09 Feb Psychological Care of the Elderly
In the U.S., like everywhere in the world, the population aged 65 years and above is growing rapidly. These older adults have different special needs some with mental and behavioral health problems. Mental health disorders including depression and anxiety are affecting an elderly’s ability to perform various physical tasks. They hinder their daily routine, and even more when the older adult is also suffering from a medical condition or a family problem caused by the death of a loved one. Addressing these problems is important to alleviate emotional suffering and improve physical and mental health and promote a better quality of life.
Cognition and Perception
The molecular and cellular mechanisms of the aging body and mind are poorly understood even today. Age-related changes are not only limited to physical aspects but also to metabolic, urogenital, digestive and neurological processes. Most older adults have problems with cognitive function and speech perception as the years pass by.
Cognitive function is defined as the intellectual process by which an individual becomes aware of, comprehends and perceives ideas. It includes all aspects of reasoning, thinking, perception and remembering.
According to clinical studies, there is a correlation between aging and cognitive decline. Evidence indicates that neural stem cells located in certain brain regions have a major role in cognitive functions like memory, learning and emotional behavior. These neural stem cells proliferate over time, causing a reduced ability to learn as well as memory performance.
Furthermore, older adults also experience a change in their speech perception. They usually complain that talkers mumble or talk too fast and they cannot hear clearly because of background noise. This change is attributed to deteriorating cognitive processes like memory, attention span, language comprehension and lower level sensory plasticity. Studies reveal that declining cognitive function affects speech perception among older adults. The way they process information is slower than younger individuals. Healthcare workers who provide care to the elderly should always consider their speech perception and cognition. A better understanding of their patients’ current physical and mental states is needed to make sure that care is provided without conflict and misunderstanding.
Self Perception and Self-concept
Depression is, unfortunately, a common occurrence among older adults. The fact that their activities and social interactions are more limited, and their nearest and dearest are often living far away, makes the adjustment to old age harder. Thus, most elderly face problems with self-perception and self-concept.
The theory of self-perception suggests that individuals infer opinions, attitudes, and internal states mostly through observing the behavior and circumstances in which they occur. On the other hand, self-concept is defined as the way an individual thinks, evaluates and perceives his self.
These two concepts change as an individual ages. It has been observed that healthy older adults have more positive self-perception and self-concept compared to those who are lonely and suffer from health issues. Consequently, healthcare providers, especially those who are the primary caregiversm should encourage seniors to have a positive attitude towards aging. This can help them increase their desire to live and make them more resilient to disease and mental illness.
Promoting a positive self-perception and self-concept entails a lot of effort on the part of the caregiver. An older adult should be immersed in various social activities to regain a sense of hope and excitement about life. This can be done by making strong social connections within the locality and allowing the elderly to be involved in activities organized by various support groups. Most older adults placed in assisted living facilities interact with and meet other residents who share similar interests. For those who are living in their own home, joining church meetings, local gathering and social celebrations are helpful ways to foster positive aging.
Nonetheless, a healthy aging process involves meaningful relationships with the family and significant others. Older adults should not be left at home doing nothing. They should be encouraged to engage in family activities and gatherings that minimize isolation. Self-perception and self-concept are directly affected by what the person does every day, so planning in advance is essential to make various activities possible.
Roles and relationships
Most of us are lucky enough to live in a family setting. It provides us with the necessary resources needed to become independent as children and stay independent as we age. Other than financial support, our families are also a source of physical and emotional care. Elderly individuals who have been with their families for years, and sometimes decades, understand their value. But we must take into account that an aging person and the family are only a small part of a much larger society. Society as a whole has an impact on the resources and services made available to all older adults and families.
In discussing aging, generation and cohort are two of the most frequently used terms. A generation is a group of individuals having the same step or line of family. Children, parents, grandparents and even great-grandparents mirror different generations. Individuals who belong to the same generation often have similar roles, responsibilities or expectations. They have different ideas about family and the personal responsibilities that need to be done.
On the other hand, the word cohort is used when society as a whole is described. It defines a group of individuals born at the same time in history, who share common beliefs and experiences. For instance, baby boomers or those born in 1946 to 1964 are a cohort. They have had an experience of a traditional family where the father works for their family and the mother stays at home for the children. Every individual belongs to a certain cohort. Clashes between these cohorts take place when individuals fail to recognize the differences in their lifestyle and experiences.
We often see the ideal image of a perfect family in the print media, television, movies and online resources. Family members help one another and rarely argue about anything, but when they do so, they solve it in a peaceful manner. However, arguments and disagreements between family members in real life are much more complex and difficult to resolve. Disagreements are often due to the differences between generations. Children, parents and grandparents have complex inter-generational relationships. Some of them are emotionally close while others are very distant. Hence, researchers use three dimensions to better understand families, especially the aging adult: emotional closeness, frequency of contact and social support.
Emotional closeness and frequency of contact have an enormous impact on inter-generational relationships. It allows us to understand why some family members are very close with one another, despite the huge age gap and living conditions, while others remain distant and shallow. In the context of geriatric nursing, social support is provided by one or several adult children in spite of distance, time and competing responsibilities. Older adults usually rely on family members, especially when they have chronic illnesses.
Depending on their upbringing and family ties, there are adult children who have a strong sense of commitment and responsibility towards their aging parents, while others have lost all contact and the ability to provide any social support for their parents and/or grandparents. However, no matter what the individuals’ circumstances, all elderly need support, including emotional and informational as well as instrumental, financial and housing.
The majority of our disabled elderly seek help from their immediate families. Some prefer to receive help from their children, spouses and immediate relatives, especially when it comes to driving, buying food and medicine and routine daily activities. However, there some older adults who prefer not to burden their loved ones and seek the help of healthcare professionals. This allows the family to place the elderly in a long-term care facility where professionals can look after them. When this decision is made, it is still important for the family members to provide emotional support and attention to ensure quality of life. No healthcare professional, no matter how committed, can truly replace family support.
Coping with Stress
During emergency situations, stress and anxiety are the natural fight and flight instincts of our body. These stressors can either be external (an intruder crawling through your window) or internal (a financial problem within the family or worry over an older adult with a mental or physical problem). Thus, when stressful challenges occur, our body senses danger and releases stress hormones into the bloodstream which increases heart rate, breathing, and other processes that prepare you to respond quickly. This natural reaction is also known as a stress response.
According to research, long-term activation of the stress response can diminish the immune system’s ability to fight disease and may also increase the risk of physical and mental health issues. For instance, studies show that stress and anxiety that occur in older adults are associated with physical problems like difficulty in carrying activities of daily living and other health problems like coronary artery disease and a decreased sense of well-being.
Furthermore, stress is linked to causing or aggravating cancer, Alzheimer’s disease, and multiple medical conditions like diabetes, heart disease and arthritis, chronic pain and cognitive changes like declining short-term memory.
Signs of Stress
Although there are differences in how an individual responds to stress; most of the time, he/she may feel the following symptoms.
- Anxiety or panic attacks
- Sadness or depression
- Irritability and moodiness
- Feeling pressured or hurried
- Difficulty concentrating or making decisions
- Sleeping problems
- Physical symptoms like headaches, chest pain, and stomach problems
- Feeling overwhelmed and helpless
- Sexual dysfunction
- Drinking too much alcohol, misusing drugs or smoking a lot
- Not eating enough or eating too much
Preventing and Coping with Stress
Coping with stress or preventing it from overwhelming us is often easier said than done. However, if you make an extra effort to deal with it, you can always smooth the aging process. For families with an older adult, especially those with disabilities, it is very important to be part of his/her daily routine. Encouraging the elderly to participate in community activities and social gatherings will allow him or her to divert attention and enhance self-esteem and alleviate stress. Older adults obviously have different interests than young people, so take time to find out what will minimize the stress of the older person in your care and guide them towards it! Whether it is ballroom dancing, church activities, or camaraderie with friends or relatives, the end outcome is the same: reduced levels of stress hormones in the body and a better quality of life.
Healthy dietary habits and regular exercise will also help the elderly cope with stress better. Taking a walk in the park or outside the house should be a part of his/her daily routine to promote proper blood circulation and improve their psychological well-being. However, if it becomes apparent that nothing you say or do works and the older adult cannot handle stress well, seeking help and talking to a psychologist may be beneficial. This healthcare professional will teach the elderly to manage their stress through various different relaxation techniques and mental exercises that you may not be familiar with. If the problem is more severe, they may refer the older adult to a psychiatrist able to relieve their symptoms of stress and depression with medication.
Values and Beliefs
Each of us has our own values and beliefs developed over time. The sense of who we are and how we perceive the world is influenced by our family, friends, and experiences. As healthcare workers, we are often exposed to patients with different life experiences and views. It is our duty and responsibility to be aware of personal values and beliefs and ensure to empower the patient fully to make them functional in their families and community.
What is a value?
Values are standards, principles or qualities that a person upholds. Values serve as a guide in our lives to make decisions and live the way we think we should. A value is usually formed by a particular belief related to a person’s behavior. It can influence our judgments and behavior- that is why healthcare workers have to be aware of a person’s values when taking care of them.
What is a belief?
Beliefs come from real life experiences, but are often forgotten and start to influence us subconsciously. They can significantly affect the quality of our work and personal relationships with colleagues and friends, and they plays a major role in our identity. Beliefs may be influenced by our morals, culture and religious affiliations. Healthcare staff working with the elderly often have their own pre-existing beliefs and stereotypes about issues like sexuality, health, alcohol, drug abuse, aging and disabilities, people’s rights and many others. This stereotyping can affect the way we interact and work with older adults because of assumptions about their actions.
Considering the Personal Values and Beliefs of an Elderly
One of the responsibilities of a healthcare provider is to control one’s own values and beliefs about the older adult he is working with. This means that he or she does not provide options or services based on what he feels is right, but what is right for the client. Older adults often have an impaired ability to decide for himself, which is why healthcare workers should consider personal values and beliefs. If we try to impose our own moral values on the elderly, it is likely that we will judge the person rather than help him. Healthcare workers should be a role model to their clients, regardless of behavior. A good client-worker relationship can be achieved by setting aside personal interests, values and beliefs, and making his or her needs a priority while respecting beliefs as well.
Sexuality and Aging
As adults age and change so does their sexual behavior. Sex may not be the same as it was in their 20’s, but it can still be fulfilling if sexual health is preserved. Older adults who live with their partners can enjoy and maintain a satisfying sexual life through proper communication. Setting aside time to be sexual and sensual together is necessary for fulfilling intimacy. Partners should share thoughts on their lovemaking and help each other understand the needs that have to be met.
The key to a lasting relationship and intimacy is communication. Hence, becoming honest in sharing sexual feelings is necessary to make it work.
Nonetheless, testosterone plays a significant role in a man’s sexual experience. This male hormone is at its greatest during the younger years, while for older men, testosterone levels start to decline. Studies show that after the age of 30, there is a one percent decline in testosterone levels each year. This means that the penis may take a little bit longer to become erect and erections may not be as hard as they used to be. Full arousal, orgasmic and ejaculatory experiences may take longer to achieve as well. Similarly, when a woman approaches her postmenopausal period, her estrogen levels will also decrease, leading to slower sexual arousal and vaginal dryness. Though they can enjoy sex without the worry of getting pregnant, changes in body shape and size may cause women to feel sexually less desirable.
Aging couples should be sure to address every sexual concern encountered and talk about it as freely as possible. Agreeing on decisions helps to boost the relationship, especially if one is ill or has a medical condition that affects sexual health. Older adults often experience various medical problems as they age, but proper communication can ease the physical, emotional and sexual problems encountered.
Factors that Affect Sexuality in Men and Women
Sexuality in men and women is affected by several physiologic, emotional as well as lifestyle factors.
Stress is the primary reason for decreased libido. Time and time again, individuals who are stressed from work, family and personal matters experience this. Older adults retiring at home are usually stressed with their caregivers, financial status, and family members. These stressors enhance the release of adrenaline and cortisol which can restrict or narrow blood circulation in the body, leading to decreased libido or sexual desire. This can cause depression in both partners, especially if the sexual needs are not met, yet both are still sexually active.
Depression and Low Self-Esteem
It is hard to feel sexy when an individual is depressed or his/her self-confidence is low. At some point, older adults feel unattractive because of the change in their body shape and size. They have fears of rejection and decreased sexual desire due to their physical appearance. Individuals who tend to consume a lot of alcohol have difficulty feeling aroused. Due to depression, some older adults get into drinking and drug abuse that can impair their nervous system and lower the sex drive. Although this provides an immediate high, alcohol and substance abuse can affect libido negatively.
Lack of sleep
A good night sleep may be hard to come by, but it is essential if you want to keep a healthy body, a sharp mind, and an active libido as you age. Older adults who lack sleep are often exhausted during the day. This can elevate cortisol levels and furthermore decrease libido. A recent study shows that a lack of sleep may lead to restless leg syndrome, a neurological disorder that places an individual at a higher risk of erectile dysfunction.
Decreased libido is a typical emotional side effect of erectile dysfunction. Once a man experiences erectile dysfunction, he beccomes anxious, and his confidence is shaken, making his libido shut down. Lower levels of testosterone and decreased flexibility while having sex can also aggravate the problem.
A hormonal imbalance among men and women has a huge impact on libido. A low testosterone level in men and a low estrogen level in women can decrease sexual desire. It can also cause physical issues like vaginal dryness and erectile dysfunction that have a negative psychological impact on older adults.
Chronic systemic illnesses like cancer, diabetes, and kidney disease can suppress testosterone levels and decrease sperm production. It can also limit the physical activity of an individual, thereby reducing the desire to make love.
Caregivers and Sexuality of Older Adults
Sexuality in older adults changes due to various factors. Health is often the main reason why sexual life is affected. Older adults who lack openness about their medical condition and its side effects are often left feeling frustrated, isolated and guilty about their lack of sexual ability. Because they cannot meet their spouse’s sexual needs, they are often depressed and stressed.
As caregivers, it is our responsibility to respect the sexuality of older adults. Stereotyping is very common in the healthcare field because of pre-existing values and beliefs, but anyone working with the elderly, especially those who have medical conditions, should be sure to respect and provide privacy for the individual.
Encouraging the older adult to stay open with his partner is very helpful to make the relationship work, regardless of the sexual changes. Discussing certain concerns like hormonal imbalance can also help ease the stress that the elderly are experiencing.
No matter how old an elderly is, assuming they are not sexual leaves them feeling inferior. Research shows that most seniors remain interested in sex, although the physical changes of aging will affect their desire to have sex. Healthcare workers have to educate older patients about sexuality changes they will go through and discuss their needs and concerns along the way. This can relieve anxiety and depression as well as feelings of inadequacy. Overall, an awareness of sexual health is essential to caregivers involved in the care of the elderly. Biases and stereotypes should be avoided to address sexual issues professionally.
Sexual Health and Sexual Orientation
As we go from childhood to adolescence and adulthood, our bodies develop and change, together with our emotions and feelings. During the teenage years, the physical and hormonal changes of puberty cause individuals to increase their sexual feelings. These feelings vary depending on sexual orientation, which can either be heterosexual, homosexual, bisexual and asexual.
Older adults under the care of healthcare professionals have different sexual orientations. We may not be able to notice it at first glance, but once we get into their lives and communicate with them properly, these sexual feelings will surface. Historically, gays, lesbians and bisexual people have a negative connotation in society, but healthcare professionals should respect every individual’s sexual preference. Older adults who have an attraction to the same sex should not be reprimanded for his/her admiration and gesture. Acceptance and respect are the keys to a healthy relationship with an older client. This may not be easy for someone with pre-existing beliefs on sexuality, but it is a necessity for healthcare providers to be fair to clients who have a different sexual orientation.
End of Life Care for the Elderly
In the final stages of a terminal illness, the type of care provided usually changes. In spite of the best care, treatment, and attention given to an older adult approaching the end of life, curative measures are modified to palliative care to relieve pain, ease symptoms and alleviate emotional stress. Caregivers often find the last stages of life challenging because the daily provision of care is combined with complex end of life decisions and feelings of bereavement. It requires a lot of support and emotional strength to ensure that an elderly is satisfied and happy with his last few days, weeks or months.
The Need for an End of Life Care
Basically, there is no particular point in time or event when end of life care begins. It usually depends on the individual and the illness he is suffering from. For instance, in the case of Alzheimer’s disease, the doctor will likely provide information on the stages of the diagnosis. This will serve as a guide to understand the progression of Alzheimer’s and an indication that an appropriate care plan must be made. The need for end of life care starts when the patient has made multiple trips to the emergency room, the illness progresses significantly, symptoms worsen, the patient wishes to remain at home and he stops receiving treatment for his disease.
Furthermore, a terminally ill patient with a deteriorating medical condition has increased physical safety needs. The family, along with the caregivers, should seek additional health services through local healthcare facilities or hospice if needed. A hospice is an option for older adults whose life expectancy is six months or less. Palliative care is given to enable the person to live his final days with as good a quality of life as possible. If hospice care is done at home, the family members will act as the primary caregivers, with supervision from the doctor and hospice medical staff. Regular visits from the hospice team will then take place to assess the patient and provide care and other services.
Providing Emotional Support
The emotional needs of patients differ in their final stages of life. Many older adults worry about their loss of dignity or loss of control as their physical abilities deteriorate. It is common for them to feel fearful of becoming a burden to loved ones. Thus, caregivers have to provide emotional support regardless of how complicated the patient’s condition may be. This can be done by being with the elderly and providing support in performing the activities of daily living. Expressing fear of death is normal, but it is important to refrain from discussing various feelings that can lead to sadness and depression. Honoring the elderly’s wishes can also be a very good idea, but never forget to support and comfort him or her in this final stage of life.
Death & Funeral arrangements
Whenever an older adult dies, family members can become overwhelmed by the responsibilities needed to arrange a funeral, especially when it happens unexpectedly. There are a lot of things that must be attended to that require attention to detail. However, to make things as smooth as possible, it is important to divide the tasks between relatives and friends who are arranging the funeral.
First, updating the immediate family members should be done as soon as possible. Bringing them together or contacting them by phone, email or social media is an opportunity to comfort one another and share the decisions that must be made such as funeral arrangements and burial wishes. If the person has made arrangements to donate his organs or body to a medical institution, the family must respect these wishes. An individual’s advance directive, health proxy or living will may guide the family through bequeathal instructions.
Funeral preparations can be quite stressful, especially if the deceased person did not leave any instructions. To make things easier, the immediate family should assess the available options and choose a funeral home they can afford. Funeral homes usually transport the body from the morgue to the funeral facility and provide the necessary equipment for the bereavement. They are also responsible for the cremation or embalming process done to the deceased. If there are religious practices that need to be observed, be sure to inform the funeral director.
Death and funeral arrangements also include preparation of documents like death certificates, birth certificate, marriage certificate, insurance policies, social security card, stock certificates, bank passbooks, income tax forms, deeds and titles of properties, and many others. These documents are needed when the deceased person has several children to divide estate properties. Know that insurance policies can be obtained only after death. Once the burial is over, claims from insurance and employment benefits can be processed. If the deceased has pending debt from banks and other establishments, it is important to inform them about the death and how it will be settled. Credit cards, bank accounts, and insurance policies should be closed to avoid further premium payments and additional obligations.