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Mrs JK, a 76 year woman suffered a significant stroke affecting her mobility and speech. Her risk factors included hypertension, Type 2 diabetes and atrial fibrillation. After a period of medical stabilisation (including being commenced on Warfarin) and rehabilitation in hospital, Mrs JK decided she wanted to try living at home again. Both her family and the rehabilitation team expressed concern about her ability to cope at home both in terms of functional independence and her ability to manage her chronic medical conditions.
Mrs JK’s case was referred to Earlsfort eHealthwatch. Our specialist Geriatric and Emergency physicians together with her medical and rehabilitation teams developed a multi-disciplinary home care strategy including electronic blood pressure monitoring, regular clinical reviews and weekly liaison with the local HSE community rehabilitation team.
After six weeks it became apparent that Mrs JK was capable of coping at home with a significant care package. Earlsfort eHealthwatch assisted in the design of that care package and remain integral to it, through continued regular clinical reviews.
Mrs JK continues to reside at home and will remain there for the foreseeable future.