3rd September 2020
(Names have been changed for confidentiality)
Referral
Tony is 60 years old, he lives alone and has a small support network. He contacted the Essex Welfare Service at the beginning of lockdown to request help with his shopping. During the conversation Tony mentioned he had gained weight recently and would like some advice about staying active. He was referred to the Stay Connected service at Sport for Confidence.
Background Information
DIAGNOSIS: Type 1 Diabetes – reports he has currently ‘lost control’ of his diabetes as his Dexcom device is not working properly – has a diabetic nurse and is in the process of resolving this issue. Neuropathy and swelling in feet. Heart bypass surgery 15 years ago. Restricted vision – had laser treatment on both eyes. Currently 17 stone, states this is the heaviest he has ever been.
MENTAL HEALTH: Depression. Experiences insomnia. Reports he has experienced MH issues since childhood. Several life experiences, which he thinks of often, contribute to his feelings of anxiety and hopelessness, these include bullying at school, neglect within the family, the murder of his pregnant daughter 20ish years ago and being homeless following the breakdown of a previous marriage. Tony states ‘my thoughts can be overwhelming, sometimes I feel like doing something I shouldn’t’ and ‘I feel like a burden at times’.
INTERESTS/ACTIVITY: Tony reports he loves music, he uses music to cope with stress and anxiety. Prior to Covid-19 Tony hosted a weekly hospital radio show every Sunday for 15 years. He is feeling the loss of this role. He enjoys walking, however is anxious about going out during the day. States he recently went out at 3am to walk as he was missing it.
OT intervention
OT’s initial phone call to Tony lasted for over an hour. Tony reported he was struggling with the changes that had come with lockdown, the loss of his role at the hospital radio, being stuck inside the flat and the extra time he had to think which brought up unhappy thoughts. Together we identified several interventions that would assist Tony in the current situation. These included:
- Planning tasks for the week and goal setting. A weekly planner template was emailed to Tony with suggestions of appropriate and healthy activities to fill his week. He states having a goal for the day and thinking of the future helps him to feel less hopeless.
- The use of calming techniques. During weekly telephone conversations we have discussed several relaxation, de-catastrophising and anxiety management techniques. Some techniques have been shared with Tony over email so he can refer to them when required, the OT has reminded Joe of the use of these techniques at various times over the past 5 months.
- Weekly welfare phone call. Tony states ‘the phone calls have given me more of a positive aspect. They have given a bit more hope which I didn’t have before.’
- Links to appropriate SFC exercise videos. Tony states the exercise videos have resulted in him ‘thinking about it more and doing some exercises when I have been sitting down. It has given me other ideas and initiatives.’
- Invitation to join Zoom calls
- Including music into the daily routine and considering future occasions when he can again use his music knowledge to connect with and help other people.
- Tony reports that once lockdown is completed and he feels comfortable taking public transport again he would like to join suitable Sport for Confidence exercise sessions at his closest leisure centre.
Over the course of lockdown Tony has experienced several significant incidents when he especially benefitting from the additional support of a weekly phone call.
- Tony experienced an episode of overwhelming depressive thoughts. He recalled difficult times he had in the past and a friend he lost to suicide many years ago. Tony stated ‘the depression is getting to me’ and ‘I have moments of thinking of self-harming again.’ OT liaised with Tony’s previous Care Co-ordinator at the Community Mental Health Team who provided assistance and guidance.
- Approximately 2 months into lockdown Tony experienced a heart attack. He spent 2 weeks in hospital before being discharged to recover at home. While an inpatient Tony was able to get his diabetes stabilised and received support from the Mental Health Team. Upon discharge Tony stated he would like to continue speaking to OT weekly as ‘it is helpful to talk things through with someone and I enjoy your calls’. During the phone conversations the OT has checked on Tony’s recovery post surgery, offered advice and reassurance when required, suggested suitable activities that Tony can do during recovery and encouraged a return to gently exercise post recovery. The OT asked for Tony’s assistance to suggest some music that older people in a seated exercise group may enjoy moving to. Tony created a playlist of suggestions for OT. He reports this gave him a focus, he felt useful and helpful. As a result he decided to make up playlists of music from different eras and playlists for when he is able to return to the hospital radio.
Summary
Tony has appreciated the weekly welfare calls, which remain ongoing. When given the opportunity to reduce the phone calls as lockdown was lifting he has requested they remain at present stating “thank you for your calls, I feel better and really enjoy speaking to you, you are really helping me”. As Sport for Confidence have returned to Tony’s local leisure centre his assisted safe rehabilitation into the community can commence as soon as he is ready.