SOWK 432 Week 4 Bio-Psycho-Social-Spiritual Assessment Assignment Example

Bio-Psycho-Social-Spiritual Assessment Paper: A Seventy-Nine-Year-Old Grandmother Living Alone, Her Daily Activities, Faith, Friendships and the Stairs in Her Farmhouse

Introduction

I interviewed my grandmother, Dorothy, a composite 79-year-old widow, at her kitchen table on the Tennessee farm where she has lived for fifty-four years. My grandfather died three years ago, and she now lives alone. McInnis-Dittrich (2014) describes a biopsychosocial approach that views older adults as whole persons whose physical health, emotional life, relationships and environment interact; this paper adds the spiritual domain, as the course model requires. The assessment gives particular attention to activities of daily living, spirituality, social functioning and environmental safety.

Biological Functioning

Dorothy has high blood pressure, controlled with two medications, and arthritis in both knees that turns every staircase into a chore. She takes six prescription medications in all, along with an over-the-counter sleep aid, which raises concern about drug interactions and dizziness. She had cataract surgery two years ago and sees well with glasses. She has mild hearing loss in her left ear but has not been fitted for hearing aids, saying they cost too much. She sleeps about six hours a night and eats two full meals a day, often skipping supper.

Activities of Daily Living

Katz et al. (1963) built their index of independence around six basic functions, here listed from eating, continence and moving from bed to chair through toileting, dressing and bathing, and on that index Dorothy is independent in all six areas, though she bathes only when her daughter is nearby because getting out of the tub frightens her. On the instrumental activities scale developed by Lawton and Brody (1969), which covers the more complex tasks independent living requires, she manages the telephone, meal preparation, laundry, medications and finances herself. She needs help with shopping and heavy housework and no longer drives after dark, so she depends on her daughter for evening trips and for groceries in winter.

Psychological Functioning

Dorothy describes her mood as "mostly good." She still grieves my grandfather, especially in the evenings, and keeps his chair by the window, but she laughs easily and looks forward to visits. She denies hopelessness. She reports occasional trouble finding words and misplaced glasses, which she attributes to age; she follows conversation well, remembers recent events in detail and manages her own medications accurately, so I saw no signs suggesting a cognitive disorder, though a routine screening at her next checkup would be reasonable.

Social Functioning

Dorothy's social world centers on family and church. My aunt lives eight miles away and visits twice a week. Dorothy attends Sunday worship, bakes for the fellowship meal and meets with a quilting group every Thursday. In winter, however, icy roads and early darkness keep her home for days at a time, and she admits that January "gets long." Her closest friend moved to a nursing home last year, a loss she feels deeply.

Spiritual Functioning

I used the FICA framework, which asks about faith and belief, the importance of faith, community and how the person would like spiritual matters addressed in care (Puchalski & Romer, 2000). Dorothy describes herself as a lifelong Baptist whose faith gives her purpose and peace. She reads her Bible each morning and says prayer carried her through my grandfather's death. Her church family is her main community outside relatives. She would want her pastor called if she were hospitalized and would like any care plan to respect her wish to keep attending worship as long as she can.

Environmental Safety

Dorothy's farmhouse poses real fall risks. Her bedroom and only full bathroom are upstairs, reached by a steep staircase with a handrail on one side only and a dim bulb at the top. Loose throw rugs cover the wooden floors, the bathtub has no grab bars or non-slip mat and the path to the mailbox is uneven gravel. These hazards matter: Bergen et al. (2016) reported that about 28.7 percent of adults aged 65 and older fell in 2014, with millions of fall injuries, and Dorothy's arthritis, medications and nighttime trips to the bathroom add to her risk. Her rural location also means emergency help could take twenty minutes or more to arrive.

Strengths

Dorothy's strengths are considerable. She is independent in all basic self-care, manages her medications and money, has a close and nearby daughter, a strong faith and an active church community. Her sense of humor and her habit of baking for others give her purpose. She is open to some changes, as long as they let her stay in her home.

Recommendations

Seven recommendations follow from this assessment. First, Dorothy should ask her physician to review all medications, including the sleep aid, for fall risk. Second, she should install grab bars and a non-slip mat in the tub, a second stair rail and brighter lighting, which her church's men's ministry has offered to help with. Third, she should remove or secure the throw rugs. Fourth, she could move her bedroom to the first floor and add a downstairs shower when funds allow. Fifth, a hearing evaluation could explore over-the-counter hearing aids, which since 2022 can be bought without a prescription at lower prices. Sixth, a medical alert pendant would provide help if she fell alone. Seventh, her church could arrange winter rides and phone calls to ease the isolation of January.

Biblical Reflection and Conclusion

In Isaiah 46:4, God promises to carry and sustain his people even into old age and gray hair (English Standard Version Bible, 2001/2016). Dorothy lives that promise; her faith has carried her through loss, and she trusts it to carry her through what lies ahead. This assessment found an independent, faithful and socially connected woman whose main risks are falls, winter isolation and medication side effects. With modest home changes, a medication review and her church's help, she can likely remain safely in the home she loves.

References

Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged ≥65 years: United States, 2014. Morbidity and Mortality Weekly Report, 65(37), 993-998. https://doi.org/10.15585/mmwr.mm6537a2

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914-919. https://doi.org/10.1001/jama.1963.03060120024016

Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3, Pt. 1), 179-186. https://doi.org/10.1093/geront/9.3_Part_1.179

McInnis-Dittrich, K. (2014). Social work with older adults: A biopsychosocial approach to assessment and intervention (4th ed.). Pearson.

Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. https://doi.org/10.1089/jpm.2000.3.129