Emma Curtis, an 84 y/o retired surgical scrub nurse, resides in Moberly Missouri. Mrs. Curtis' immediate family consists of her daughter Donna, her son-in-law Jack, and a sister who live in town. Mrs. Curtis has two grandchildren and three great-grandchildren who live in the Kansas City area. They visit 3 to 4 times per year.
Mrs. Curtis has lived in the same small one-level home for 40 years. She has maintained the home independently since the death of her husband Ben 14 years ago. For the past 10 years, following a fall which resulted in a left hip fracture with ORIF, she has received assistance with the yard and heavy housework. During her rehabilitation from the hip fracture, Mrs. Curtis decided she did not wish to resume driving, as it was too stressful for her. She gave her car to her teenage great-grandson.
Mrs. Curtis likes to play cards and attends church once or twice a month. She has a twelve-year-old poodle and a parakeet. She communicates daily with her sister and two other widows in her neighborhood. Her circle of friends and family is progressively shrinking as she is outliving those around her. Transportation is provided by friends or her daughter and son-in-law.
Until recently Mrs. Curtis was able to prepare her own meals and do laundry and light housekeeping. She was independent in all personal care. She described the onset of her current muscle weakness as fairly sudden. She first noticed getting very tired and weak over a month ago while walking home after visiting her sister who lives only 2½ blocks away. Previously, she had been able to walk without becoming tired. She describes her recent status change: "I've been falling down a lot lately when I go walking, or when I get out of the bed or a chair, and I have a lot of trouble getting back up. I can't get my feet to go in the right direction."
Although she indicated she has not yet been seriously hurt when she fell, she is falling frequently enough that she is scared to move about. Mrs. Curtis stated she has also started to notice a painful stinging and burning in her fingers, hands and toes, along with a numb and "spongy" sensation on the soles of her feet that has been more intense in the past couple of weeks.
Starting about one week after she first noticed the initial weakness, she has become progressively less able to prepare meals, manage her household tasks, or pick up small items such as coins or safety pins. Because of the progressive debility and frequent falls, Mrs. Curtis has resumed use of the wheeled walker she received at the time of her hip fracture. She has been staying in her daughter's double-wide mobile home with a walk-out basement for the past week. The open floor plan allows Mrs. Curtis to more safely manage her walker during ambulation. Her daughter performs all household chores and assists Mrs. Curtis with bathing and with her a.m. and p.m. personal care routine.
Mrs. Curtis stays alone during the day while her daughter is at work. Donna is a third-grade teacher in the public school system. Donna is finishing up the last month of her final year of teaching prior to retirement. She has indicated she is willing to take a leave of absence or quit her job if necessary to be available full-time as the primary caregiver for her mother.
Two days ago, Donna came home from work and found her mother disoriented and lying on the floor, where she had apparently been for several hours. She took her mother by car to the emergency room for examination. Mrs. Curtis was admitted for observation, hydration, and evaluation.