timer that alerts a person every so often, a light that blinks, or a watch vibration.

         Another intervention that could be implemented for clients who have experienced a stroke or have a diagnosis associated with UE weakness or limited ROM would be an exercise class. Clients could be seated and we would perform movements to simulate those required to shift gears, put on a seatbelt, steer a steering wheel, and open and close a door. This would promote carryover to increase these individuals’ abilities to perform some of the foundation physical actions of driving.

Glyph Reflection

          Similarities in my glyph portraits include the following: believing that leadership can be both an inborn trait or a nurture over nature quality, believing that the vast majority of OTs are leaders, holding leadership positions, having a combination of out-in-front and behind the scenes leadership style, believing that self-awareness is a required trait of a leader, and believing that creativity and organization are qualities of a leader. Though I did not have much experience in the MOT program when creating my first glyph, I still had views that have not changed even after gaining experience. I knew that the majority of OTs were leadership simply from meeting various practitioners during my prerequisite coursework and shadowing, as well as professors in this program. Additionally, I have always felt that self-awareness is a quality that is beneficial and needed for any situation or position. Reflecting on your actions and knowing what your effect is on others is incredibly important.

One difference in particular that I noticed was the category indicating if I felt I held more leadership positions at that point than my peers. My first glyph shows that I felt I did because I held various positions during my time in undergraduate school, I was involved in organizations, and volunteered much more than my peers at the time. However, now I put that I feel the opposite. This is not because I gave up all of those leadership opportunities, but it is because my peers are just as involved as I am. I would not say that I hold more leadership positions at this point, but I still feel that I have leadership qualities. A positive outlook on this change is that I am surrounded by like-minded, leadership-oriented peers to hold me to that same standard.

Nutrition and Aging

          I identified multiple key takeaways from the nutrition and aging lecture. The first regarding our bodies’ ability to absorb vitamins and other nutrients in the gastrointestinal tract decreasing with age. This implies that as we age, we cannot maintain the same intake of macronutrients and micronutrients and yield the same benefits as we did when we were younger. This is important because if we encounter a client who is Vitamin B deficient, but reports taking a Vitamin B supplement their entire life, we can then further investigate to see if the client has increased the amount of the vitamin as needed.

         This principle is also true for protein intake. As we age, we need to eat more meat and more protein than before. However, as we age, our ability to chew and swallow, our taste, and our digestive system are all altered, leading to less intake of protein due to the barriers associated with it. This is a chronic problem because at the time we need to increase our protein intake, we are typically decreasing it. This contributes to loss of muscle mass, slowed wound healing, and many other aspects of a client’s health. Muscle loss impacts all aspects of a client’s life—mobility, strength, balance, self-care, and more.

OT can address this by referring clients to a dietitian for a mechanically altered diet for chewing or swallowing difficulties and then working with the client on self-feeding by providing adaptive utensils or other equipment as needed. Additionally, to address this in a group setting, we can lead a cooking group to assist clients who are malnourished in preparing protein-rich meals and identifying various foods that are protein-rich. By increasing protein intake, muscle mass is increased, increasing a client’s ability to improve his or her strength, mobility, and self-care abilities.

         Food insecurities are a problem larger than I previously imagined. The ability of a client to prepare, purchase, or eat healthy meals is limited when the client’s income is limited. If a client is told to increase their food intake for weight gain, they tend to forget the fact that those foods should meet their nutritional needs, not just their calorie needs. The likelihood of a client to find a budget-friendly meal that is readily available, meets their calorie needs, and meets their nutritional needs is very slim. This increases the likelihood of the client to seek out fast-food options because they know that it will be cheaper and most likely meet their calorie needs.

OT interventions to address this with individual clients can include budgeting to identify what amount of money can be spent on groceries, then identifying what meal combinations meet the client’s needs, and teaching the client to prepare those meals at home. In the event that the client’s budget does not accommodate their nutritional needs, we can provide them with local resources to utilize that will assist them in meeting those needs, such as food banks, congregate meal programs, senior box programs, etc.

         Loneliness and isolation are two chronic issues that have a large impact on an elderly person’s life. If a person is lonely, he or she is not going to be motivated to go to their kitchen and prepare a large, nutrient-dense meal. These individuals are also more likely to have a food insecurity because healthcare costs for single individuals are on average $130 more than those outside of that category. That means that if this person does have a nutrient deficiency and seek medical services to address this, they have less money to then purchase meals that will improve their health. This leads to a cycle of more medical issues, less money, and less healthy meals to improve health.

The following sentence from the assigned reading also stuck out to me regarding caregiver and client education: “Fernández- Barrés and colleagues (2017) found that many caregivers lack knowledge about proper nutrition requirements and healthy cooking techniques, but that their knowledge improved significantly after just a 1-hour education session” (Johnson & Janssen, 2018). In just one session, a caregiver can gain the knowledge to not only improve their own nutrition and health, but also improve their ability to prepare nutrient-dense meals using proper technique for our clients. We should not underestimate the power of caregiver education and the impact it can make on our clients’ lives.

References

Johnson, M. & Janssen, S. (2018). Malnutrition among older adults: The role of occupational therapy. OT Practice, 23(3): 12-15.