Communication 5 summary

Senescence growing old or aging

Open to learning and respecting the elderly
Despite changes and difficulty in this period of time, still offers enjoyment
Elderly show lack of biological adaptability physically, socially and psychologically
o Mentally set rigidity
o May be physically and mentally slow
A lifetime of experience teaches many things such as better ways of handling people, getting
around shyness and confidence in ones own decision making
Retirement baby boomers large economic and societal force
Place of work gives person purpose, time structured activities, circle of friends and
acquaintances. Retirement removes this
Who you are before retirement is a good predictor of after. Boredom -> chronic grief
Societal attitude burden on society as economically unproductive
View retiree based on what they have done for society
Volunteer work can strengthen self-image
Grandparents and grandchildren relationship is important
Elderly disengage because of stigma or no longer feel productive or useful
Elderly reduced roles in friendships (i.e. no longer boss, workmate etc.)
Discrimination intensifies role reduction
Society has devalued importance of elderly
Primary relationships remain with age and become more important. Knowledge of this is
important to react appropriately
Separation from others is part of life
Incidence of illness higher in elderly that individuals
Compliance is difficult
Dementia senile loss of memory loss, disorientation and confabulation (loss of memory
and making things up) Also accompanied with paranoia, agitation or depression. Progressive
loss of function then occurs. Initially lack of insight then rejection then loss of awareness
Elderly more likely to suffer disability and also compound disability.
Ability to function based on ADLs. Falls may cause loss of function and independence
Elderly require patience. Allow them to prepare themselves
Stigma compounds disability in the aged associated with
o Retirement, economic loss, social isolation, touching (wrinkles and spotted skin
should not be touched), sex
Elderly lose people around them as part of life, also anticipate their own death
If low quality of life, death may not be unwelcome
Fear of loss of independence
Loss of health, vigour and occupation with age
Coping mechanisms with multiple loses excessive defensive behaviour, withdrawal, false
humour, dependence, depression, reminiscing
Quality of life is just as important as quantity of life
Loss can spiral to suicide
Elderly may suicide due to loneliness, altruistic reasons and chronic disease
Most people who commit suicide tell someone before it happens
Suicide may be one aspect of self-destructive behaviour
 Patients draw up wills when competent
DNR do not resuscitate (when heart or breathing stop) No artificial hydration or nutrition
does not want nutrition if cant express wish and unable to swallow

Lecture

Physiological and psychological changes menopause, retirement, decreased income,

change in living arrangements, access to healthcare
Polypharmacy, sexuality and risk of self-injury become important
Mixed emotions for older people happy, depressed, loneliness
What can we do? Keep relationships strong, volunteer, talk to them, find places where they
can meet others, mobility may be an issue, watch out for depression and isolation
Be open minded, supportive, understanding and empathic
Stages of loss denial, anger, bargain, depression and acceptance

1. Differentiation recognising the differences before and after retirement and acting
appropriately. Disengagement retirement as a removal from society
2. Who you are before retirement is a good predictor of how you are after. Motivated people
with strong relationships and strong social support network often remain like this after
retirement.
3. Negative events: Loss of those around you, disengagement from society, loss of purpose,
loss of circle of friends, devaluation from society
4. The elderly sever friendships as part of a more general disengagement from society.
5. Independence is important to the elderly as independence is the source of freedom. A loss
of independence places a restriction on the ability of the elderly to do things that they enjoy.
The loss of independence denigrates the elderly into a single mass where individuality is lost
and therefore they are liable to social stigma and stereotyping. The loss of value placed on
the elderly has further implications and can cause a loss of purpose in life which may evolve
into depression like elements
6. The key concept in this statement is alone. For most individuals social interaction forms a
key basis and concept at all points in a persons life. By dying alone, one comes to the
conclusion that ultimately all the important relationships in ones life are severed and also
their value in society is lost. At this important time in life, by being alone the elderly may
have a feeling that they are no longer wanted or cared about in the world
7. Reminiscing may be undergoing a review of his or her life. Allows elderly to organise their
thoughts and attitudes, help them remember proud moments of their life. Ask about how
they were like when you were younger. All humans face loss
8. Advanced directive living will and health care agent. Living will list of patient wishes if
they cannot express them at a later date. Healthcare agent decide on patients behalf what
measures to prolong or continue life
9. Comfort measures only treated to improve quality of life rather than length of stay.
Symptoms will be treated even if they result in earlier death

Case study

1. From the observation made by the health worker in Case study 7-1, we can see how who
we were before the illness influences who we are during the illness. Please elaborate on
this point from the case. What do you think of the clients coping strategy?
 The clients coping strategy is to use her inner OCD to cope with the progression of her
illness that she cannot control. It also shows us that having an illness does not change who
you are, it may sometimes manifest the part that you werent quite aware of.
2. Read case study 7-2. At what point is it advisable to institutionalize a loved one? What stage
of loss was Ben, the husband, going through? When all the rewards for coping seemed to be
gone. When you have to watch a person you have loved slowly turning into a toddler. With
loss of memory comes disorientation of time, people and places. A demented person uses
confabulation to mask his or her problems for as long as possible. Dementia may also be
accompanied by paranoia, agitation, or depression. Irritation, denial, frustration,
acceptance.
3. Read case study 7-3. If you were instructed to give Mrs. Olshaw a low salt, low cholesterol
diet, what would you have told the patient? What would you have told the daughter? Would
you do anything else? I would tell the patient that for her own wellbeing, it is recommended
to switch to a low salt, low cholesterol diet. We could find healthier alternatives to Meals on
Wheels, so she could still keep her convenience and at the same time improve her health. I
would have told the daughter that during this switch, there may be many obstacles. The
family needs to work together to overcome this. I need to make the daughter aware that
change for an elderly patient may take a lot longer than change for the youth, and patience
is a must when it comes to change for the elderly.
4. Refer to case study 7-4. Albert engages you as one of his fathers health professionals and
asks what you think. What would you say? I would encourage him to allow DNR and DNI,
because this is fathers will. Although it has been 5 years since the decision, but the patients
autonomy should be respected. Additionally, his father shows no sign of improvement and
does not look like he could be saved and returned to normal living
5. Refer to case study 7-5. When Sarah finally breaks down crying and agrees to comfort
measures only, one of your associates objects for religious reasons. How would you handle
the situation? What would you say to Sarah? What would you say to the rest of the family?
What would you say to your associate who objects? I would tell Sarah needs to know that
she is making the decision on free will and she should not feel pressured into making any
kind of decision. I would say to the rest of the family, that they need to making this decision
for the patient instead of for themselves.

Research

Wong, P. T., & Watt, L. M. (1991). What types of reminiscence are associated with successful aging?.
Psychology and aging, 6(2), 272.

https://jshellman-reminiscence.wiki.uml.edu/file/view/Watt_Wong_Reminiscence+Taxonomy.pdf

6 types of reminiscing for the elderly

Successful agers slowed significantly more integrative and instrumental reminiscing and less
obsessive reminiscing
o Instrumental perception of competence and continuity
o Transmissive passing on ones cultural heritage and personal legacy
o Escapist glorify past and deprecate the present
o Obsessive obsess over guilt from the past
 o Narrative descriptive rather than interpretive collection of the past
o Integrative accept ones own past but also accept differing views
Not the process of life review that is important but achievement of integrity that is
important. Absence of significant difference in transmissive reminiscing between
unsuccessful and successful aged elderly possibly area of further research
Possibly memories guided by self-view of oneself in the present. I.e. positive present will be
more likely to reflect on proud achievement in the past

Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The gerontologist, 37(4), 433-440.

http://gerontologist.oxfordjournals.org/content/37/4/433.short

Successful ageing low probability of disease, high cognitive and functional capacity and
active engagement with life
Social realtions isolation and lack of connectedness associated with increased morbidity
and mortality
Work membership provides two kings of supportive transavtions socio economical
(respect,a ffection etc) and instrumental (direct assistance, providing physicla help)
Marital status prevents against reduction in productive activity
Isolation is a risk factor for health
Social support both emotional and instrumental have possitve health benefits
No single type of support is uniformly effective
Older people typically do not consider themselves old as long as they remain active and
productive in some meaningful sense. However confusion does stem based on what
productivity means to each individual

Group practice log

Reflection (Discussion + discovery of improvement)

Barry is an elderly man who has recently lost one of his best friends after a long struggle with cancer.
Although Barry has been reluctant to speak about his experience his doctor has recommended that
he attend a support group and share his experience with likeminded individuals. You are a medical
science student volunteering at a support group for elderly who have lost close friends

A: Hello, how are you, my name is Ronny. I am a medical science student volunteering at this
support group for those who have lost close friends.

B: Hello good thanks, Im Ronny.

A: So I was wondering, what brings you here today?

B: Well recently, my friend Barry has passed away.

A: It seems like you have a lot of pent up emotions about this time. Would you be able to share any
of those with me?

B: I guess Im here for a reason arent I? Ive known Barry since we were in primary school, he was
my first friend when I moved over here

A: It sounds you had a lot of history with Barry. You guys must have had a lot of adventures together
growing up.
B: He was always there for you know? Through thick and thin. I remember one time when we were
out catching rabbits with my fathers rifle. Just us two right in the bush

A: The way you describe him almost makes his seem like hes your brother. You two seem to connect
on so many levels. Having to find out about his diagnosis must have been such a revelation

B: Its really something Id rather forget to be honest. I remember it was a day like any other. I
glanced down at my phone and saw his name pop up. I answered like any other day. Hey Barry how
are you doing. I didnt think there was anything wrong at the time, but as soon as I heard him speak I
knew something was wrong, the only thing he said was I need to tell you something It wasnt like
any other time he had spoken to me

A: You must have felt so confused at the time. Not really knowing whats happening but having the
thought that something really wrong had happened.

B: As soon as I met him, he just looked defeated. We just stood there for a couple of hours. I didnt
want to push him to speak until he was ready, he was always that type of guy.

A: Those hours must have been excruciating. Having to have your friend deal with his issue and bae
unable to tell you. But also being unable to ask him yourself. You must have felt as if you were in
limbo.

B: I have no idea what was happening at the time. But like anything I thought it was something we
could move through. His prognosis initially seemed quite good and I was hopeful but as things
continued to fail on him, that hope slowly diminished and after a while I had no idea what was
happening.

A: It sounds like dealing with Barrys illness was a very slippery slope and a rollercoaster of emotions.
Your relationship seems to have really been put to the test

B: Barry never married so I was his closest person in the world. He wasnt just a friend and to him I
wasnt either. We definitely got closer because of the illness and it is something I will always cherish.
I dont regret anything that we have done together

A: It seems that even though this experience was hard and difficult to go through, youve really
matured and learned a lot

B: He taught me more about myself than I ever knew. RIP

What was done well and what can be improved

I think what I did well this time is that I was more calm and listened more intently. As this was just
between my friend and I, I was less conscious of being viewed negatively by others and this helped
me perform better. I feel that I did give myself more time to think during the questions which may
disrupt the course of the conversation. I focused more intently on asking good open ended
questions as I felt this was my weak point. However, transitioning this to the workshop I feel will still
be difficult as I have to think more on the fly and maintain composure with someone I do not know