complex dynamics of assessment and intervention planning with respect to depression, delirium and dementia.

Treatment Case Study Assignment

Retrieved from California State University, Sacramento Division of Social Work

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Purpose: This assignment offers an opportunity to consider the complex dynamics of assessment and intervention planning with respect to depression, delirium and dementia. 


Identifying Information

Name:  Estella Luna

Age:  83 years old

Ethnicity:  Mexican American

Marital Status:  Lost husband 2 years ago


Ms. Luna is an 83 year old woman who now lives alone with her small dog, Buster and her two cats, Lucy and Ethel.  Estella lost her husband, Roger two years ago after a painful bought of lung cancer.  She had cared for him in the home where they had been living for 48 years.  The home had been their pride and joy; they had put lots of time and energy into their vegetable and flower gardens for many years.  Estella has seen many changes in the neighborhood where she and her husband raised their two children and where their grandchildren have often come to visit.  She still has some friends in the neighborhood, and it is this fact that helps her feel safe, although the crime rate in the area is quite high. 


Estella and her husband were very close and had a deep and joyful relationship.  Caring for him as he died was very difficult for her both emotionally and physically.  Her grief was severe and she still is overcome with episodes of great sadness and tears.  Her family has tried to keep her busy and engaged.  Her pets are great company for her and have been thought to be a motivating factor for her in getting through some of her most difficult days. 


Estella has a few health problems that she has been managing fairly well.  She suffers from arthritis of the hip and back, and has some circulation problems associated with late onset diabetes.  She takes several medications to manage these health issues.  She cooks and cleans and goes out with neighbors or one of her family members to shop and run errands. 


Some of the neighbors have noticed that Estella has been out walking without Buster, which is very unusual.  They have called Estella’s children to let them know that on several occasions, they have seen Estella wandering around in the neighborhood at atypical times such as after dark and have helped her home. 


When her son, Michael came to see her yesterday, Estella seemed to take an especially long time to come to door.  She was reluctant to let him in the house, not recognizing him.  She was tearful and distraught.  She seemed overwrought with worry, agitated and distracted.  Estella was not making sense when she did speak and seemed confused.  When she went to get a drink to serve her son, she was uncertain about where she kept her glasses.  Michael notices that Estella, who is normally organized about her medications, has a number of bottles open on the kitchen table.  He realizes that she is perspiring and flushed.  She calls for her husband, Roger to tell him Mikey is home from school. 


Guide Questions

Answer all question using citations from your readings.  Be sure to attach a reference list of your citations to your assignment when you turn it in. 


 How would you describe the presenting problem for this case?

  2. What signs and symptoms do you identify?


 What diagnoses are you considering and why? Be specific and refer to the DSM criteria outlined in your readings.  Support your considerations with signs and symptoms that Estella is demonstrating. 

   4. What strengths and resources do you see for Estella?


   5. Are there race, ethnic or gender issues that you should consider in your assessment and treatment plan?


   6. Using the biopsychosocial indicators, describe in detail how you would go about conducting a full assessment of Estella.  Be sure          and identify assessment instruments and provide a rationale for why you would use them. 


   7.  What other information would you like to have?  Who else would you like to interview or consult with?  Are there other         diagnostic tests or screenings you would recommend?  If yes, which are these?  Provide your rationale.


    8.  Based on your assessment and preliminary diagnosis, identify treatment goals and intervention plans. 


    9. What community resources and/or referrals would you make?






Kirst-Ashman, K., & Hull, G. H. (2006).  Understanding Generalist Practice, 4th ed.  Belmont, CA:  Thomson Brooks/Cole.  Chapter 5:  Engagement and Assessment in Generalist Practice (pp. 136-179)


McInnis-Dittrich, K. (2005).  Social work with elders, 2nd ed.  Boston: Pearson.

Chapter 4:       Conducting a Biopsychosocial Assessment (pp. 85-115)

Chapter 5:       Differential Assessment and Diagnosis of Cognitive and Emotional Problems of Elders (pp. 116-150)


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