Care and mobility considerations
General information
In some parts of the country resources may be limited, and people are unable to obtain help with their medical condition and personal care that would be deemed to be necessary. A simple arithmetical approach to how much attention/supervision is given to a person on a daily basis may under estimate considerably the amount of care and/or supervision the person actually needs, especially if that care is not readily available to the individual.
Schizophrenia may develop in a middle-aged person (30 to 50 years) when the main symptom is one of delusions of persecution. They believe that other people, including family and friends, are trying to harm them. This can lead to hostility and an aggressive attitude towards others. These delusions may be of a circumscribed nature only, i.e. that others are trying to harm them, and respond to medication. The person is less likely to be affected by the negative symptoms of the condition and carries on with the majority of the usual tasks of daily life. He or she is unlikely to have any long-term requirement for care or supervision.
People whose behaviour is very disturbed may put themselves or others at risk. Supervision by day and night might be required in some cases. The most severely disturbed are likely to be admitted to hospital. People, who are stable on medication once the acute episode is treated, are unlikely to require supervision at night. A history of suicide attempts would increase the need for supervision. A suicide attempt is more likely in someone who has been acutely disturbed and whose treatment is not fully controlling the symptoms. The risk might be greatest after a recent hospital discharge, and especially in those with newly diagnosed schizophrenia.
People with schizophrenia should not have a physical difficulty in walking. Side effects of drugs causing stiffness of muscles and involuntary movements may affect the lower limbs, but not to such an extent that walking is severely limited.
People with schizophrenia may need supervision or guidance out of doors as a result of poor concentration, impaired thought processes, odd behaviour and social withdrawal. Problems may occur if people are very disturbed or deluded, although this situation should be short lived when medication is used to control such symptoms. Some people may engage in inappropriate conversations with total strangers, or be so socially withdrawn they would be unable to ask someone else for directions or help. Many people however with moderate schizophrenia well controlled on medication who live in the community are able to find their way around with little difficulty.
The following tables present pen pictures of customers’ likely mobility and care needs at varying levels of functional severity.
Mild Functional Restrictions
| Category | Description |
|---|---|
| Disabling Effects | Many people with this level of functional restriction would not have any noticeable disabilities on an everyday basis. Their mood would be normal; they would be alert and orientated with no evidence of confusion, memory loss, poor concentration, disordered thinking or impaired judgement. Symptoms of anxiety or panic arising from the schizophrenia would be unlikely to be prominent or cause any functional limitation. Limb function would be normal. |
| Mobility | People with this level of restriction would, for example normally have no difficulty finding their way around outdoors because they do not usually experience any confusion, inattention, memory loss or impaired judgement. Physical walking ability is unaffected. |
| Care | People with this level of restriction would, for example normally be expected to care for themselves by maintaining personal hygiene and preparing meals etc. They would have little or no functional limitation on a day-to-day basis arising from any symptoms nor would they need supervision or watching over to prevent abnormal or untoward behaviour. |
Moderate Functional Restrictions
| Category | Description |
|---|---|
| Disabling Effects | People with this level of functional restriction may experience hallucinations, delusions and disordered thinking such that they are unable to initiate and complete the usual tasks of daily living. Insight into their medical condition may be limited and the need for treatment denied. Self-neglect, social isolation and/or social withdrawal may occur. Confusion, incoherent speech, decreased memory and impaired judgement may be present. Symptoms of anxiety and panic disorder may occur as part of the schizophrenic illness. Limb function would be normal. |
| Mobility | People with this level of restriction would, for example display inattention, confusion, incoherent speech, memory loss, impaired judgement and anxiety and panic disorder which would indicate that they may need guidance or supervision outdoors. Physical walking ability is unaffected. |
| Care | People with this level of restriction would, for example need to be encouraged to initiate and complete activities of daily living e.g. they may need to be told and encouraged to get up, wash, dress and prepare meals to maintain a reasonable standard of hygiene and nutrition. They may have support mechanisms in place to maintain a stable routine for the person to prevent relapse and exacerbations of symptoms or need to be reminded and encouraged to attend a day center, hospital or psychiatric clinic appointments. They may need to be encouraged to participate in social and leisure activities to reduce social withdrawal and isolation, need help with communication, correspondence and financial matters or need someone to supervise their medication. Some supervision indoors due to inattention, confusion, incoherent speech, memory loss and impaired judgement may be required. |
Severe Functional Restrictions
| Category | Description |
|---|---|
| Disabling Effects | Hallucinations, delusions and thought disorder may impair ability to carry out normal tasks of daily living. The person may be disorientated, confused, have poor concentration and loss of memory. Speech may be unintelligible. At times, behaviour may be bizarre, anti social and, very occasionally, hostile or aggressive. Some people may be very withdrawn and apathetic with minimal social interaction such that self-neglect is severe. Insight into the illness may be very limited. |
| Mobility |
People with this level of functional restriction would, for example display inattention, confusion, incoherent speech, memory loss and impaired judgement, which is likely to indicate that they would need guidance or supervision outdoors. They would perhaps exhibit antisocial, bizarre or occasionally hostile or aggressive behaviour, which is likely to indicate that they would need guidance or supervision outdoors. Physical walking ability is unaffected. |
| Care |
People with this level of restriction would need, for example help to initiate and complete activities of daily living e.g. they may need to be told and encouraged to get up, wash, dress and prepare meals in order to maintain reasonable standard of hygiene and nutrition. Need regular contact to prevent self-neglect and a decline into apathetic behaviour. If not encouraged, the customer may lie in bed all day and do nothing, or engage in aimless, repetitive activities. They would need be reminded and encouraged to attend day hospital, day center, hospital and psychiatric clinic appointments. Help in communicating with others including correspondence and financial matters. Need to be encouraged to interact with other people, to participate in social and leisure activities to reduce social withdrawal and isolation. They would have support mechanisms in place to maintain a stable routine and environment to prevent relapse or exacerbation of symptoms and need supervision from a carer to reduce risks of self-harm to themselves, and occasionally others. They would need encouragement to eat or drink and require supervised medication. |
