Biographical Sketch
N.M. is a 75-year-old woman living in California. She is a native of the area. N.M has aspects of both Jewish and Irish ethnicities. She was chosen for the life review interview because she is a very close family friend; hence it was easy to access her for a series of interview sessions. She appears so neat and composed. N.M. is the last born in a family of five children. N.M is a widow. Her husband of 35 years died four years ago after suffering a cardiac arrest. N.M and her late husband moved into her parents’ house after both passed away. Together with her husband, they have three children, two boys, and one girl. Her firstborn is 33 years old, and the second-born, 30 years and the last born is 27 years old. Her last born lives with her, his wife, and one grandchild. She has four grandchildren, with the eldest being eight years and the youngest three years old. N.M has a high school diploma and worked as an administrative assistant until when she retired at the age of 60.
Before securing a job as an administrative assistant, she worked as a receptionist in a hotel and as a cashier in a supermarket. Currently, N.M. is not working and spends more of the time at home. She loves singing and spending time with her children and grandchildren. Her biggest achievements are finishing high school and having children. She considers these two things her major achievements. According to N.M, getting a high school diploma was a miracle. Her family was not well up when she was young and was struggling financially. As a result, all her siblings dropped out of high school, and she was the only one who was able to complete through scholarship. She loves and values her children so much, and they are a source of joy to her. N.M stated that she always looked forward to having her children, and when this finally happened, it was such a great achievement and a dream come true. She was once rewarded for being the best employee in her company, which was one of her most proud moments. She was named the best employee of the year, which made her feel proud of her dedication and efforts in the company.
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Seeing her children acquire college degrees are some of her proud moments in life. N.M desired to get a college degree, but due to financial challenges, she was unable to do so. She did not want her children to have the kind of life she ended up having, and as a result, N.M. and her husband made every effort to ensure that their children acquire the best education and have college degrees. Every time she attended her children’s college graduations, she felt proud of the fact that together with her husband, they were able to take their children through college-level education. She always dreamt of having her own business, and although age has caught up with her, she still hopes to establish it in the near future. She would want to open a grocery store so that she does not always have to depend on her children for financial support. She stated that she hates asking for money from her children, and although they never complain about supporting her financially, she feels that she is a burden to them, and she should have her own source of income. Although she is dealing with some health problems, she is confident that she can run a business and become economically and financially independent.
When asked to rate her health status, N.M. stated that it is fair. According to her, although she was diagnosed with high blood pressure, she can keep it under control using medication and diet. The condition has not incapacitated her, and she can go about her daily chores, although with some challenges. N.M. stated that despite the fact that she feels weaker than a couple of years ago, her mobility is not affected so much, and she is able to take care of her grandchild when her son and his are off to work. However, she stated that she sometimes feels a lot of fatigue and must be slow in her daily activities. The interviewee mentioned that she had observed several changes related to the aging process. Her hair gradually started turning grey, and it is all grey now; her physical ability had declined. For example, she is no longer able to run like she used to do when she was 40 years old. She loved running or walking for long distances. That is no longer possible because she lacks the physical strength to do so, and her knees and joints experience pain whenever she engages in vigorous activities even for very short periods.
N.M stated that she spends more time on activities that she previously used to accomplish within a very short period, and some tasks have become impossible for her to do. Her vision has also declined, and she is unable to see or recognize things from far. As a result, she is forced to use glasses when reading or when outdoors. In addition, the interviewee’s hearing ability has declined, and, in most cases, peoples have to repeat what they are saying louder so that she can hear. The interviewee showed me a picture of herself when she was much younger, and she noted that her skin was no longer the same. According to her, her skin is currently highly wrinkled, and she associated this with old age. N.M. also stated that she finds it hard to get up from the floor. As a result, she is forced to get up like small children by turning round first and then get on her knees so that she can slowly rise. The interviewee stated that her physical and functional ability has reduced over the years, and she is no longer the same person she used to be twenty years ago. This has made her depend on her children for some activities to be done.
Changes in physical strength and functionality bothered the interviewee the most. N.M was worried that her declining physical strength might hinder her plans of setting up a business to reduce her dependency on her children for financial support. N.M stated that she did not want to become overly dependent on anyone like a child or end up in assisted living facilities. The interviewee wants to live with her family without them having to do everything for her. In addition, the fact that her hearing has been declining worries her because, as she stated, she could not imagine losing her ability to hear in the end, especially due to the fact that she loves listening to some good music. These changes have, in some way, affected the interviewee’s quality of life. She sometimes feels depressed and finds it difficult to find joy or enjoy daily activities as she used to when she was younger. She sometimes thinks of what will become of her if her functionality and physical ability continue declining, and this makes her feel sad often and losses the hope of every enjoying anymore. She no longer enjoys going about her daily activities because her ability to function has reduced and the effects of some of these activities. N.M. expressed fear about the future. She expressed fears that she might lose her functionality completely, and she must completely depend on others. The interviewee stated that she hated the thought of moving out of her house and living in an assisted living facility which her children had been talking to her about.
The interviewee has mild depression as related to reduced functionality and physical ability, as evidenced by frequent feelings of sadness and loss of hope due to the aging-related issues she is facing. The goal of interventions is to help N.M. express her feelings and accept the life events she has no control over. One of the interventions to help N.M overcome this problem is to help her determine the life events that are beyond her ability to control. Also, this can involve discussing her feelings about a lack of control. There is a need to ensure that the interviewee recognizes and resolves her feelings related to her inability to control some life events before she accepts and becomes hopeful. The other intervention is encouraging N.M. to express her feelings of sadness and help her identify alternative ways of handling her sadness in order to gain control of her emotions.
There are some differences between the changes experienced by the interviewee and those experienced by a hospitalized patient of the same age. The rate of functional decline in hospitalized elderly patients is high compared to those who are not hospitalized. The hospital environment focuses on medical management of illness and not on the improvement of a patient’s functioning. As a result, reduced activity and movement resulting from hospitalization cause a rapid decline in functionality among elderly patients. In addition, hospitalized patients, especially the elderly, are most likely to develop pressure ulcers. A hospitalized elderly patient is likely to have a rapid bone loss, delirium, immobility, and sensory deprivation.
Bed rest causes reduced ability to exercise because of numerous physiologic changes that happen. Acceleration in bone loss causes an increased risk of experiencing injuries to the bones as well as joints. As a result of a reduction in muscle mass and changes in the physiology of a hospitalized elderly patient, deconditioning occurs, and this leads to weakness. A reduction in function happens as a consequence of the physiologic changes that happen and this, in turn, causes a lack of ability to do some of the usual daily activities.
Part #3 – Medication Use and Nutrition (20 points)
The interviewee uses hydrochlorothiazide 25mg once a day at bedtime for high blood pressure, aspirin 81mg once a day, atorvastatin 80mg once a day, and multivitamin once a day. N.M. did not present any over the counter drugs or herbs during the interview. She stated that she was not suing them. She has no allergic reactions to food or drugs. N.M. experiences general forgetfulness and this has, in the past, made her skip pills. As a result, her son decided to set alarms as well as call her while away at work to ensure that she does not forget to take her pills. However, due to the fact that he has a busy schedule, he sometimes forgot to make a call to remind her to take her pills. In order to solve the problem, they decided to purchase a Tabtime Vibe Vinbrating Pill Timer Reminder, which she claimed that it has been of major help to her when it comes to adherence to medication.
N.M finds the reminders effective because her hypertension has improved due to adherence to medication thanks to reminders. According to her description, the device has several compartments with alarms that vibrate and a beep every time she is required to take her medication. She not only uses it at home but is also able to carry it in her pocket or handbag when she has to be away from home. She sometimes experiences dizziness, weakness, and headaches, which are the side effects of hydrochlorothiazide. N.M. stated that she initially did not know that the symptoms were the side effects of medication until she talked with her physician, who informed her of these side effects. Her physician is aware of the multivitamin that she takes. When asked about any adverse reactions, mishandling, or overdose of her medications, the interviewee stated that she has in the past had an overdose of hydrochlorothiazide by accident, which caused her a low blood pressure, extreme dizziness, and fainting. As a result, she was hospitalized for four days. The interviewee receives information regarding her medications from her primary care physician. She stated that she is in constant communication with him regarding her condition and the medication that she uses.
The interviewee understands the reasons for taking her medications. For example, she knows that she takes hydrochlorothiazide 25mg to reduce and keep her blood pressure under control, and aspirin is meant to reduce her chances of developing a heart attack or suffering from a stroke. She understands that she has chronically high blood pressure, and this increases her risk of developing a heart attack or stroke. N.M. is also aware of the fact that she takes atorvastatin 80mg a day alongside an appropriate diet to reduce the levels of low-density lipoprotein (bad cholesterol) and increase the levels of high-density lipoprotein (which she referred to as good cholesterol). Also, the interviewee demonstrated little understanding of the common side effects associated with the medications. She only stated three side effects associated with hydrochlorothiazide only. The side effects N.M. stated included feeling dizzy, headache, and feeling weak. She further stated that although her physician informed her of the various side effects, she could not remember them because, as she stated it, she has never experienced adverse side effects. N.M. is not at risk of an adverse reaction because she has no drug allergies, and she takes them as prescribed. Adherence to dosage is ensured through the use of reminders. However, in the absence of reminders, the interviewee may experience adverse reactions because of an overdose. The number of medications is similar to that of hospitalized patients with a similar condition. The community-dwelling interviewee has a better understanding of medications compared to those who are hospitalized. The interviewee has a good understanding of her medication. However, she needs to have a better understanding of the side effects associated with the medications so that she is able to seek for medical help any time she notices any of them.
N.M mainly consumes foods rich in whole grains, a variety of vegetables, and fruits. The dairy products she uses are low in fat, and she does not use them daily. The interviewee is following a strict diet plan that is commonly referred to as Dietary Approaches to Stop Hypertension (DASH). A DASH diet focuses on foods that have low levels of sodium and rich in minerals such as potassium and calcium as well as magnesium. N.M. incorporates this diet in her menu by including more vegetables and fruits, and dairy products that are low in fat. She also consumes white meats such as fish and poultry. This type of diet also restricts her consumption of red meats and beverages that contain sugar. When asked about the ability to shop for groceries, the interviewee stated that she has no difficulty shopping for them. However, shopping and meal preparation is, in most cases, done by her son and his wife. N.M. skips meals at times due to changes in appetite. This is especially the case when she feels hopeless and sad about her ability to function in the future based on her current situation. She has no impaired function, and her children are financially able to provide the required types of food for her. The interviewee is not prohibited by her culture or religion to consume any foods. N.M. does not experience any difficulty while chewing or swallowing food. However, in the past few months, she has noticed some changes in taste. The interviewee stated that she takes adequate amounts of fluid as recommended by her physician while putting into consideration the provided fluid restriction guidelines.
The interviewee provided a 24-hour meal plan followed the day before the interview as follows:
Breakfast
Three slices of whole wheat bread with a tablespoonful of organic peanut butter with no added salt
An apple (medium size)
A cup of tea
Lunch
Two medium pieces of chicken
Spinach (2 cups)
Two baked potatoes
A glass of fresh orange juice
Dinner
Half cup of brown rice
Two teaspoons of olive oil
Half cup of black beans
Glass of low fat milk
A cup of berries
Snack
Mango (medium)
Two wafers
Yoghurt (no fat, low in calories)
The above diet consumed by the interviewee is appropriate for a hypertensive patient because it meets all the DASH diet requirements to ensure that she manages her blood pressure effectively.
Part #4 – Family, Intergenerational Relationships and Ethnogerontological Factors
According to N.M., the parent generation is expected to raise children, take care of their parents and grandparents as well. Her family is tightly knit. They are emotionally close despite the fact that they live in diverse areas. They ensure that they are in constant contact with each other and try as much as possible to visit one another frequently. Therefore, for those who live in close proximity with one another, they frequently see each other, and for the ones far away, emotional closeness is ensured through making phone calls often, or emails, among other communication, means. The interviewee stated that her family members take care of one another throughout the generations. In her family, family members are expected to help the elderly. They always come together to ensure that the elderly family members who also have chronic illnesses receive appropriate care. Grown-up children take responsibility for their aging parents, and they are committed to taking good care of them regardless of the distance between them or other life responsibilities. They are expected to provide different kinds of support, such as payment of bills, home, and shopping, among others.
The interviewee does have a strong affiliation with the Jewish culture. The only aspect that has been passed on to children and grandchildren is religion. Having Jewish roots, her family practices Judaism, which has been passed down to her family’s generations. Her cultural beliefs about health influence how the interviewee acts in order to retain her health as well as restore it back when ailing. She beliefs that healthcare professionals, such as doctors and nurses, act as healers who have a divine impact and that they are the emissaries of the will of God. N.M. consults her children and close family members, such as her siblings, on matters related to health care. The interviewee stated that she feels she can make her own decisions, but she values her family’s opinion in important decisions. No identified family member is in charge of making decisions regarding healthcare, and as a result, disagreements arise sometimes. In such situations, the interviewee stated that the concerned family member gives the preferred decision/action. The interviewee uses home remedies for conditions such as cold or cough. The home remedy was taught by her parents when she was a child, and she has passed it down to her children. I have experienced a patient who used home remedies, and the remedy’s ingredients were assessed to determine their appropriateness for the patient. Information on the remedy was also collected to determine its effectiveness and safety. I was surprised by the interviewee’s intergenerational relationships and the fact that there are specific things that one is obligated to do. This was surprising because, in the current family setup, the only tightly knit members are, in most cases, those within the nuclear family.
Part #5 – Conclusions
Aging is a process that is inevitable for everyone. There are factors related to aging that can be controlled, but there are also those that cannot be controlled. As a result, it is essential to accept and help elderly people accept what they cannot control to live a quality life. Handling the aging process appropriately is important in ensuring that one lives a good and happy life. Support from family members is essential through ought the aging process because, as people age, their functionality and physical ability decrease. In addition, there are some illnesses that come along with old age hence the need to provide support to elderly patients for recovery.
