Charles is a 85 year old man living with his 81 year old wife, Susan, in the community. They have been coping well with their daily and social activities and walk everyday in the neighbourhood for 15 - 20 minutes until recently. Susan claimed that Charles was going downhill fast because he had fallen multiple times in the previous 2 months, fortunately without major injuries. He no longer wanted to join her for walks because he was concerned that he may fall at the same time he was not happy to be house bound.
Charles has emphysema due to smoking in his younger years that is well controlled with 3 puffers and he has longstanding high blood pressure that was also well controlled with 2 medications since his early 50's.
Apart from his recent falls his ankles started to swell during the day for which he was prescribed a water pill which his family physician instructed him to take it when necessary. Charles claimed that he was taking it every day around noon when the swelling was too bad to tolerate. He mentioned that he was frustrated with his situation because he had to stay close to the washroom after he took the water pill.
Susan said that she had not experienced Charles so weak and uninterested in their activities. She went on to say that he spent most of his day in the recliner or lying on the couch which she seriously concerned her.
During the interview with Charles, Mathilda learned that he is knowledgeable about his emphysema and blood pressure medications and took it as prescribed. When Mathilda measured his standing up blood pressure it became evident that it was too low for someone his age and may be have been the reason for his dizziness and falling. His family physician agreed to stop one of his blood pressure medications and monitor his blood pressure in a few weeks. She recommended that he stops the water pill which would eliminate frequent trips to the washroom and that he try non-medication approaches to prevent the swelling in his ankles.
She also learned that Charles was not eating breakfast or lunch regularly, and snacked throughout the day until dinner time when Susan made a home cooked meal. He was not drinking enough fluids during the day because he was concerned about his excessive trips to the washroom. Mathilda made practical suggestions regarding eating regular breakfast and lunch, increasing his protein intake and taking a supplement to prevent weakening of skeletal muscles and lowering the risk of falling.
Charles was initially discouraged by the many changes in his medications, daily activities and diet. He claimed that it was too much to handle but agreed to work with the pharmacist and Susan. Together he and Mathilda prioritized the list of problems and complaints and made a step-by-step action plan that was do-able for Charles. Mathilda followed up as agreed to monitor his progress, supporting him and answering his questions.
It is now 3 months after Charles met with Mathilda for the first time: Susan reports that Charles is back to his old self. He states that he has his energy back, has not fallen in the last 3 months, resumed walking with Susan in the afternoons, and is able to participate in their social activities like they used to before all the problems began. He is not taking a water pill and decided to wear compression socks that takes care of the swelling in his ankles. His blood pressure is well controlled with only one medication and he reports not feeling dizzy so often. He is following the pharmacist's suggestion regarding eating breakfast and lunch, increased his water intake, and takes a vitamin D supplement.
Charles mentions that he's noticed improvement in his bowel behaviour, also he does not make as many trips to the bathroom to empty his bladder during the day, and he gets up only once during the night compared to multiple times before.
He is considering Mathilda's suggestion to get a walker for walking outside with Susan in winter time and when he goes to places that he is not familiar with. She explained that people with emphysema have a tendency to fall and that a walker will provide additional stability and protection. She also identified the need to have his bone health tested, for which he has an upcoming appointment.
Charles says he is satisfied with his current health status and Susan is happy that he pursued the changes that have improved the quality of both their lives.