Community elderly case study: Mrs Perez prevention guide

Question one supplies its own answer structure and the marks are in using it. Six named categories — biophysical, psychological, physical environmental, sociocultural, behavioural, health system — and the case gives you something for each if you look. Biophysical: 73 years old, asthma, a severe exacerbation requiring hospitalisation. Behavioural: two packs a day. Physical environmental: three cats in the home, which is an allergen exposure sitting alongside an asthma diagnosis. Sociocultural: a Cuban American woman living alone, which bears on both support and on how health advice is received. Health system: a nebuliser prescribed as needed, which puts the judgement about when to use it entirely on her. Psychological is the one the case leaves thinnest, and saying what you would need to assess is a better answer than inventing it. Work the six as headings and question one writes itself.

The second question is easy to answer at the wrong level. Primary, secondary and tertiary prevention are defined by where they sit relative to disease onset — before it, at early detection, and after it to limit consequences — and in a patient who already has asthma the levels are all still available, but they attach to different things. Primary prevention for Mrs Perez is not preventing asthma, which she has; it is preventing the influenza and pneumonia the clinic's own data flags, through vaccination, and preventing a first cardiac event given her smoking. Secondary is screening and early detection: peak flow monitoring, spirometry, screening for depression or cognitive change in someone living alone. Tertiary is limiting the damage from established disease: inhaler technique, an action plan, smoking cessation support, addressing the cat exposure. Three of each is nine strategies, so keep each one short and make the justification the sentence that earns the mark.

The third and fourth questions carry the epidemiological framing the scenario opens with, and it is easy to read past. The clinic's admissions shifted year on year from colds and sore throats toward bronchitis, asthma, pneumonia and influenza. That is the reason late fall is named: it is the window before respiratory season, when vaccination, inhaler review and action plans still change the winter's outcomes. Plan the health promotion activities for that population rather than for Mrs Perez alone, since the question moves from the individual to the aggregate. And the evaluation question asks for criteria, not intentions, so name what you would measure — vaccination coverage, admission counts against last year's, inhaler technique demonstrated, quit attempts — and when you would measure it.