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Case study: Mrs Eileen

Background of Patient

The case study is about Mrs Eileen and she is administered to the emergency department after the fall. The patient complains about right wrist pain, obvious deformity swelling, pain and decreased movement. The medical history of the patient indicates that she has type II diabetes, hypertension, osteoarthritis and hypercholesteremia. She has recently prescribed with antidepressants as she is diagnosed with depression and she also has bilateral knee replacement five years ago.

She is managing her daily activity on her own and doesn’t require and she doesn’t require any mobility aid. The patient family background indicates that after her husband’s death her health deteriorated and she doesn’t know how to drive so rely on public transport that resists her socializing. She is living in rural are after her marriage and has 2 children they live with their families. She is prescribed with certain medications that include Atorvastatin, aspirin, Candesartan, Panadol osteo, Glucovance and Sertraline.

The Social Determinants of Health

These are considered to be the non-medical factors that have greater influence over the health status of the patient. The social determinants that are considered during the patient care include “the condition in which the individual is born, grow, work, age and different force that shape daily life (Daniel et al., 2018). The clinical practices are considered to undertake the social determinant during the patient assessment to understand different aspect that can lead to deteriorated health status. The different social determinants that are to be considered during patient care include income, social support, early childhood development, education, employment and housing and gender (Andermann, 2016).

The disparities in health status and health outcome of the individual are directly related to different social determinants. The health care associates are expected to address the social determinant during patient care to provide an accurate health care facility. Every individual has the right to have health equity which includes the elimination of the discrimination by providing equal opportunity to every individual concerning their health status (Murray, 2018).

The major role of the nurses during patient care directly increase their responsibility to correctly measure the social determinants that are related to the patient background that can increase the complication of the patient. The social determinant needs to be combined with care to maintain the equity in the health care sector and it should not be neglected during the patient care. There are different way in which nurses can be educated that how to integrate the social determinant which includes motivational interviewing, stimulation and empathic inquiry (Thornton & Persaud, 2018)

Social Determinants of Health in The Case Study

The first social determinants that can be analysed after going through the case is the individual factor that includes psychological distress. Mrs Eileen lives lonely and she does not socialize due to lack of driving skill that leads to increase her stress. Loneliness is considered to be the stage where an individual faces absence of social contact, belongingness that lead to a sense of isolation. Many factors are triggered by disrupted mental wellbeing that includes depression; reduce positive emotion, decrease life satisfaction and poor sleep quality (Beutel et al., 2017). The loneliness is responsible to increase the chances of morbidity and mortality in the individual due to negative health and behavioural outcome faced by the individual. The individual facing stress and mental discomfort are more susceptible to acquire hypertension, hypercholesterolemia, metabolic syndrome and heart disease (Richard et al., 2018).

The second social determinant that is directly related to the case study is social and community context includes decreased social support. Mrs Eileen is unable to avail health care facility as she lives in the rural area that includes decrease care facility and lacks social support that can help to avail proper health care facility. The social support is also considered to be one of the important factors that have a direct impact over individual health. The social support is considered to be the support provided by the surrounding population that can help the individual to maintain the health status. The different supports that can be provided by the surrounding population include affection, empathy, instrumental aid and physical support. The social support helps the individual to regain the self-confidence that directly leads to an improvement in the quality of life the individual. The social support can be provided by the social partners, family members, close friends, neighbours and social workers (LaRocca & Scogin, 2015).

The third social determinant that can be predicted after reviewing the case study is food insecurity that leads to deteriorated health. Mrs Eileen mentioned that after her husband died she has lost her appetite and she is prescribed to have a light diabetic diet. The food insecurity is directly associated with decreased availability of the nutrition and uncertainty of food consumption. The food insecurity is directly related to the increased risk for multiple complications like heart disease, obesity and depression.

Many factors can lead to food insecurity in the individual that lead to severe health issues in the individual (Roncarolo & Potvin, 2016). Many issues are associated with the food insecurity which leads to the development of the negative feedback loop that is responsible for deteriorated health status. Food insecurity leads to increase morbidity rate and it also increases the chances of functional impairment in some individuals. Food insecurity directly leads to a decrease in the quality of life of the individual by increasing the physical discomfort of the individual (Pooler, et al., 2018).


Mindfulness intervention is considered to be one of the best methods that can be utilized for stress reduction in the older individual. Mrs Eileen is encountering stress due to loneliness and it has also lead to depression for which she is having medication. Mindfulness-based intervention is considered to be the therapeutic method that can be applied to improve the physical and mental wellbeing of the individual. The mindfulness-based interventions have a different aspect that includes cognitive therapy, behavioural therapy and commitment therapy that is exploited to reduce the stress of the individual (Mohammed et al., 2018). The mindfulness-based stress reduction intervention not only helps to reduce the stress but it is also involved in reducing the pain, impairment and memory.

The mindfulness-based stress reduction intervention directly related to improving the psychological health of the individual. The psychological health of the individual can be improved by reducing the loneliness, depression, anxiety, stress and sleep issues. The intervention is also involved to improve the physical health of the individual that helps to maintain the physical and mental wellbeing. The older individual requires mindfulness training to improve the psychological and emotional wellbeing of the individual. The health is associated with a combination of physical, emotional and mental wellbeing that can be gained by mindfulness training (Geiger et al., 2016).

The lifestyle intervention can be used to improve the social support of the individual that will help to improve the mental wellbeing of the individual. Mrs Eileen stays alone and does not have social support that decreases her chances to avail accurate health care facility. The lifestyle intervention will help to improve the social presence of the individual that help to increase social support. The lifestyle intervention will include a different aspect that will help the individual to improve the social circle which helps to improve the perspective toward life. The first aspect includes social facilitation intervention that helps to improve the interaction of the individual with peers with the aim for mutual benefit.

There are the different programs that are included in the intervention like charity-funded friendship club, shared interest topic group, daycare centre and friendship enrichment program. The next aspect of the intervention includes psychological therapies that help to improve the social support of the individual which include cognitive enhancement therapy, humour therapy and reminiscence group therapy (Gardiner et al., 2016). Some other lifestyle intervention that can help to improve the including health and social care provision intervention that includes different professional to support the individual in need. The health and social care professional can help the individual to get appropriate social support. Befriending is another approach that can help the individual to improve the social circle by increasing interaction with other individuals to improve the friend circle (Landeiro et al., 2017).

Proper nutrition intake is one of the important aspects that are related to healthy aging and this intervention can help to improve the health status. Mrs Eileen has poor dietary habit after her husband died that directly impacted the health status. The dietary intervention will help the individual to maintain the proper nutrition intake that helps to maintain the health status. The low food intake or poor dietary habit can lead to serious health complication that will increase the risk for the disorder (Robinson, 2018).

The dietary intervention will include a different aspect that collectively helps to improve the nutritional intake of the individual. The first aspect of the intervention will include a food frequency questionnaire that helps to understand the nutritional intake of the individual and food preferences. The second aspect includes providing a dietary chart to the patient that helps to maintain the daily routine of the nutrition intake. The last aspect in the intervention include nutrition intake monitoring to understand the effect of the diet over the individual (Calvo-Malvar et al., 2016).


Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ : Canadian Medical Association journal =

journal de l'Association medicale canadienne, 188(17-18), 474–483. https://doi.org/10.1503/cmaj.160177

Beutel, M. E., Klein, E. M., Brähler, E. (2017). Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 17(97), 1-7. https://doi.org/10.1186/s12888-017-1262-x

Calvo-Malvar, M., Leis, R., Benítez-Estévez, A.J. (2016). A randomised, family-focused dietary intervention to evaluate the Atlantic diet: the GALIAT study protocol. BMC Public Health, 16, 820, 1-9. https://doi.org/10.1186/s12889-016-3441-y

Daniel, H., Bornstein, S. S. & Kane, G. C. (2018). Addressing social determinants to improve patient care and promote health equity: an American college of physicians position paper. Ann Intern Med, 168, 577-578.

Gardiner, C., Geldenhuys, G., & Gott, M. (2016). Interventions to reduce social isolation and loneliness among older people: an integrative review. Health & Social Care in the Community, 26(2), 147–157. DOI:10.1111/hsc.12367

Geiger, P. J., Boggero, I. A., Brake, C. A., Caldera, C. A., Combs, H. L., Peters, J. R., & Baer, R. A. (2016). Mindfulness-based interventions for older adults: a review of the effects on physical and emotional well-being. Mindfulness, 7(2), 296–307. https://doi.org/10.1007/s12671-015-0444-1

Landeiro, F., Barrows, P., Nuttall Musson, E., Gray, A. M., & Leal, J. (2017). Reducing social isolation and loneliness in older people: a systematic review protocol. BMJ Open, 7(5), 1-5. DOI:10.1136/bmjopen-2016-013778

LaRocca, M. A., & Scogin, F. R. (2015). The effect of social support on quality of life in older adults receiving cognitive behavioral therapy. Clinical gerontologist, 38(2), 131–148. https://doi.org/10.1080/07317115.2014.990598

Mohammed, W. A., Pappous, A., & Sharma, D. (2018). Effect of mindfulness based stress reduction (mbsr) in increasing pain tolerance and improving the mental health of injured athletes. Frontiers in Psychology, 9(727), 1-10. DOI:10.3389/fpsyg.2018.00722

Murray, T. A. (2018). Overview and summary: addressing social determinants of health: progress and opportunities. OJIN: The Online Journal of Issues in Nursing, 23, 3.

Pooler, J. A., Hartline-Grafton, H., DeBor, M., Sudore, R. L., & Seligman, H. K. (2018). Food insecurity: a key social determinant of health for older adults. Journal of the American Geriatrics Society, 00, 1-4. DOI:10.1111/jgs.15736

Richard, A., Rohrmann, S., Vandeleur, C. L., Schmid, M., Barth, J., & Eichholzer, M. (2017). Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLOS ONE, 12(7), 1-18. DOI:10.1371/journal.pone.0181442

Robinson S. M. (2018). Improving nutrition to support healthy ageing: what are the opportunities for intervention?. The Proceedings of the Nutrition Society, 77(3), 257–264. https://doi.org/10.1017/S0029665117004037

Roncarolo, F., & Potvin, L. (2016). Food insecurity as a symptom of a social disease: Analyzing a social problem from a medical perspective. Canadian family physician Medecin de famille canadien, 62(4), 291–292.

Thornton, M., Persaud, S., ( 2018). Preparing today’s nurses: social determinants of health and nursing education. OJIN: The Online Journal of Issues in Nursing, 23(3).

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