Patient-Centered Family-Focused Community-Based

History and Carolina: Patient is 78 y/o John: Patient is 80 -Patients are frail elderly They both live in
PE female and has been y/o male living together. Both having Fairview, Quezon
complaining of diagnosed with their own health issues. city. The nearest
constipation for 3 months. disc disease of Carolina takes care of her medical health
 Hypertensive the lumbar spine. husband, she bathes him assistance is FEU-
 Diabetic and assists him in doing NMRF Medical
 Excruciating Knee  Smoker most of his activities of Center.
Pain  (+) Gout daily living.
Physical Exam reveals: Arthritis
 BMI- 18kg/m2 Both are at risk of injury
 BP- 167/79 mmHg and both needs emotional
 HR- 61 bpm support.
 T- 37.4 C

Analysis Diagnostics: Family Life cycle: Family in

 Screening Tests: Blood pressure Later years.
measurement, height and weight
measurement, mammography, fecal
occult blood test, colonoscopy, serum
lipid measurement, hearing test,
depression questionnaire, bone mineral
density, fasting plasma glucose
(frequency appropriate for their ages as
endorsed by U.S. Preventive Services
Task Force)

Plan of Therapeutics:  Use family Government

Management  Encourage regular intake of assessment tools programs for
medications like APGAR, senior citizens:
 Disability rehabilitation for John, SCREEM to check  Health and
including physical therapy sessions. on family wellness
Non-pharmacologic interventions: functionality and program
 Vaccination appropriate for their age; dynamics of the for senior
 Flu shot patients, as well as citizen
 Pneumovax Vaccination their coping ability  GSIS
 Tetanus Booster as a family.  SSS
 Encourage and promote healthy  Screen for  PCSO
lifestyle caregiver  Expanded
 Dietary Plan syndrome Senior
 Smoking cessation for John  Family meetings Citizen’s
 Exercise every 30 mins 3-5x a and counselling Act
day (brisk walking)  Screen for -Engagement with
 Accidental fall/ injury precaution emotional and socio-civil org. for
 Psychosocial support for the elderly financial neglect of social reintegration
 Counselling for depression. the patients’ family
members