Care Needs For the Elderly: Case Study

• Katherine Mahon

Introduction

I am required to write an assignment on a person in the late stages of adulthood in general and then compare it to an actual person’s physical, intellectual, emotional and social (PIES) development. I will explore my own personal fears and anxieties about working with people in my care and write recommendations on how I can positively respond to the needs of the person during this stage of life. I have consent from the person chosen to complete this assignment on and their name has been changed to protect their identity. Methodology will include information taken from class printouts with regard to human growth and development, speaking with the person chosen to complete the assignment on, the student manual, independent research and healthcare information online.

PIES of development during late adulthood.

Physical

Late adulthood is anyone over the age of 65 years (Student manual, 2015), typically retirement age. The more common physical changes that take place include skin elasticity loss, hearing and vision impairment/degeneration, increase in mobility challenges due to cerebellar ataxia which affect balance and mobility, arthritis (joint inflammation) or osteoporosis (bone fragility). Age related illnesses begin to develop such as cancer and disease of the circulatory system for example, arteriosclerosis (arterial wall hardening), these are the most common cause of death in over 65’s in Europe (Eurostat Statistics Explained, 2015).

Intellectual

Intellectually the speed at which information is stored and received may decrease as we age, known as cognitive decline, some may suffer memory loss or develop neurodegenerative diseases which is the progressive degeneration of mental functioning for example dementias (JPDN, 2014). These are incurable conditions that result in the death of nerve cells, however some can be managed with medications.

Emotional

Theorist Erick Erickson (Student manual, 2015) defined the later stage of life as a tension between ego integrity and despair, individuals either accept their lives as having meaning or they feel it was unfulfilling and unproductive thus feeling despair. Psychologist Robert Peck took Erickson’s theory a step further and believed this involved three distinct tasks that must be accomplished in order to accomplish integrity. These are: Ego differentiation, finding self-worth in sources other than those invested heavily in for example, a parent with their children might seek a wider circle of friends. Body transcendence, not letting physical limitations surmount the rewards of other adaptive skills learned such as cognitive/emotional/social skills. Ego transcendence, facing the reality of death by making life more meaningful or secure for younger generations (Medscape, 2015). Emotionally it can be a stressful time due to seeing others or they themselves becoming ill or dying and losing their independence which can lead to fears, anxiety or depression.

Social

Socially it can become a time of positives or negatives, depending on the individual, as some look forward to retirement while others avoid preparing for it. Though due to the positive promotion and attitudes of services such as Age action Ireland, a charity that offers services for older people through citizen advocacy such as voluntary repair services, or lifelong learning groups (Age Action Ireland, 2015) or Active Retirement Ireland another voluntary organisation whom organise opportunities for activities such as outings, socials, holidays, community sports/work (Active Retirement Ireland, 2015), it has become easier to access services and lead a fuller, happier and healthy retirement. Or should a person not have strong family support, suffer illness, mobility challenges, be affected by discriminations such as ageism or financial difficulties, it could become a time of isolation due to withdrawal from society.

PIES of development of individual as well as your own personal prejudices, fears and anxieties.

Physical

Mary is 70 years old, her physical appearance has changed rapidly in the past ten years, as wrinkles have appeared due to less collagen production, liver spots and broken blood vessels on her face have become more prominent. Her hair has turned grey and she is not as tall as she once was by approximately an inch, due to the decrease in her bone density. She had originally stopped driving due to naturally slowed reflexes and the timing of her reactions, a situation which would now be complicated by arthritis and currently a leg ulcer, she has home help assisting her on a daily basis. Her dexterity has suffered, she cannot sew, however she can still play piano for short periods, which she partakes in socially, given the chance.

Intellectual

Mary suffers with mild short term memory loss at times, however this only seems to occur on a noticeable scale should she develop a urinary tract infection. She tries to stay as active as possible cognitively through light reading, watching educational shows on T.V or listening to audiobooks in the evenings.

Emotional

Mary has a positive attitude and feels she has done the best she could in her own life and with regard to her family and children. However she has mentioned the loss of her sister and a close friend as of late as a tough period to get through but gains strength from family gatherings/visits, she finds them uplifting and remains in strong contact with some of her children and grandchildren, on a daily basis as they live nearby.

Social

Mary has quite an active social life and takes part in her senior citizens group events on a regular basis unless her leg ulcer has returned. She enjoys bingo most weeks with her friends or family, and with home help care, can travel to the shops easily though her son will do her food shopping weekly, she likes to get out and about weekly to the hairdressers, visit friends, especially those whom may be ill. Financially she is stable which allows her a lot of freedom also. She is a strong spirited lady whom does not let her physical challenges hold her back lightly.

My prejudices fears and anxieties.

Before beginning my placement as a rehabilitation assistant, I was anxious to make sure I could develop a good rapport with the service users, understand their challenges well and work strictly to all policies and procedures and make sure I didn’t make any mistakes to the best of my ability. Something I might have dismissed on a daily basis myself before placement could be detrimental to the health of a person in care, such as not tying a shoe lace tight enough or not observing a change in behaviour in a client whom is having their medications reduced. I have now learned from my placement experience that I have a strong ability to foresee problems ahead of time, am observant, productive and have developed an excellent rapport with the service users in my care. It has reaffirmed for me that I have chosen the correct career path to which I will continue learning and working to the highest standards possible.

Variations/factors affecting individual at this stage of life.

Developmental factors that affect individuals at this stage can vary from physical or cognitive illnesses, intellectual or emotional challenges. Environmental surroundings such as location of a person’s home can affect a person in relation to amenity availability, if they live in the countryside, they may not have transport to shops or social activities. If they are in a residential care setting, are they getting the physical, intellectual, social or emotional supports needed. Environmental also includes whether their home is constructive to their health for example if the home is damp, it could cause respiratory illness. Financial stability can affect a person in their retirement years greatly, if they are not stable they may find themselves having to choose between heating or food during the winter months, these situations can also cause their physical and mental health to be affected, perhaps with the onset of depression which may lead to isolation and loneliness or a lack of nutrition leading to illness. Should there be no family or friend supports, again, mental health can be severely affected (Student manual, 2015)

Recommendations to respond confidently to needs of person.

If an older person presents with an illness, the first step must be, to be evaluated by their doctor and depending on the needs of this person, a plan must be put into place to secure their future development. There are many services available and can range from home care help to assist the person with their activities of daily living such as cooking, shopping or dressing or perhaps a personal assistant to check in on them throughout the day and to make sure they are in a safe environment, occupational therapists help a person achieve maximum independence in their environment or local voluntary organisations can organise meals on wheels to deliver meals to a person in need. A person might need long term care in a residential facility, these can be private or public, can have specific units for particular disorders such as dementia units attached to the main residence. Many nursing homes offer multiple services such as long stay, respite, convalescent or post-operative care, and within these homes they offer activities such as arts and crafts, group exercise activities. By maintaining close family and friendships, fulfilling activities of daily living such as a good nutritional intake, staying active, taking classes or participating in social activities, are known to be connected to a happier, meaningful life. As a carer, by making sure all of these essential things are supported and encouraged in a holistic manner, one can respond successfully to the needs of a person.

Conclusion

In conclusion I have found researching the changing care needs in late adulthood with regard to human growth and development insightful, I believe in order to achieve a happy and meaningful retirement to the best of a person’s ability even should illness occur, preparation is paramount in giving them that chance. I agree with Erick Erickson’s theory on integrity and despair, in that in order to successfully accept those life changes and feel a sense of completeness or closure, a person must feel they have lead a productive life and not feel guilt or have any accomplishments left unachieved, these all aiding in a feeling of hopelessness or leading to depression.