NOTRE DAME UNIVERSITY

Graduate School

3rd Trimester S.Y. 2018 – 2019

Nursing 608 – Advanced Adult Health Nursing

CASE STUDY

On

The Life Experiences of an Elderly

Submitted By: ANNIE ROSE D. RACOSAS, RN

Submitted To: PROF. GIRLIE GEPTE – HERMOSO, RN, MAN

 INTRODUCTION

Aging is an inevitable process that will be experience by all individual starting from
conception to death. It is an essential part for necessary to achieve physical growth and
accomplishing different developmental task throughout life. The process is constant and
continuous in accordance with time. During the aging process, an individual is passing different
stages of life to develop, adjust and grow according to the demands needed in each stages. For
some aging is normal and need to be accepted, but for some, aging can be extended and only those
who will accept they will aged are the ones who will experience and feel it.
Different pre conceived ideas are being stipulated in relation to aging pattern. These ideas
include about ways and means of caring for older adults. Such ideas are being influenced by one’s
observation to elderly family member, friend or neighbours and social media. The way individuals
behaves towards an elderly depends on their perception, beliefs and tradition. In western countries,
aging person is normally placed in home cares where they believe care will be given appropriately.
But, for us Filipinos, traditionally elderly are kept by the family members. The community views
sending elderly in home care as an act of neglecting elderlies, and that is the reason why, family
members of an elderly find ways to take care of their old members at home.
According to Eliopoulos (2005), there are different division of older age group: young old
(ages 65-74), middle old (75-84) and old-old (85 and above). The different groups also have
different physical, emotional and social aspects of aging and it also varies from one individual to
the other.
With this background, this case study was conducted with a client who is consider old-old
or very old. The client in the study is Angelina Mata-Racosas, a 93 year old female widow who
lives in her own house together with her single mom caregiver and the caregivers’ 4 year old
daughter. The researcher is very interested to know the patterns of Angleina’s life, her experiences
and feelings toward her physical and biological condition, her emotional and mental state, her
relationship towards her family, friends and neighbours and also towards her caregiver.
The study focuses on the changes Angelina is experiencing and her ways to surpass all the
challenges, difficulties and struggles she is facing every day. Interview with the client and
caregiver was done by the researcher to know the client deeper and to understand her situation, her
ideas and perception and what are the things she still wanted to achieve in her life.
 The researcher aims to cite different experiences an old-old client is experiencing to be
able to properly understand them and the study results will serve as a guide in proper way of
dealing with individuals same of their age. It will also help family members open their minds to
extend their patients towards them and for caregiver to have a better understanding on addressing
their feelings, emotions and different essential needs to have a quality way of remaining years in
life.

OBJECTIVES:

1. To be able to identify different changes in physiologic, sociologic and psychologic

aspects of an elderly client.
2. To determine and understand the needs of an elderly client.
3. To value the importance of an elderly client to the life of an individual.

RESULT OF THE INTERVIEW

Brief Background of the Elderly Client

Angelina Mata-Racosas is the client being interviewed in the conduct of the study. She is
a 93 year old elderly born on September 23, 1925 at Midsayap, North Cotabato. She is 19 years
widow of Florencio Racosas who is farmer. Angelina is a housewife of 5 sons and 1 daughter.
Through farming, they were able to send their children to school and 5 of them graduated a 4-year
course and the other 1 got married and decided to work with them in the farm. All of their children
have already family and are living their own houses. Angelina decided to live in her own house
and refuses to live with her children. Although her house is just near the houses of her 5 children.
 Her eldest son died due to stroke and according to her really broke her heart. It is according
to her very difficult to burry a son. The same pain is again experience by Angelina when her,
second child died just last year due to very hypertension leading to stroke. She felt very sad about
what happened and even think and bargain the Lord that if possible, take her life in exchange of
her son, since, she is already old and already have fulfilled what she wanted. The mourning process
is very difficult for her, she had a difficulty going to sleep and even suffered depression because
of what happen. But Angelina, has a very strong personality molded by time, making it possible
for her to adjust and move forward with the help of advises and support from her other children.
At present, Angelina is leaving in her own house with the daughter of her niece who serves
as her caregiver. They are three in the house together with the daughter of the caregiver. Angelina
can only walk few steps and most of the time uses wheelchair. She can sit on her own from lying
but unable to stand without support. Her caregiver assist her to transfer from bed to wheelchair or
wheel chair to bathroom toilet bowl for passing stool or commode chair for passing urine. She
needs assistance in going to the bathroom but able to take a bath of herself alone. She is regularly
checked by her children who secure they have food stocks, medication and milk.

Client’s Physiologic/ Biologic Changes

The client is an old-old adult and is expected to be experiencing different body changes.
She is visually appears very old with a wrinkled skin, white and thin hairs, kyphotic posture and
an observable slow and weak movements. The client is dependent on her caregiver in transferring
her from bed to wheelchair and to pushing the wheelchair going to the where she wanted to go.
Though she is wearing a diaper, she’s unable to urinate in the diaper while lying, instead she must
be assisted into standing position to be able to urinate in her diaper. She almost urinate every hour
especially at night, where she always call the attention of her caregiver who is sleeping just outside
her doors to be able to hear her once she called.
She is not hypertensive nor diabetic. She has no other illness diagnosed except for arthritis.
Most of the time she complaints of knee pains that even toughing will trigger the severity of the
pain. The change of position is very difficult for her, for change in position will induce the pain
that even toughing her knees is not possible. Pain reliever like mefenamic or celecoxib is great of
help in ceasing the pain felt. Her laboratories are normal except her high uric acid that is also the
reason of her knee and joint pains. Massage will give her relief of pain, also application of
ointments namely sanitary balm and salompas is her way of minimizing the pain.
She has no maintenance and only taking vitamins (Pharmaton) every day. She is admitted
in the hospital maybe once or twice a year due to severe cough or pneumonia. It is noticed that she
easily get infected with cough once there is a change in weather or cough is prevalent in the
neighbourhood. She would sometimes feel weak and request her grandchildren who are nurses to
insert an IV cannula and give her at least 500mL to 1L of Normal saline with B-complex. After
the infusion of IV fluids, she felt strong and verbalizes a better feeling,
She complaints of difficulty of falling asleep during the night due to the pain in her knees
and the fear that she will not wake up in the morning. She always call the attention of her caregiver
to make sure that she is not alone. There are times that she will request for a sleeping pill to have
a good sleep but not on a daily basis.
Angelina has a very sharp memory and able to recall names of her relatives and friends.
She can able to recall events in the past, recalling date and venues of special occasions. She can
recognize a person by simply looking at them. Her eyesight is very clear and able to see even n a
far distance. She never complaints anything about her eyesight and hearing capabilities. She can
communicate well due to her good hearing senses and she can converse clearly. These intact
sensory skills make her conversant to family, friends and relatives. She loves having conversations.

Client’s Sociologic Changes

Angelina is a housewife who used to stay at home to take good care of her children, does
household chores, does gardening and maintaining their vegetable garden, where the crops are
being sold by them. According to her, she usually stay in their house and only go to the town to
do marketing and buy necessary things needed by her family. She and her husband is not used of
going to the city or big establishments to do shopping. It is also very rare that they go out for a
vacation like going to the beach. They are very focused on making money from their rice and
vegetable farm. They only buy for their necessities and save their money. They were able to save
and invest by buying farm lots. Due to their perseverance, they were able to have hectares of land
to do farming that supported the education of their children. They were also able to give each of
their children a lot for them to farm on their own and a lot where they can build their own houses.
Angelina is not used of going to neighbours to talk and have conversations. She only visits
family and relatives on special occasions like birthdays, weddings and funerals. She has 8 siblings
who are the ones visiting her instead. Her focus is on her husband and children and so when she
had a grand children, she often take care of them since her house is just between the houses of her
children. She loves children and verbalizes that she is very happy once her grandchildren is visiting
her. She usually ask her children to organize a lunch or dinner in her house during special occasions
or even once a month for her to see her grandchildren and their families. She said, seeing her
grandchildren gives her lot of happiness specially the sons and daughters of her grandchildren.
Despite of her condition, she would ask to allow her hold young children and let them sleep in her
lap. She is very happy if her young grandchildren blessed her hands and kisses her. She is very
happy having conversations with children and it gives her a smile on her face and sometimes a
very loud laugh.
During the interview, Angelina verbalizes the struggles and difficulty she felt when her
husband died but according to her she is happy that her husband died and ends his suffering. Her
husband was 3 years bedridden before he died. She is the one taking care of her husband with the
help of her children and grandchildren. She has seen the sufferings of her husband and letting him
go is the thing she must do to cease the pain her husband is experiencing. Despite of the pain losing
her husband, Angelina continue living her life focusing on guiding her children and grandchildren.
According to her, she always observes her children and finds a way to talk to them to give advises
in their life.
She is not an active member in any community’s gatherings or organizations. She only
attend in community gatherings if it is mandatory. She is just active in church for going on masses
and attending novena prayers. She just join in attending prayers for the death of community
member. At present, only attending masses on Sundays and visit to a close relative burial is her
activity outside her house.
 Angelina’s 17 grandchildren are now all professionals. They are all close to her since their
houses are near to their lola. Some of them have their own families and are earning. They gather
on special occasions and sometimes plan to have a family vacation, but, Lola Angelina refuses to
have celebration outside their barangay. She just wanted to have a time spend with them for eating
and having conversations. If they planned to have out of town vacation, Angelina will not go with
them and decided to stay at home. She said it is very tiring for her to travel and will be difficult
for them to assist her. Even how much encouragement they will do, Angelina still refuses to go
with them. Angelina verbalizes that having conversations her children and grandchildren is her
completes social life.

Client’s Psychological Changes

Angelina being a 93 year old elderly have faces different situations that challenges her
psychological strengths and adaptation. She verbalizes that there are so many events that tested
her emotional stabilities and her fighting spirits. Racing her 6 children with a very difficult way of
life makes her strong physically and develop a strong personality to surpass the hardships in life.
She said her husband is very supportive and a good provider making it easier for her to face all the
challenges in life. She said her husband is always by her side and they live helping each other to
support their children. When their children gets sick, she needs to have a strong fighting spirit to
give care to their sick child and also provide the needs of her other children.
Providing the basic needs of their family is their main goal and to be able to send their
children in school to make sure that they will receive good education that they as parent don’t
have. The perseverance and eagerness to uplift their situation is their key to continue striving and
working hard. Angelina said, there are times that she wanted to give up but seeing her children
gives her hope and courage not to stop and to hope for the best. According to her, “I move on after
each hardships, because my children needs me and so I need to go forward with our life.”
In her 93 years of existence, Angelina experienced defeat, failure and loss. The recent loss
of her son is one the difficult downfall in her life. She even said that God must have taken her life
instead because she is already old and tired. She have done everything she wanted and is willing
to sacrifice her life for her son. During this time, Angelina cried most of the time, staying beside
the coffin of his son. According to her, there is no greater pain than seeing your son died before
you. Angelina almost have the hard time falling asleep, making her children worry about her, But
maybe because of her strong personality, Angelina gradually moved on after having conversations
with her other children, grandchildren and close relatives.
Angelina said that sometimes she’s having self-pity especially if her love ones failed to
visit her for a long period of time. She sometimes said they only visits me if I am sick, but
according to her once she is being visited by them she felt better. Angelina will always say that
she is ready to die, that she has fulfilled everything she wanted, her children and grandchildren are
successful. She said her remaining purpose in life is to guide her children and grandchildren,
sharing her wisdom to them.

Interview with Client’s Caregiver

Five years ago, Angelina is still independent with all the household chores and her self-
care and so, she is just living alone in her house and just invite her grandchildren who is available
to stay with her at night. When Angelinas’ health started to deteriorate and her arthritis worsen
making it difficult for her to walk alone. Her children offered her to choose from them, to whom
she will stay so that she will have a companion and someone to look after her but, Angelina refuse
to stay with them and insisted that she stays in her own house. Her children then decided to look
for someone to be with her at her house since they all have their own houses and family to look
out to. The clients’ first caregiver is a 13 year-old Teduray that stayed with her for more thaN a
year. She is the one cooking, cleaning the house and assisting Angelina in mobilizing. During
those times, Angelina still able to wash her on clothes and even do gardening. Her first caregiver
got married and eventually resigned. Her next caregiver and still her current caregiver is a 28 year-
old, single mom who is also a daughter of Angelina’s niece. Her caregiver is Viginia M. Neri, a
28 year old single-mom of Kayla , who is 4 years old. They are both living with Lola Angelina for
more than 3 years now.
 Upon interview, Virginia said that taking good care of Angelina is difficult but she
gradually adjust to what the client wanted and her preferences. Angelina is very meticulous in
terms of cleanliness and the way she is dong the household chores. According to her, Angelina
observes all her actions like watching the television, used of electric fan and even charging her
cellular phones. Angelina will blame her for high electric bills due to her consumption and even
water bills that according to Angelina is the improper use of water during washing clothes and
frequent bathing. Virginia cried because of these accusations of Angelina and talk with uncles and
auntie who are children of Angelina. She almost decided to leave when, children of Angelina ask
her to extend her patients and stay. They advised her to neglect the non-sense statements of
Angelina and offer her higher salary with PhilHealth and SSS benefits. Virginia because of her
need for money to support her daughter, accept the offer and stayed with Angelina. Angelina’s
children also talked with her and told her to minimize the complaints t her caregiver.
Virginia said that the other reason why she stayed is that, Angelina loves her daughter and
even look after her while she is doing chores. Kayla also loves her lola and they have a noticeable
closeness. Virginia also learned how to deal with her and already know her routine. Virginia is the
one assisting Angelina in passing urine and stool, she brings Angelina in the bathroom for her bath,
cook for her and wash her clothes. Virginia don’t have difficulty in cooking for her because
Angelina is not very meticulous with her food preferences, as long as she cooks vegetable, it is ok
with her. The most difficult part for Virginia, is that Angelina is not sleeping well at night and will
call her very 30mins or 1 hour to assist her in urinating or ask her to massage her knees or simply
checking if she’s around and awake. Virginia also have inadequate sleep because of these but she
said during the day if Angelina is a sleep, she also take the chance to nap to get additional rest and
sleep.
According to Virginia, Angelina sometimes shared her emotions to her. Angelina will
verbalize that she felt bad if her children and grandchildren don’t visit her and only remembers her
if she is sick. Virginia would always tell Angelina to understand them, for they have they job and
work where they are busy with. Virginia said, Angelina will always say that she is wanted to die
and very tired of the joint pain she is experiencing. Virginia always encourage her and boost her
morale and sometimes deliver jokes to lighten up the conversation.
Taking care of an elderly is never easy and Virginia showed patients and respect in caring
for Angelina making her an effective caregiver.
 SUMMARY AND CONCLUSION

The client in the study have different changes physically, sociologically and
psychologically. The changes happens as she ages and there are different things influences her
adjustment and coping with these changes.
In summary, Angelina is experiencing joint and muscle pain as she ages. She was
diagnosed with arthritis that is a common manifestation in elderlies. It is an evidenced anchored
by Wear and Tear Theory of Aging. Studies of people with osteoarthritis suggest that cartilage age
over time and this degeneration is not due solely to strenuous exercise but also to general wear and
tear (Mauk, 2010). Based on the data gathered, Angelina is susceptible to infection and easily gets
cough and flu. Anchoring the theory of Immunologic/Autoimmune, there is a decreased immune
function in the elderly that increases the chance of the older adult developing community acquired
infections.
Every individual have a distinct role and function in relation to the society. Unlike other
elderly, Angelina is not an active member of the community gatherings or groups but she
frequently attend masses and prayer for the death community members. She is not used of going
out and having conversations with community people when she’s younger and continues same
behaviour up to the present, According to Sociological theories, Angelina’s behaviour is supported
by Continuity theory wherein her personality remains consistent throughout life (Mauk, 2010).
Her strong relationship with immediate family is kept and maintained by her since her children
and grandchildren are the ones she considered as person important in her life that completes her
social life.
Considering the psychological aspect of the client, she verbalizes that despite of
intermittent worries due to physical changes and pain, she feels contented and satisfied with her
life. Anchoring the 8 Stages of Psychological Development by Erik Erikson, mid 60’s to end of
life have a developmental task of integrity versus despair. In the case of the client in the study, she
successfully achieved integrity as evidenced by her reflection on her lives and feeling the sense of
satisfaction, being proud of their accomplishments having a feeling of sense of integrity, and they
looking back on their lives with few regrets. There maybe unstable emotions at times but the sense
of being fulfilled is felt by Angelina.
 The caregiver of the client is great of help in assisting the needs of Angelina both physical
and emotional needs. She was able to adapt and adjust according to the needs of the client making
the life of Angelina more comfortable. Her children and grandchildren presence, moral and
financial supports are very influential to the adaptation and survival of Angelina in the remaining
years of her life.
In summary, life of an elderly is not limited to her financial and physical needs but the
totality of her/his well-being defends on the support that she receives from her environment.
Elderly, is someone who needed attention, care, respect and most especially love so that her
remaining years of existence is memorable and a happy one.

NURSING IMPLICATIONS

Elderly varies from one individual to the other. Each have a unique and distinct
characteristic that is a result of their own personality and influences by their experiences,
environment and interpersonal relationship. As a healthcare provider, we must open our minds that
not all clients have the same perspective in life and that they are needing different ways of dealing
and giving care to them.
Based on the case study done, each client have variety of needs and as a health care
provider, it is important to identify the needs of his/her client. Considering the physical needs of
the client, health care provider must encourage independence especially on actions or routines that
the client can do without support or assistance. In this way, the elderly client will feel her/his worth
and that he/she has an important contribution in his/her care. As a nurse, we must also be sensitive
on things that our client needs assistance, like transferring or mobilizing and safety must always
be a priority for elderly have a lesser strength compared to young ones. As a nurse giving care for
an elderly client, we must encourage them to verbalize need for assistance or help. It is our job to
give and administer the medication needed by our client as prescribed but alleviating the pain or
client felt is not limited on giving medications but to offer independent nursing management for
the relief on their complaints.
Basically, a health care provider focused more on the physical needs of the client but, we
must not forget that we must render holistic care to our elderly clients. Like any other individual,
they are needing emotional, social and psychological support. We must give them time to verbalize
their feelings and respect their attitude, behaviours and relationship towards the society. We must
respect their preferences in dealing with community people, caregiver and family because each of
us has a different patterns of dealing with the people around us. Nurse must also value the
importance of family, caregiver and support system in the life of an elderly. They greatly influence
in their quality of life, thus, we as nurses must include them in the planning in the care of our
elderly. To ensure effective care to our elderly, it is important to collaborate with one another as a
team for effort from the health care provider, caregiver, family, support system and the elderly
itself.
We must remember the importance of patience, respect and love in giving care to our
elderly patient because will strengthen their self-worth and value.

BIBLIOGRAPHY:

1. Mauk, Kristen L. (2010). Gerontological Nursing. Competencies for Care. (2nd ed.).
Massachusetts: Jones and Bartlett Publishers.
2. https://www.google.com/search?q=erik+erikson+8+stages+of+development&tbm=isch&
source
3. https://www.verywellhealth.com/wear-and-tear-theory-of-aging-2224235
4. https://www.verywellhealth.com/programmed-theories-of-aging-2224226
5. https://courses.lumenlearning.com/teachereducationx92x1/chapter/eriksons-stages-of-
psychosocial-development/