HEAVEN !

• NICE guidelines:
• Education and self management
• Inhaler
• Pulmonary rehabilitation

• Multidisciplinary intervention (Wasterlain, 2013)
• Regular hospital check ups
• Relaxations skills
• OT equipment
• Group and individual intervention

Considerations

• National COPD Audit England and Wales 2014
• No typical presentation of COPD
• COPD umbrella term - is this client-centered?

Raymond's journey with COPD

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Stage 3

PHYSICAL IMPLICATIONS

DIAGNOSIS AGED 65

OCCUPATIONAL IMPLICATIONS

• No longer able to engage in occupations once meaningful to him (Kanervisto et al, 2010; Kuna & Kuprys-Lipinska, 2014)
• Requires full assistance with ADLs

• Can no longer use the stairs
• Severe fatigue, shortness of breath and excessive cough
• Dependent on carers and Carol to move
• Frequent acute episodes and chest complications
• Comorbidities - 76% (Kessler et al, 2011).

INTERVENTIONS

SOCIO-ECONOMIC IMPLICATIONS

• Surgery
• Oxygen - at least 15 hours a day
• Hospital admissions
• Palliative care
• Anti-depressants
• Major tranquilizers

• Socially isolated
• Struggles to communicate
• Limited role within the family
• (Kuna & Kuprys-Lipinska, 2014)
• Inability to work - loss of income

IMPLICATIONS FOR CAROL

EMOTIONAL IMPLICATIONS

• Limited finances (Kuna & Kuprys-Lipinska, 2014) - exacerbated as financially also supporting children.
• Caring duties partially relieved due to hospital admissions
• Psychological distress (Grant, Cavanagh & Yorke, 2012)

Stage 2

• Depression and anxiety (Yohannes & Alexopoulos, 2014)
• Embarrassment (Arnold et al, 2011)

DIAGNOSIS AGED 65

OCCUPATIONAL IMPLICATIONS

PHYSICAL IMPLICATIONS

Begins to experience occupational imbalance.

Leisure

• Avoidance of being outdoors for fear of exacerbation - auctions more difficult to attend, although can participate in them online (Williams et al, 2010)

Productivity

• Took early retirement due to COPD - loss of earnings ~ £200, 000 ( Fletcher et al 2011). Now claiming attendance allowance.

Restorative

• Sleep abnormalities (Ranjbaran et al., 2007)
• Breathless at rest - rest requires effort and energy

Self-care

• Washing and dressing
• Problems with activities requiring physical exertion
• Significant breathlessness even at rest
• Minimal use of stairs
• Increasing acute episodes
• Chronic cough and phlegm (Chan, 2004)
• Dependent on perception (Williams et al 2010)

• Needing assistance from Carol with personal care and other daily activities (Fletcher et al 2011; Chan, 2004)
• Reduced physical activity - exercise can reduce symptoms (Park et al, 2013)

IMPLICATIONS FOR CAROL

• Previously employed in the army but now works part time as a security officer

• Visits auctions and collects army memorabilia

• Planned retirement has been postponed as needs to financially support his children

SOCIO-ECONOMIC IMPLICATIONS

• Effects on finances - carers allowance + Raymond's attendance allowance
• Loss of personal liberty (Seamark et al., 2004)
• Decline in ADL (Seamark et al, 2004)
• Effect on relationship- communication, closeness (Seamark et a., 2004)

• Becoming increasingly isolated (Williams et al 2010) and not wanting to spend time with grandchildren (Chan, 2004)
• Unable to continue any physical aspects of work so LT sick leave

INTERVENTIONS

EMOTIONAL IMPLICATIONS

• Low in mood
• Onset of anxiety and depression
• Loss of self esteem, life roles and occupational identity (Chan, 2004)

Stage 1

DIAGNOSIS AGED 65

PHYSICAL IMPLICATIONS

OCCUPATIONAL IMPLICATIONS

• Breathlessness and fatigue during physical activity e.g. stair climbing and strenuous exercise
• Chest tightness
• Morning cough
• Recurring chest infection

• Can still visit auctions but cannot walk very far or stand for a long time
• Limited to what he can buy because he cannot lift and carry heavy items
• Still able to work with support from employers

IMPLICATIONS FOR CAROL

SOCIO-ECONOMIC IMPLICATIONS

• Increase in household duties
• Taking a more active role with grandchildren
• Reduction in time for occupations

• Limited involvement with grandchildren
• Job is becoming considerably more tiring but employers are helping Raymond to find more flexible ways of working so he is still able to financially support his family

INTERVENTION

EMOTIONAL IMPLICATIONS

• Stress and anxiety
• Uncertainty about the future (Chan 2004)

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