Case Study (Sorrento): 86-year-old patient (Valerie) – Aged Care Resident, Dementia
This case study is a real patient scenario. The images have been created from real photographs taken with permission. This is a real person in a real situation but illustrations have been used in order to protect their identity. Images & Content © Seating Matters 2024.
Background
- 86-year-old resident of care facility
- Dementia
- Limited mobility
- Unable to reach out and feed herself or take a drink independently
- Spent much of the day with her arms crossed
- Limited social engagement or interaction
Problems with Old Chair
Valerie previously sat in a standard wooden frame chair that is used in many nursing homes. She used this chair for approximately 8 hours per day. Some of the problems noted were:
- The chair was too wide
- The back height was too high
- Armrests were too high and too far away from Valerie’s body
- Valerie tended to slump forward when she was sitting for long periods
- She would spend much of her day with her head slumped forward, which significantly limited her communication, social interaction and visual field
BEFORE
Valerie sitting in her old chair
AFTER
Valerie sitting in a Sorrento™
Caregiver Issues
Valerie did not communicate much throughout the day and, due to the protective position of her hands and arms, she had difficulty completing small tasks such as drinking or eating. Valerie required assistance for these tasks, but this proved very difficult to provide due the position of her head. Her caregivers often felt worried that she would choke, and her motivation for feeding was quite poor.
The caregivers also noted that, when assisting Valerie to transfer from the chair, she would be quite stiff and her range of motion, particularly of her upper limbs, was restricted.
Postural Issues
- Leaning to the right side was causing an imbalance in Valerie’s weight distribution.
- More weight was being taken through the right side of her pelvis, increasing the risk of a pressure injury in that area.
- This could cause or attribute to a scoliotic deformation of the spine.
- Valerie may have been experiencing difficulties breathing or digesting food.
Intervention
After assessing Valerie’s needs, it was deemed appropriate for her to trial a Seating Matters Sorrento™ chair.
Results
Postural Changes
Immediately, a difference to Valerie’s postural alignment was recorded. As a result of using tilt in space and changing the position of the centre of gravity, Valerie was able to:
- Maintain an upright head position with little exertion or strain.
- Use the armrests for support and positioning, which helped maintain a midline position of her trunk and head.
- Evenly distribute her weight through both sides of her pelvis.
Caregiver & Family Feedback
- Valerie had become more communicative.
- She was more alert and responsive throughout the day, particularly when feeding.
- She was at much less risk of choking or aspirating.
Functional Changes
Over time, and as she felt more confident, Valerie began to use the armrests in her new Sorrento chair.
As a result of feeling much more secure and stabilised in her correctly adjusted chair, she no longer crossed or ‘fixed’ her arms and was able to reach out to drink a cup of tea and eat independently.
Impact on Skin
- The position of Valerie’s pelvis was improved and there was a more even weight distribution throughout her body.
- She no longer leaned heavily to one side.
- The risk of pain and developing a pressure injury was significantly reduced.
The tilt in space feature was used in this case, not only to improve comfort and posture but also to distribute pressure evenly throughout all contact areas. By tilting the chair, as seen in the image below, weight was redistributed from underneath Valerie’s sacrum and ischial tuberosities (ITs) and spread throughout her back and other load bearing areas.
Social Interaction
- As her Sorrento chair could be wheeled from room to room, Valerie was able to attend social events taking place in the nursing home, such as bingo, arts and crafts, and music classes.
- Being able to hold her head upright and look around the room without difficulty or strain had a big impact on Valerie’s motivation. She became more interactive with caregivers and other residents throughout the home, regaining her social and personal identity.
- It was gratifying for those that cared for Valerie to be able to see her face when seated. They had previously often only been able to see the top of her head.
Valerie’s story and other patient case studies are found in The Clinicians Seating Handbook. This practical guide by world-renowned OT, Martina Tierney will assist you in the prescription and use of therapeutic seating for patients with various conditions. It’s the best place to start.
*Note – the purpose of this blog is to give an overview of the product with some tips to consider on its use. This is not intended to be a substitute for professional or medical advice, diagnosis, prescription or treatment and does not constitute medical or other professional advice. For advice with your personal health or that of someone in your care, consult your doctor or appropriate medical professional.
