Health and Social Care of the Elderly

Growing old and gray is one thing most people dread. They long to maintain their youth by keeping a fresh perspective in life, a positive outlook and attitude, keeping themselves fit and healthy, and feeding their minds with intellectual stimulation. Some even go to the extent of pursuing artificial means of looking younger such as undergoing cosmetic surgery just so their looks will not reveal how old they are.

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However, the fact of the matter is that everyone ages. The elderly, need all the care, support, and understanding they can get from the people around them because their advanced age limits their capabilities, leaving them feeling helpless and worse, useless. If before they were productive individuals, now, mostly ailing from certain illnesses, they have no choice but to depend on others to help them survive.

One major concern of the elderly is contracting diseases, as their bodies become more frail and immune to illness. The growing prevalence of diseases, as well as the discovery of new ones, has served as a motivation for society’s overwhelming concern about health and fitness. This has given impetus to the evaluation of lifestyles lived and habits learned over the years that may contribute to one’s present health status.

Research has likewise included the study of personality patterns linked to some diseases. “All too often, when dealing with illness, medical investigators (as well as laypersons) think they are asking the question, “Why do people become sick?” but they are often studying “Who becomes sick?” (Friedman, 2007). This has given the pathological study of diseases another dimension – that of a psychological one.

Myers (1995) has outlined how a person’s coping mechanisms in response to certain life events lead him to either health or illness. If a person’s appraisal of the life event is a challenge; and his personality type is easygoing, non-depressed, or optimistic; he has healthy personal habits and enjoys close and enduring social support, then he tends to be healthy. On the other hand, if his appraisal of the life event is a threat, his personality type is hostile, depressed, or pessimistic; he has poor health habits such as smoking, not enough exercise and has poor nutrition; he lacks social support, then he tends to illness. These personality patterns are often already set when a person reaches old age.

The term “psychosomatic” comes from the root words psyche or mind and soma or body. It described psychologically caused physical symptoms. Laypersons easily dismissed some recurrent symptoms complained about by those deemed feigning illness as unreal or “merely psychosomatic. “To avoid such connotations and to describe better the genuine physiological effects of psychological states, most experts today refer instead to psychophysiological (“mind-body”) illnesses.

These illnesses, which include certain forms of hypertension, ulcers, and headaches are stress-related.” (Myers, 1995). The persons suffering symptoms from such illnesses are not merely feigning them to have an excuse to avoid stressful situations, but are experiencing discomfort. For others who hold prolonged resentment, anger, or anxiety and often repress these negative emotions to brew deep inside, such feelings may stimulate an excess of digestive acids that destroy parts of the lining of the stomach or small intestine leading to ulcers. Still, for others experiencing chronic stress, the possibility of retaining excess sodium and fluids, together with constriction of the arteries’ muscle walls may lead to increased blood pressure. (Light, et al, 1983).

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Many elderly individuals suffer from depression because they are already limited in their capabilities. Some need to undergo therapy just to get by and get on the process of aging. Cognitive Behavior Therapy is one effective approach that can indeed help them. Clients suffering from psychological problems are assumed to focus more on the flaws that pull them down than on their potentials that may spur them up to success. Aaron Beck agrees that much of our psychological problems are caused by “cognitive distortions” due to our acknowledged human fallibility. Beck (1987) came up with the concept of a “negative cognitive triad” that describes the pattern that triggers depression.

In the first component of the triad, the client exhibits a negative view of himself. He is convinced that he is to blame for whatever pathetic state he is currently in because of his inadequacies. Secondly, the client shows a negative view of the world, hence, a tendency to interpret experiences negatively. He nurtures a subjective feeling of not being able to cope with the demands of the environment. Third and lastly, the client projects a gloomy vision of the future. He can only anticipate failure in the future.

Beck (1975) developed a model to treat depression. He writes that, in the broadest sense, “cognitive therapy consists of all of the approaches that alleviate psychological distress through the medium of correcting faulty conceptions and self-signals” (p. 214)

The goal of therapy is to help the client realize that reorganizing the way they view situations will call for a corresponding reorganization in behavior. In therapy, clients are taught Thought Catching, or the process of recognizing, observing, and monitoring their thoughts and assumptions, and catch themselves especially their negative automatic thoughts when they dwell on it. Once they are aware of how their negativity affects them, they are trained to check if these automatic thoughts are valid by examining and weighing the evidence for and against them.

The therapist uses a variety of therapeutic strategies depending on what he decides will work on his particular client. He also delegates responsibility to his client by expecting him to do homework outside the therapy sessions. Homework or Task Assignment is aimed at positive behavior that brings about emotional and attitudinal change (Corey, 2005). Therapists also engage in Socratic dialogues with the clients, throwing questions that encourage introspection with the goal of the client arriving at his conclusions. Reality Testing lets the client do tasks to disprove negative beliefs such as phoning a friend to disprove the belief that no one wants to speak to him. (Field, 2000)

Therapy for depressed elderly focuses on their specific problem areas and involves doing activities to deeply process the problem and probable solutions.

This can result not only in a client feeling better but also behaving in more effective ways. Clients feel overwhelmed with all their responsibilities and their inability to attend to all the details of their lives leads them to be depressed. The therapist usually needs to take the lead in helping clients make a list of their responsibilities, set priorities, and develop a realistic plan of action. “Because carrying out such a plan is often inhibited by self-defeating thoughts, it is well for therapists to use Cognitive Rehearsal techniques in both identifying and changing negative thoughts. If clients can learn to combat their self-doubts in the therapy session, they may be able to apply their newly acquired cognitive and behavioral skills in real-life situations.” (Corey, 2005, p.291)

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Another technique in Cognitive Behaviour Therapy is Alternative Therapy. It focuses on coping options. Clients are encouraged to generate several alternative solutions or courses of action to given situations that might render them helpless. This brainstorming welcomes even ridiculous or counter-productive ideas, as the benefits and costs of each alternative are discussed anyway. This exercise makes the clients realize that they can be in control of situations after all. (Field, 2000)

Finally, in Dealing with Underlying Fears and Beliefs, the therapist makes the client go to the core and origin of such beliefs and discuss the vulnerability factors that exist with them. These beliefs are then challenged again using tasks (Field, 2000).

After undergoing intensive CBT, relapse prevention is essential. Throughout treatment, clients are encouraged to integrate the techniques they have learned in therapy in their daily lives intending to keep CBT effective even when therapy ends (Roth, Eng, and Heimberg, 2002).

However, clients are also warned that they might still encounter difficult times in the future even after successful treatment but their newly acquired skills at dispelling negative thoughts and reactions must be at their disposal to use whenever they would need them and maintain the belief that a single difficult event is not a failure on their part. “An important goal of therapy should be to ensure that clients can apply cognitive and behavioral techniques on their own, with less reliance on the therapist over time, thus facilitating relapse prevention efforts.” (Roth, Eng and Heimberg, 2002, p. 453)

The term Social Gerontology was originated by Clarke Tibbits in 1954 to delineate that area of gerontology concerned with the effect of social and sociological conditions on the aging process and the consequences of the process. Social gerontologists are interested in how the older population and the diversity of aging experiences affect and are affected by the social structure. This gives rise to far-reaching problems in health and long-term care, the workplace, pension and retirement practices, company facilities, housing design, and patterns of government and private spending. “Already it has led to new specialties in health care and long-term care, the growth of specialized services such as assisted living and adult day health programs and a leisure industry aimed at the older population.

Changes in the socio-political structure, in turn, affect characteristics of the older population and civic engagement initiatives.” (Hooyman & Kiyak, n.d.). For instance, the growing availability of secondary and higher learning, health promotion programs, and retirement planning offers hope that in the future, older people will be better educated, more secure economically, healthier, and more engaged socially than the present generation of the elderly.

The idea of an active lifestyle for the elderly is vital and widely accepted. The World Health Organization defines it to be the “process of optimizing opportunities for health participation and security in order to enhance the quality of life.” This would include all people – those who are frail, disabled, or who require assistance with daily activities. Such a definition changes our view that old age is a period of passivity to that of continued participation in the family, community, religious and political life.

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Most services for older people are oriented toward minimizing environmental demands and increasing supports. These services may focus on changing them, the social environment, or both. Physical changes such as ramps and handrails and community services such as meals-on-wheels and Escort vans are simple ways to re-establish the older person’s level of competence and confidence.

On his own, an elderly individual may be helped to feel independent and still useful in many ways. He must follow all the health rules: Exercise, eat a balanced diet, get enough rest and sleep, not to mention brush, floss, and gargle every day. He has to consult his dentist and doctor at regular intervals. If he needs dentures, make sure they fit and are comfortable. He has to visit his doctor for check-ups especially when on hormone therapy or the like. Submitting oneself to x-rays is needed too, upon doctor’s advice.

As long and as much as possible, the elderly individual must rely on himself to manage the basic activities of daily living such as dressing, grooming, cooking, and general housekeeping. However, when the need arises, he must not hesitate to avail of the services of a therapist (e.g. for massage), a part-time nurse to remind one of time to take medication, and the like.

The elderly would be wise to surround themselves with people, especially loved ones. One need not be a recluse. One piece of advice would be – join family activities – parties, picnics, even short trips. This would imbue the old one with greater respect, security, and a sense of belongingness. Join a religious organization where one may be assigned to visit the slums and probably aid the underprivileged. One will probably thank his lucky stars that he is not one of them.

One can also go back to school and earn that M.A. or Ph.D. Old age is not the end of the endeavor. At least, learn something new – any useful skill will do – auto repair, dressmaking, cosmetology, computer science, etc. The list is endless. Each to his interest. One can even enter politics if he can stand the stress. There are many activities one may engage in if he gets involved in community life – typing lessons, dancing lessons, learning to drive are other examples. It’s a well-known fact that non-use of certain parts of the body leads to Atrophy.

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