Knee and hip replacements
Person
Douglas1 is an 82-year-old gentleman who despite having had a knee and hip replacement is in relatively good health. He has become gradually more fatigued over the last couple of years.
He has developed more generalised aches and pains, particularly when he has been static for a little while and then needs to become active although has no specific arthritic diagnosis.
This has particularly impacted on his sitting to standing transfer resulting in him drinking less to avoid the need to pass urine as frequently.
Douglas has had two falls in the home, neither leading to serious injury and he is currently being treated for a urinary tract infection (UTI). He has some mild ankle oedema which only becomes more pronounced following longer periods of standing.
He walks with a Wheeled Zimmer Frame around the home and has an attendant propelled wheelchair for longer outings.
[1] Name used for illustration purposes only.
Environment
Douglas lives alone in a house with stairs. There are two bannisters on the stairs which lead to a bathroom with toilet and 3 bedrooms. There is a toilet on the ground floor. He has a solid fuel fire which heats a back boiler and therefore the home’s hot water supply. He currently has a sofa and two high back fireside style armchairs.
Occupation
Douglas is independent with his personal care although he bathes less frequently than he would like and only with a family member in the house. On other days he has a wash at the sink.
Reducing fluid intake to manage the passing of urine is due to difficulty standing, but this makes the problem worse as urea in the bladder is more concentrated and more of an irritant therefore increasing frequency.
He is unable to manage the setting of the fire himself although has small bags of coal made up to put on during the day. Carers visit in the morning to make the fire, breakfast and leave a cold prepared lunch. A family member visits each evening with a hot meal and to provide some company.
Outcome – Clinical Reasoning
Multi C-air with single motor Tilt in Space
The Multi C-air provides the most holistic solution to meet Douglas’ needs. Firstly, the full rise feature of the mechanism will support Douglas to stand with minimal effort. This will reduce the joint pain he has been experiencing on standing and encourage him to drink more fluid as he will be less worried about going to the toilet. In turn this reduces the risk of falls and urinary tract infections.
The tilt system will allow him to rest through the day without having to go upstairs for a lie down if he wishes therefore preserving his energy for engagement in more meaningful activities.
The single motor Tilt in Space ensures that when reclining, his body angles are maintained, therefore limiting the risks of shear and friction on his skin during chair movements.
The Multi C-air comes with up to six interchangeable backrest and ten interchangeable seat cushion options with varying degrees of pressure relief. This ensures that as Douglas becomes potentially less mobile or frailer the cushions can be changed to meet his long-term and on-going needs. This makes the Multi C-air a highly cost-effective solution that could move from home to a care environment if that were ever required.
Back Cushion - Waterfall
The waterfall back cushion provides Douglas with a high level of comfort. The fully adjustable sections of the waterfall cushion will help him to manage lumbar support and headrest as he feels appropriate. The backrest provides maximum comfort both in upright sitting and recline positions so that at no time does Douglas feel in unnecessary pain.
Seat Cushion - Viscoform
Although Douglas is mobile there is a good chance that he will be seated for more than one hour during the day. This then increases his risks of developing pressure damage and the Viscoform’s high density foam base with memory foam top layer provides him with both comfort and protection.
Fabric
Dartex VP multi-way stretch fabric was recommended to aid pressure management and to help with heat dispersion because, although he is mobile, he may be seated for relatively long periods and this therefore manages the risks proactively.
