Insight from the Elderly’s Perspective

How elder adults view themselves and the values they hold

Every society is made up of people of various ages and each has a role to play in the society to ensure there is a balance. Different cultures have their own assumptions and expectations of elder adults and aging in general. Today, many people do not want to age. Many do not want to be seen with wrinkles on their faces or their bodies sagging. This is why cosmetic surgery has become a multi-million dollar industry. Elder adults view themselves positively and negatively. Some feel accomplished and enjoy the fruits of their hard work. They enjoy the company of their children and grandchildren as they pride in them. 

Some of the values that elderly adults who view life positively have include hard work where they encourage those they interact with to work hard in life as it can pass the like the wind. Other values include a connection with the world, proper communication, compassion, honesty, respect, and positivity. They expect children to be respectful at all times as culture demands. The grumpy and depressed elder adults most of the time do not have any want any association with the world and will avoid making any effort in life, as they will be discouraged, in despair and negative about themselves and life in general. 

Assess and determine his/her needs and establish appropriate 

My neighbor is an elder adult who has lived life for the last eighty years. She has had her share of good tidings and discouragements in life. Above all, she has managed to live life to the fullest and is now enjoying her old age. Her health is her priority in life and she desires to live longer and see her great-grandchildren. Some of her needs include desiring company in order to deal with the loneliness she has. She also has trouble moving around because of her poor eyesight and her frail bones can sometimes give way. Spectacles would be appropriate for her in this case. Her memory is also fading away and there are times when she does not know where she needs to go or what she needs to do. Getting involved in conversations and talking about the past will help retain the memories. 

It is because of this that her children got her a nurse who is there to help her and to ensure she gets around with ease and can be the company that she needs. She refused to go to the home of the elderlies because she wants to be around her grandchildren and to live in the house she has lived in for over forty years and not with strangers. To her, her matrimonial home is important. 

Summary of findings 

The secret to her long life was summarized in healthy living and eating. She views life positively and worked hard to achieve all she has. She prides in her children and her accomplishments in life. 

One of the findings that I made was that she like other many elderlies needs a lot of help with basic things such as communication and sometimes even eating. A research that was done by Vaingankar et al., (2016) revealed that caregivers participate highly in the activities that are related to feeding, communication, and bathing among the elder adults. This is because at her age, she is very frail and her bones are not as strong as they used to be. She also suffers from memory loss and there are times when her hands shake and she is unable to use them. 

The other finding made is that she suffers emotionally as she experiences a lot of loneliness. It is because of this that she participates in weddings and birthdays. She suffers psychologically when she gets depressed about her loss of memory, eyesight, and hearing. When people consider her a burden and a nuisance, it makes her feel unloved and unwanted. When her children prefer virtual communication to visitations as she has been used to her whole life, she views it as incompetency in the society. In spite of this, she remembers her golden days with no regrets whatsoever. She also considers herself as a custodian of the family traditions and many others consider her wise. 

Physical and mental functional assessment 

The physical and mental functional assessment was done using the Tinetti Gait and Balance Instrument. A sample of the Using this instrument, information was gathered regarding the physical health of the elderly. It was determined that the elderly leaned or slid when she sat on her chair. She was able to get up from the chair and was able to rise in just one attempt. She was able to walk without help but slowly, her standing was also limited to a few minutes. If pushed, she begins to fall because of her weak body. The gait assessment determined that her steps were symmetrical and that she had a moderate deviation when walking and that her heels were apart as she walked. 

Using the Katz Index of Activities of Daily Living, the findings obtained showed that the elderly received no assistance when showering and when getting dressed. She also does not need any help when using the toilet. She can get out of bed without any assistance and can control her continence. She is able to feed herself. Regardless of this, there are times when she is unable to move or do these activities on her own due to factors such as falling sick and weather changes such as during cold temperatures where she only wants to be in bed or near the fireplace. 

Compare and contrast the age-related changes of the older person 

The first age-related changes observed in the elderly is the memory loss. Many adults do not want to forget who they are or those around them. The elderly interviewed had started to lose the names of places and people. There were times when her memory was good and times when she seemed not to have any memories of certain people or things. The other age-related changes include loss of eyesight and hearing. She was unable to hear properly or see objects from afar. Functional abilities were also noticeable. This is because the elderly mentioned she had fallen down in a number of occasions. Falls are also considered as the leading cause of admissions in hospitals and accidental demise in elder adults (Iwasaki et al., 2015). This she attributed to her poor eyesight, lack of coordination and general body weakness. Her bones and joints suffered an age-related change where her bones were not as strong as they were. She mover slower and could not lift any heavy objects. 

The age-related changes can be compared to many other elderly adults because this is what many of them experience. Memory loss, for example, which can be subjective or objective is very common among the elderly adults (Brigola et al., 2015). 

Preliminary issues identified

One of the issues identified is the ageism issue. The elderly felt like she has no concrete place in the society and that life was better in the olden days. She believes the elderly are undervalued and unappreciated in life which has led to a tarnished society. 

Another issue found in the research was the abuse of the elderlies. They majorly face emotional abuse where they are neglect and treated as burdens. This makes them depressed and leads them to despair. Many are not given the respect they deserve and are considered incompetent and a waste of resources. The society has to be appreciative of the elderlies. 

The elderlies prefer living alone. The interviewed elderly preferred living in her house rather than going to a home for the elderlies. Many do not want to be a burden to their children and as such opt to live alone or have someone to help them around and outside the house. 

The final issue observed is lack of consistent involving activities for her to get involved with. This makes her day less involving and interactive. This leads to loneliness and can sometimes lead to depression where the elderly longs for death. 

Identify three alterations in health that you would propose and describe them

Dementia is one of the health alterations that could be affecting the elderly. Dementia is a condition that is used to generally describe the decline in the mental ability to an extent that it interferes with the daily living of an individual. It is caused by the damage of brain cells. One of the most common types of dementia includes Alzheimer’s. It affects the ability to pay attention, judgment, visual perception and reasoning 

Falls are a leading cause of many of the deaths in the region. This is because many elderly adults live alone and therefore are prone to falls with no one to help them. They end up dying because of broken bones such as the spine. U.S. Department of Health and Human Services 

Depression is a common mood disorder and affects how individuals think, feel, sleep, eating or even work. The elderly are likely to fall into depression because of the lack of respect the face, loneliness and it may co-occur with serious illnesses such as heart disease, cancer, and diabetes. It is characterized by feelings of worthlessness, guilt or helplessness, difficulty in concentrating and remembering things, difficulty in sleeping and pessimism (U.S. Department of Health and Human Services, 2015). 

Identify a minimum of three comprehensive interventions for each problem

Dementia does not have a cure. However, it can be controlled through medication and other simple techniques such as viewing life positively. The elderlies can also choose to engage other people in their games and activities that challenge them to remember. 

Falls can be prevented by re-designing the house and doing away with any staircases. The elderly should be given a nurse to help in movement and ensure in case of a fall, it can be reported almost immediately. 

Depression can be treated through psychotherapy, medications and both of the two techniques. This will help do away with the depression and ensure the elderly is feeling better. The elderly can also choose to spend time with people. This will reduce the loneliness and hopelessness. 

References 

Brigola, Allan Gustavo, Manzini, Carlene Souza Silva, Oliveira, Gabriel Brassi Silveira, Ottaviani, Ana Carolina, Sako, Michelli Pacheco, and Vale, Francisco Assis Carvalho. (2015). Subjective memory complaints associated with depression and cognitive impairment in the elderly: A systematic review. Dementia & Neuropsychologia, 9(1), 51-57. https://dx.doi.org/10.1590/S1980-57642015DN91000009 

Iwasaki, S., and Yamasoba, T. (2015). Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging and Disease , 6(1), 38–47. http://doi.org/10.14336/AD.2014.0128 

U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S. Government Printing Office. 

Vaingankar, J. A., Chong, S. A., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., and Subramaniam, M. (2016). Care Participation and Burden among Informal Caregivers of Older Adults with Care Needs and Associations with Dementia. International Psychogeriatrics, 28(2), 221-231. 

Appendix 

Patient Questionnaire 

INTERVIEW OF CHOSEN ELDER ADULT 

Name: ­­­­­­­­­­­­­­­­­­­­­________________________________ Age: ­­­­­­­­­­­­­­­Eighty years old 

Brief Introduction (Background information): 

I was born in 1938. I was able to attend school and finally graduated with a diploma in Education. I became a teacher because I love children. I love their company. Over the years I have managed to get my degree and Masters. I have also climbed the ladder and managed to teach students from kindergarten all the way to college students. I got married and had three children. Currently, I have four grandchildren and many others who I have helped over the years achieve their dreams. 

1. Philosophy on living a long life (believing in yourself, positive attitude, encouragement from significant others, eating right, sleeping well, exercise, avoiding stress, seeking help 

My philosophy in life is having I have the potential to do all I set my mind to. I believe I have lived this long because I did the right things at the right times. Living healthy is also a philosophy I have had in life. 

2. Thoughts about when a person is considered “too old” outlived, no need to live, declining in many things such as memory and health, loneliness, incompetent and outdated 

When a person considers me “too old”, it makes me feel outdated and incompetent in life. It sometimes shows how they focus on my health problems or my fading body such as loss of hearing, eyesight, and memory rather than the life I have lived. It gets lonely too because no one is around me all the time besides my nurse yet I have my family. On the bright side, it only shows how far I have come in life. Eighty years and still going. 

3. Opinion on the status and treatment of older adults 

Elder people are treated as a burden and as baggage that many would rather not deal with. We demand a lot of attention because we are weak both physically and mentally. We are considered to have outlived our usefulness and people who should have died by now. Positively, we are considered as custodians of the history of our families which we pass down to the younger generations 

4. Beliefs about health and illness 

I believe health is important and illnesses should be handled immediately after it is diagnosed. However, right now I have no control over some of it. I am partially deaf and blind. My memory is fading with each passing day. Soon I may not remember my own children. Also whenever I fall sick, there is always the anxiety of it leading to my death. I attend counseling sessions where I am able to talk about my past and retain some of my memory. 

5. Health promotion activities he or she participates in 

I take time to do walks around the park, slowly of course and for short amounts of time. I am happy I did more exercises when I was younger, so it is not so hard to move around however slow I may be. I make regular visits to see my children and grandchildren, they also visit me from time to time. I take my medication regularly. I play easy games with my grandchildren. 

6. Something special that helped the person live so long mindset, support groups, homes for the elderly, participating in special activities like wedding and birthdays 

My philosophy in life has made me live this long. My positive attitude towards life has played a key role in it. I am also religious. I had support groups in my seventies. I go to some of the homes for the elderly and interact with my peers as we try and remember the good days. I also enjoy attending weddings and birthday parties where I get to be around people who inspire me to live long. 

7. Life-span of other family members 

My mother lived to ninety-five years. She could not remember much during her last years. My father died when I was in college. My grandmother lived for ninety years. 

8. Special dietary traditions in patient’s culture attributed to aiding long life 

In my tradition, we believed that eating organic foods without any additives led to longer and healthier lives. I believe eating a lot of fruits has helped in increasing my years. Especially coconuts. I also used honey instead of sugar on numerous occasions. I use a lot of Aloe Vera products as well. 

9. Any remedies/medications that have been handed down in family/group. If yes, describe. 

No medications or remedies have been passed down. 

10. Patient’s description of current and past health status 

I used to have all my senses working perfectly. Currently, I have poor eyesight, hearing and I have lost some of my teeth. I can walk on my own but I still need help so that I do not fall. I lost my balance and fell once. I ended up with a broken nose. I cannot eat a lot of hard foods. It has to be blended for me, especially some of the fruits. My memory is not so good. 

11. The values that guided life so far 

Honesty, commitment, integrity, hard work, determination, and love. 

Additional Questions 

Any personal accomplishments you can share with me? 

I received numerous awards as a teacher because my students would always perform so well. 

I got recognition from the state for my contribution to the community. 

What about the current inventions do you not like? 

I believe as much as technology has made life easier, it has also made physical interaction impossible. My children prefer calling me, while I prefer they visit me as often as they can. 

Do you think about dying? 

Most of the time. I, however, do not focus so much on it because I believe it will happen when it happens. 

Summary 

I have lived my life and my desire is that my children also get to live a long fulfilled life like mine or better than mine. I have had ups and downs but I would not change my life-changing decisions such as my career path and spouse. I have had a good run. I still hope to live longer than my mother. 

A contrast of client’s responses with findings in current literature 

Some of the elderlies would rather go to homes to avoid being a burden. She, however, was part of the group of elderly adults who preferred to live alone. 

She is able to bathe herself and regularly feed herself which is in contrast with the findings that stated most caregivers highly participate in feeding, bathing, and communication. 

In spite of many elderlies opting to be depressed because of how they are treated, she opted to focus more on the positive aspect of life. 

TINETTI BALANCE ASSESSMENT TOOL 

PATIENTS NAME ______________________ D.o.b. ___________ Ward ______ 

BALANCE SECTION 

Patient is seated in hard, armless chair; 

	Date
Sitting Balance	Leans or slides in chair = 0 Steady, safe = 1
Rises from chair	Unable to without help = 0  Able, uses arms to help = 1  Able without use of arms = 2
Attempts to rise	Unable to without help = 0  Able, requires > 1 attempt = 1  Able to rise, 1 attempt = 2
Immediate standing Balance (first 5 seconds)	Unsteady (staggers, moves feet, trunk sway) = 0  Steady but uses walker or other support = 1  Steady without walker or other support = 2
Standing balance	Unsteady = 0  Steady but wide stance and uses support = 1  Narrow stance without support = 2
Nudged	Begins to fall = 0  Staggers, grabs, catches self = 1  Steady = 2
Eyes closed	Unsteady = 0 Steady = 1
Turning 360 degrees	Discontinuous steps = 0 Continuous = 1  Unsteady (grabs, staggers) = 0 Steady = 1
Sitting down	Unsafe (misjudged distance, falls into chair) = 0  Uses arms or not a smooth motion = 1  Safe, smooth motion = 2
	Balance score	/16	/16

TINETTI BALANCE ASSESSMENT TOOL 

GAIT SECTION 

Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. 

	Date
Indication of gait (Immediately after told to ‘go’.)	Any hesitancy or multiple attempts = 0  No hesitancy = 1
Step length and height	Step to = 0 Step through R = 1 Step through L = 1
Foot clearance	Foot drop = 0 L foot clears floor = 1  R foot clears floor = 1
Step symmetry	Right and left step length not equal = 0  Right and left step length appear equal = 1
Step continuity	Stopping or discontinuity between steps = 0  Steps appear continuous = 1
Path	Marked deviation = 0  Mild/moderate deviation or uses w. aid = 1  Straight without w. aid = 2
Trunk	Marked sway or uses w. aid = 0  No sway but flex. knees or back or uses arms for stability = 1  No sway, flex., use of arms or w. aid = 2
Walking time	Heels apart = 0  Heels almost touching while walking = 1
	Gait score	/12	/12
	Balance score carried forward	/16	/16
	Total Score = Balance + Gait score	/28	/288

Katz Index of Activities of Daily Living 

Abbreviations: I, independent; A, assistance; D, dependent 

1. Bathing (sponge, shower, or tub): 

I: receives no assistance (gets in and out of tub if tub is the usual means of bathing) 

A: receives assistance in bathing only one part of the body (such as the back or a leg) 

D: receives assistance in bathing more than one part of the body (or not bathed) 

2. Dressing: 

I: gets clothes and gets completely dressed without assistance 

A: gets clothes and gets dressed without assistance except in tying shoes 

D: receives assistance in getting clothes or in getting dressed or stays partly or completely undressed 

3. Toileting: 

I: goes to “toilet room,” cleans self, and arranges clothes without assistance (may use ob­ject for support such as cane, walker, or wheelchair and may manage night bedpan or commode, emptying it in the morning) 

A: receives assistance in going to “toilet room” or in cleansing self or in arranging clothes after elimination or in use of night bedpan or commode 

D: doesn’t go to room termed “toilet” for the elimination process 

4. Transfer: 

I: moves in and out of bed as well as in and out of chair without assistance (may be using object for support such as cane or walker) 

A: moves in and out of bed or chair with assistance 

D: doesn’t get out of bed 

5. Continence: 

I: controls urination and bowel movement completely by self 

A: has occasional “accidents” 

D: supervision helps keep urine or bowel control; catheter is used, or is incontinent 

6. Feeding: 

I: feeds self without assistance 

A: feeds self except for getting assistance in cutting meat or buttering bread 

D: receives assistance in feeding or is fed partly or completely by using tubes or intra­venous fluids