Case #11: Andrew and Roweena Abbott (adapted from Unfolding Case Studies, 2001)

Andrew Abbott, age 80, is the primary caregiver for his wife Roweena, age 78. Roweena was
diagnosed with Alzheimers disease three years ago. Mr. Abbott has just begun bringing his wife
to the Adult Day Care Center (ADC) at Manorview, an assisted living retirement community. He
tells you that the most problematic situations related to caring for his wife at the present time
are: 1) episodes of incontinence, especially at HS, 2) increasingly unsteady gait, 3) she
continuously follows him from room to room. He also stated that sometimes she doesnt know
he is her husband. He is having difficulty getting her ready to come to the ADC because of
difficulties she has with dressing. Today, she put her undergarments on top of her dress. Mr.
Abbott talked briefly (and tearfully) of his hopes for retirement life and how Rowenas disease
had taken away their plans for the future.

1. Given the above data, in what stage of Alzheimers disease is Mrs. Abbott?
She is in the 6th stage of alzheimers disease. Known as severe cognitive decline.
Mrs. Abbott is in the 6th stage of alzheimers. This is known as a severe cognitive decline.
2. List 3 of your main goals or concerns in taking care of Roweena for the day?
Make sure she gets enough to drink, enough to eat, and exercise.
Safety, Rehab and physcology.
3. Describe a typical day at an ADC.
The patient will be dropped off in the morning, the patient will have breakfast and watch or hear
current news, the patient will exercise, and the patient can also do arts and crafts...whatever
they want to do for fun
Throughout the day, they will engage in meaningful activities tailored to their interests and
cognitive and physical abilities everything from music, crafts, dancing, adaptive sports, pet
therapy, gardening and even field trips. Exercise is also part of their daily routine as well as a
nutritional breakfast, lunch and snack.
Mrs. Abbott is at the ADC 4 days a week from 0900 to 1700. During her first week, Mrs. Abbott
tried to leave the building on two occasions, repeatedly saying she had to leave school because
it was time for her to get home to do her chores. She is not eating well. She has had two
episodes of urinary incontinence.

4. What steps/interventions would you take to assist Mrs. Abbott with her eating and
bladder function?
They can make a schedule for times she will go bathroom. Give her high calorie foods and
snacks, cut foods for her
Schedule regular bathroom breaks, and give her small meals, give her soft ware, protein drinks,
soft foods, foods that she likes or wants, and cut the food into bits.



5. As Mrs. Abbott attempts to leave the building, she says I have to leave school. Its time
for me to get home to do my chores. How would you respond to Mrs. Abbott? Why?
Try to calm her down and get her to come back inside. Tell her shes not in school and she
doesnt have chores to do.
Explain to her that she should stay inside, and tell her the truth and that she is safe. Id give her
a clock to help her keep track of time and that she can go home at a certain time.


After a few weeks Mr. Abbott comes in tearfully. He thought the ADC would make taking care of
Roweena at home easier, but he remains depressed over his wifes illness and their situation.
He states that he and his wife has lived longer than they should have and suggests it would be
much easier just to take a gun and get it over with. Roweena is falling more often and he is
struggling keeping up with her hygiene needs. It appears as though Mr. Abbott has had very
little sleep and may have lost some weight.

6. What is the difference between ADC, Assisted Living, and a LTC facility? Which would
you recommend for the Abbotts?
ADC: Day Care dont stay overnight
Assisted Living: They live in the facility, but they get their own space. They keep their own
independence. They can still do their ADLs
LTC: Facility where patients live in a facility but they need help doing their ADLs
ADC: day care
Assisted Living Facility: they live in a facility where they are still independent
LTC: Helping when they cant do simple things on their own

7. What are your top 3 concerns for Mr. Abbott?
The he will kill Roweena and himself, hell lose too much weight, become depressed
That he will kill himself and Mrs. Abbott, depression, and Malnutrition.

8. How do you respond to his statements?
Tell him thats hes not alone and that they are doing all they can do to help Roweena and
himself..Other family members that can help
Tell him that he is not alone and that there are other options instead of ADC that will help you
keep your relationship with his wife. Ask him if there is any other family members to help him.
Tell him that he needs to take care of himself before he can take care of his wife.