A 79-year-old widow with advanced glaucoma lives alone, has burned herself on the kettle twice, and misses her eye drops most days. Her daughter asks whether she can still live independently.
Examination Findings
A 79-year-old widow with advanced glaucoma: vision 6/18, fields constricted to central islands. She has burned her hand twice on the kettle this month and admits missing eye drops ‘most days’. She lives alone and refuses to consider leaving her home.
Investigations
Task-based ADL assessment in her own kitchen: pouring, cooking, medication handling, personal care. Note lighting, contrast, and organisation. Brief cognitive screen. Review the drop regime — can it be simplified?
Questions to Think About
- Which daily tasks should be assessed first, and why?
- What practical techniques make the kitchen and medications safe?
- How is the balance struck between safety and her independence?
Diagnosis
Advanced glaucoma with tunnel vision in an elderly woman living alone — activities-of-daily-living training for kitchen safety and medication management.
Reasoning
Reasoning: her vision will not improve, but her tasks can be made safe — the assessment must happen in her own kitchen, where pouring, dials, and medication bottles reveal their hazards. Contrast marking, tactile cues, a level indicator, a proper pill system with a simplified regime, and good task lighting address the actual risks, while occupational therapy and family involvement sustain them. Independence is the goal, earned through adaptation. Diagnosis: advanced glaucoma with unsafe ADLs in solo living. Management plan: home ADL assessment, kitchen and medication adaptations, OT referral, regime simplification, family involvement, and safety follow-up.
Differential Diagnosis
- Cognitive impairment affecting safety — screen; burns and missed doses in an elderly person living alone need a cognitive check, not just vision strategies.
- Untreated hearing loss — check; safety alerts need a working sense.
- Depression — screen; self-neglect can masquerade as purely visual difficulty.
Management
Typical management includes: home ADL assessment; kitchen adaptations (lighting, contrast marking, level indicators, safe pouring technique); medication system (organiser, large-print or talking labels, regime simplification with the prescriber); occupational therapy referral; family involvement; and scheduled review of safety and independence.
Key Learning Points
- ADL training starts in the person’s own kitchen, not the clinic — real tasks reveal real hazards.
- Medication safety is the highest-stakes ADL: organisers, talking labels, and simplified regimes prevent both missed doses and double dosing.
- Contrast and touch replace vision in the kitchen: bump dots on dials, level indicators, consistent organisation of every shelf.
- Independence is preserved by adapting tasks, not by taking them away — involve her in every change.
Red Flags
- Repeated burns, missed essential medication, or self-neglect — escalate to home support services promptly; strategies have limits.
- Cognitive impairment on screening — safety planning changes fundamentally; involve the family and GP.
- Refusal of all help with deteriorating safety — a safeguarding discussion with the GP may be needed.
Educational content only — not medical advice. Clinical decisions must be made by a qualified professional for the individual patient.
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