Jacqueline has been living with her husband in a small village in a single family house for 50 years. Having recently being diagnosed with dementia following a stroke, she cannot remember her family. Memory clinics are not suitable for her case, and her husband, whose name she remembers most of the time and who she feels safe with, is left to mainly tend to her daily needs. She also has several other health concerns such as hypertension, weak bones and joints (osteoporosis/osteoarthritis) and breathlessness that developed following breast cancer radiotherapy (she had breast cancer in her late forties).
Mobile device skills
Affinity to new tech
Digital Health Literacy
Assistance (ICT use)
What's important to Jacqueline
– She is no longer able to express her wishes and preferences, but her husband remembers that she liked her home, garden, and family (5 children, 20 grandchildren, 18 great-grandchildren). She also felt strongly about personal hygiene, being properly dressed and styling her hair.
– Several strokes
– Subject to falls
– Increasingly severe memory loss and cognitive disorders (hallucinations, anxiety)
– Hypertension (40+ years)
– Osteoporosis, Osteoarthritis
– Incontinence (2+ years)
– Breathing difficulties (breathlessness)
– No longer able to get around and cope with basic daily living activities; seldom goes out, prefers to spend the time in her armchair sleeping; has had chronic pain for many years, sleeps badly; has mobility problems and all activities take a long time. Her husband prepares basic meals; he does not sleep well due to Jacqueline wandering at night.
– Blood tests (cholesterol, sugar, etc.) usually normal
– Electrocardiogram (ECG) showed strokes
– Has only 40% breathing capacity
– High blood pressure recorded when in pain or from urinary infection;
– High frailty index
Events, issues & personal concerns
– Easily short of breath
– Chronic pain
– Disturbed sleep
– Fears visitors
– Frequent falls and complications (broken arms, ribs, concussion)
– No use of the right arm and weak left arm (due to overuse)
Treatment: medications, therapies, etc.
– Has been taking between 10-15 pills per day for decades
– Pills, recently reduced by half by her GP, include: hypertension, chronic pain, 2 pills for her heart, blood thinner, muscle relaxers, natural tranquilizer, puffs, and occasionally pain killers and medication for acid stomach
Own resources & assets / support
– Since her stroke a year ago, her husband has been undertaking most household tasks supported by a housekeeper, who comes for 2 hours / day.
– Her children like to help when they are visiting.
– Her husband can use the computer.
Care professional concerns
– Husband not prepared for sudden life changes
– Both do not want to move to town for better services
– Husband sees caring as his duty; care home not an option
– Outside support difficult, she only recognises her husband
– Husband is overstressed, can make mistakes with meds
– Jacqueline’s husband wishes for a respite support plan for both of them to better cope with her condition. This includes more regular visits by adequately trained social carers so that Jacqueline could, with time, potentially feel comfortable with them.
– Jacqueline and her husband require assistance with ensuring all medication is taken correctly and at the right time.
– Her husband wishes that her episodes of waking up and wandering around the house at night were better managed, so that he is aware when she is active or when she does things which may have safety implications (e.g., trying to open the front door, turning on appliances).