Psychosocial Needs of the Elderly
February 17th 2008 13:41
The Importance of Meeting an Individual’s Psychosocial Needs
Being healthy and living life to the fullest are some of the desires each of us naturally has. Especially as we move on to the tail end of our lives. But how can we achieve such desires? According to Kaplan and Sadok, a healthy older age is a state of maintaining a level of social activity that is only slightly changed from that of earlier years (1998). And so staying healthy does not only mean staying physically fit, but also continuing to grow intellectually, emotionally, and psychologically. As a proof, we see that as older people experience increased isolation, they become vulnerable to depression, as well as to other diseases, and eventually succumbing to death. In contrast, growing evidence shows that maintaining social activities is valuable for physical and emotional well-being. Such social activities include contact with younger people, providing care to younger generations, and continued interactions with relatives and friends.
However, impediments to good psychosocial status at times may not be eluded. We see old persons being discriminated, forcing them to withdraw from the society. A death of a very close relative or a long old friend adds up to isolation and even depression. There are instances that retiring from work, instead of providing relief, further aggravates ones perception of being sad, alone, and worthless. All of these things may inevitably come to one’s life. But what is important is how to deal with such circumstances, in order to move on and live life out of integrity.
Ageism
Ageism is one of the potent problems a person may encounter as he reaches late adulthood. Ageism refers to the discrimination toward old persons and to the negative stereotypes about old age that are held by younger people (Butler, 1982). Old people may themselves resent and fear other old ones and discriminate against them. As a result, social interactions are being compromised and withdrawal from society is almost sure.
What is the problem with ageism? According to Butler, ageism makes people think that old age is linked to loneliness, poor health, senility, and general weakness. And so young people are afraid of aging. Moreover, even worse, other people treat the elderly as worthless part of the community. Others associate old age to barrier in achieving good quality of life.
However, are these negative expectations regarding old age true? No. In fact, although 50% of young adults (in the US) expect poor health to be a problem for old people, 75 % of people 65 to 74 years of age describe their health as good. Two-thirds of people 75 and older feel the same.
Indeed health problems may be a concern among old age. However, these problems naturally occur because of the natural physical changes among elderly. And if we dig deeper and study the next aspect- the quality of life during old age- we shall see that there are something more to discover.
Good physical condition is not the sole determinant of good health. Another factor that contributes to such is a good quality of life. And a person’s quality of life depends on the society and more importantly on himself.
Surveys of old people show that social contacts are highly valued. In addition having been close to brothers and sisters and possessing the trait of dependability, as young adults are associated to a sense of well-being at age of 65. Basing from these facts, we again emphasize an important element of having a meaningful older years- meeting psychosocial needs.
But how can these psychosocial needs be met with ageism around? Is it not in ageism we tend to encourage isolation and build more grounds for depression? Therefore, negative perspectives about aging have to be addressed. And we can do this by educating especially the younger members of the society.
Countertransference
Countertransference feelings about aging may also affect ones expectation about old age. Countertransference is a physician’s feelings or attitudes toward older people. The feelings about aging expressed by a physician may be determined by past experiences, and they function on both a conscious and unconscious level. And these feelings they as they interact with their old patients.
Some physicians may have fears about their own old age or may have had conflicts about the aging or death of parents or grandparents. And these fears they may consciously or unconsciously share to their patients. Negative as these fears are, they may influence old people in having poor expectations about aging. Thus, stress and depression set in.
The above scenario has to be avoided, not only by physicians but also by allied health professionals. Clinicians therefore have to be aware of the ideas they impart to their aging clients.
Socioeconomics of Old Age
“The economics of old age is of paramount importance to older people themselves and to society at large (Kaplan and Sadok, 1998)”. In the US, the year 1959 shows that 35.2 % of people above 65 lived below poverty line, but by 1995, this had declined to 10.5%. This decline resulted from benefits people get from Medicare, Social Security, and private pensions. In the Philippines, we may not present any statistics on the status of the elderly group. But certainly, greater effort has to be done in order to uplift the government’s support system for old people. Nevertheless, persons who are ill may benefit from reimbursements being provided by Philhealth, SSS, and other insurance firms. However to qualify for benefits, a person must have worked long enough.
Retirement
The older population is divided with regard to perceiving the effects of retirement. For many old people, retirement is a time for pursuit of leisure and for freedom from duties of previous working commitments. For others, it is time of stress, especially when retirement results in economic problems or a loss of self-esteem. Ideally, employment after age 65 should be a matter of choice. But in the Philippines, a number of people aging 65 and above never cease to work because of financial reasons.
Sexual Activity
In the US, an estimated 70 % of men and 20 % of women over 60 years old are sexually active. Studies would show that sex drive does not decrease as men and women age. In fact, some report an increase in sexual drive. Sexual activities are usually limited by the absence of an available partner or as we have discussed, the physiological changes that have occurred.
Psychiatric problems of Older People
Loss is the predominant factor that characterizes the emotional experiences of older people. Old people must deal with the grief of such losses like death of spouse, relatives, and friends, change of work status and prestige, and decline of physical abilities and health. Living alone is also a stressor that affects 10 % of the elderly population.
Major depressive disorders may affect old people because of such losses. Usually, depression in old people is accompanied by physical symptoms or cognitive changes that mimic dementia.
The incidence of suicide among old people is also high. Such suicide is perceived differently on the basis of gender: men are thought to have been physically ill, and women are thought to have been mentally ill.
Thanatology: Death and Bereavement
Thanatology is the study of the experiences of dying and bereavement. And people’s reaction to death may be summarized into five stages: shock and denial, anger, bargaining, depression, and acceptance.
Some people take long time before having a transition from one stage to another. And for family and clinicians to be sticking with them during those times is very essential. Our goal is to help dying people to get through a hopeful completion of these five stages.
When a person is under shock or denial, clinicians and caregivers must communicate to patients and their family basic information about the illness, its prognosis, and the options of supportive treatment. Inherent in effective communication is allowing for patients’ emotional responses and reassuring them that they will not be abandoned.
People under the stage of anger get frustrated and irritable with their conditions. Whenever we treat angry patients, we must realize that the anger being expressed cannot be taken personally. An emphatic non-defensive response can help defuse patient’s anger and can help them refocus their own deep feelings that underlie the anger. We also have to recognize that anger may represent a patient’s desire for control in a situation in which they feel completely out of control.
In the third stage of bargaining, people may attempt to negotiate with physicians, friends, or even God. In return for a cure, they promise to fulfill one or many pledges. The management for such condition includes assuring a patient that he or she is being taken care of to the best of the clinician’s abilities.
In the fourth stage, patients show clinical signs of depression like withdrawal, psychomotor retardation, sleep disturbances, hopelessness, and possibly suicidal ideation. When major depression sets in, drug (anti-depressants) and psychosocial therapy are required.
In the stage of acceptance, patients realize that death is inevitable, and they accept the universality of such experience.
Being healthy and living life to the fullest are some of the desires each of us naturally has. Especially as we move on to the tail end of our lives. But how can we achieve such desires? According to Kaplan and Sadok, a healthy older age is a state of maintaining a level of social activity that is only slightly changed from that of earlier years (1998). And so staying healthy does not only mean staying physically fit, but also continuing to grow intellectually, emotionally, and psychologically. As a proof, we see that as older people experience increased isolation, they become vulnerable to depression, as well as to other diseases, and eventually succumbing to death. In contrast, growing evidence shows that maintaining social activities is valuable for physical and emotional well-being. Such social activities include contact with younger people, providing care to younger generations, and continued interactions with relatives and friends.
However, impediments to good psychosocial status at times may not be eluded. We see old persons being discriminated, forcing them to withdraw from the society. A death of a very close relative or a long old friend adds up to isolation and even depression. There are instances that retiring from work, instead of providing relief, further aggravates ones perception of being sad, alone, and worthless. All of these things may inevitably come to one’s life. But what is important is how to deal with such circumstances, in order to move on and live life out of integrity.
Ageism
Ageism is one of the potent problems a person may encounter as he reaches late adulthood. Ageism refers to the discrimination toward old persons and to the negative stereotypes about old age that are held by younger people (Butler, 1982). Old people may themselves resent and fear other old ones and discriminate against them. As a result, social interactions are being compromised and withdrawal from society is almost sure.
What is the problem with ageism? According to Butler, ageism makes people think that old age is linked to loneliness, poor health, senility, and general weakness. And so young people are afraid of aging. Moreover, even worse, other people treat the elderly as worthless part of the community. Others associate old age to barrier in achieving good quality of life.
However, are these negative expectations regarding old age true? No. In fact, although 50% of young adults (in the US) expect poor health to be a problem for old people, 75 % of people 65 to 74 years of age describe their health as good. Two-thirds of people 75 and older feel the same.
Indeed health problems may be a concern among old age. However, these problems naturally occur because of the natural physical changes among elderly. And if we dig deeper and study the next aspect- the quality of life during old age- we shall see that there are something more to discover.
Good physical condition is not the sole determinant of good health. Another factor that contributes to such is a good quality of life. And a person’s quality of life depends on the society and more importantly on himself.
Surveys of old people show that social contacts are highly valued. In addition having been close to brothers and sisters and possessing the trait of dependability, as young adults are associated to a sense of well-being at age of 65. Basing from these facts, we again emphasize an important element of having a meaningful older years- meeting psychosocial needs.
But how can these psychosocial needs be met with ageism around? Is it not in ageism we tend to encourage isolation and build more grounds for depression? Therefore, negative perspectives about aging have to be addressed. And we can do this by educating especially the younger members of the society.
Countertransference
Countertransference feelings about aging may also affect ones expectation about old age. Countertransference is a physician’s feelings or attitudes toward older people. The feelings about aging expressed by a physician may be determined by past experiences, and they function on both a conscious and unconscious level. And these feelings they as they interact with their old patients.
Some physicians may have fears about their own old age or may have had conflicts about the aging or death of parents or grandparents. And these fears they may consciously or unconsciously share to their patients. Negative as these fears are, they may influence old people in having poor expectations about aging. Thus, stress and depression set in.
The above scenario has to be avoided, not only by physicians but also by allied health professionals. Clinicians therefore have to be aware of the ideas they impart to their aging clients.
Socioeconomics of Old Age
“The economics of old age is of paramount importance to older people themselves and to society at large (Kaplan and Sadok, 1998)”. In the US, the year 1959 shows that 35.2 % of people above 65 lived below poverty line, but by 1995, this had declined to 10.5%. This decline resulted from benefits people get from Medicare, Social Security, and private pensions. In the Philippines, we may not present any statistics on the status of the elderly group. But certainly, greater effort has to be done in order to uplift the government’s support system for old people. Nevertheless, persons who are ill may benefit from reimbursements being provided by Philhealth, SSS, and other insurance firms. However to qualify for benefits, a person must have worked long enough.
Retirement
The older population is divided with regard to perceiving the effects of retirement. For many old people, retirement is a time for pursuit of leisure and for freedom from duties of previous working commitments. For others, it is time of stress, especially when retirement results in economic problems or a loss of self-esteem. Ideally, employment after age 65 should be a matter of choice. But in the Philippines, a number of people aging 65 and above never cease to work because of financial reasons.
Sexual Activity
In the US, an estimated 70 % of men and 20 % of women over 60 years old are sexually active. Studies would show that sex drive does not decrease as men and women age. In fact, some report an increase in sexual drive. Sexual activities are usually limited by the absence of an available partner or as we have discussed, the physiological changes that have occurred.
Psychiatric problems of Older People
Loss is the predominant factor that characterizes the emotional experiences of older people. Old people must deal with the grief of such losses like death of spouse, relatives, and friends, change of work status and prestige, and decline of physical abilities and health. Living alone is also a stressor that affects 10 % of the elderly population.
Major depressive disorders may affect old people because of such losses. Usually, depression in old people is accompanied by physical symptoms or cognitive changes that mimic dementia.
The incidence of suicide among old people is also high. Such suicide is perceived differently on the basis of gender: men are thought to have been physically ill, and women are thought to have been mentally ill.
Thanatology: Death and Bereavement
Thanatology is the study of the experiences of dying and bereavement. And people’s reaction to death may be summarized into five stages: shock and denial, anger, bargaining, depression, and acceptance.
Some people take long time before having a transition from one stage to another. And for family and clinicians to be sticking with them during those times is very essential. Our goal is to help dying people to get through a hopeful completion of these five stages.
When a person is under shock or denial, clinicians and caregivers must communicate to patients and their family basic information about the illness, its prognosis, and the options of supportive treatment. Inherent in effective communication is allowing for patients’ emotional responses and reassuring them that they will not be abandoned.
People under the stage of anger get frustrated and irritable with their conditions. Whenever we treat angry patients, we must realize that the anger being expressed cannot be taken personally. An emphatic non-defensive response can help defuse patient’s anger and can help them refocus their own deep feelings that underlie the anger. We also have to recognize that anger may represent a patient’s desire for control in a situation in which they feel completely out of control.
In the third stage of bargaining, people may attempt to negotiate with physicians, friends, or even God. In return for a cure, they promise to fulfill one or many pledges. The management for such condition includes assuring a patient that he or she is being taken care of to the best of the clinician’s abilities.
In the fourth stage, patients show clinical signs of depression like withdrawal, psychomotor retardation, sleep disturbances, hopelessness, and possibly suicidal ideation. When major depression sets in, drug (anti-depressants) and psychosocial therapy are required.
In the stage of acceptance, patients realize that death is inevitable, and they accept the universality of such experience.
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