ACCENTUATING THE POSITIVES -ISSUES IN WELLBEING, AGEING AND MEMORY LOSS FROM AN OT PERSPECTIVE

Karen Wood, OT Gwynedd & Mon Memory Clinic

AIMS OF THE TALK

An overview of how the changes that can occur in ageing and development of memory problems may have an impact on wellbeing

How some older people, people with memory problems and caregivers view their situation

Discuss how occupational therapy can have a role in promoting wellbeing

WELLBEING

2012 Dodge et al: difficulties in defining wellbeing“subjective well-being consists of 3 interrelated components: life satisfaction, pleasant affect, and unpleasant affect. Affect refers to pleasant & unpleasant moods & emotions, whereas life satisfaction refers to a cognitive sense of satisfaction with life.” (Diener & Suh, 1997)

Ryff, 1989 looked at constituents of well being:autonomy; environmental mastery; positive relationships with others; purpose in life; realisation of potential and self acceptance.Other dimensions: ability to fulfil goals; happiness; life satisfaction

Rogers, 1961, looked at wellbeing in terms of “the good life” each person strives towards becoming a “fully functioning person” - open to experience, is trusting in his/her own organism and leads an increasingly existential life:“adjectives such as happy, contented, blissful, enjoyable, do not seem quite appropriate to any general description of this process I have called the good life...adjectives which seem more fitting are [those] such as enriching, exciting, rewarding, challenging, meaningful. This process of the good life is not...a life for the fainthearted. It involves the stretching and growing of becoming more and more of one’s potentialities. It involves the courage to be. It means launching oneself fully into the stream of life...”

“each time an individual meets a challenge, the system of challenges and resources comes into a state of imbalance, as the individual is forced to adapt his or her resources to meet this particular challenge” (Kloep, Hendry & Saunders, 2009)

“when individuals have more challenges than resources, the see-saw dips along with their wellbeing and vice-versa”(Dodge, Daly, Huyton & Sanders, 2012)

AGEING

Physical changes

Psychological

Cognitive

Economic

Social

DEVELOPMENT OF MEMORY PROBLEMS; DEMENTIA – THE DOUBLE WHAMMY...

Memory

Concentration

Visuospatial & constructional skills

Executive function

Language

EFFECT ON:

Self image & Expectations

Roles & Occupations

Relationships & Responsibilities

EXPERIENCING THE NEGATIVES

Gwen – mood, reporting cognitive problems,

Lily – early dementia

Tom – cognitive problems

Elizabeth – Tom’s wife & caregiver

Mair – early dementia

IS IT ALL BAD?

Maturity Experience Freedom Time Knowledge & skills Ability to adapt Resilience

AGAINST AGEISM

“The aged are an asset not a liability to society because of the invaluable contribution they can make by virtue of their accumulated wealth of knowledge and experience” (UN 1982)

SOME INSPIRING OLDER PEOPLE

Helen Mirren Paul McCartney Buster Martin Mary Berry Terry Pratchett Some of my best friends...

WHAT IS OCCUPATIONAL THERAPY?

“OT takes a person centred approach to both mental and physical health and wellbeing, enabling individuals to achieve their full potential.

OT provides practical support to enable people...to overcome barriers that prevent them from doing the activities (occupations) that matter to them. This helps to increase people’s independence and satisfaction in all aspects of life.”

(COT)

OCCUPATION

“refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day to day tasks such as self care, work or leisure” (COT)

Occupation should be a “synthesis of doing, being and becoming” (Wilcock 1998)

ASSESSMENT

Of skills & abilities, limitations & needs – person’s perspective & objective view

Functional – application to activities & occupations

Home environment Holistic

INTERVENTIONS

Person centred – according to the individual, their situation & environment

Identify realistic goals Aim to optimise independence & wellbeing

through use of meaningful activity & occupation

Practical problem solving Affirmation & reinforcement

REAL LIFE

FOR INDIVIDUALS

GWEN

Said she would like to : feel brighter & more motivated, return to gym, start baking

To have kitchen assessment, start going out for walks – setting targets, reported she needs to be “pushed”, positive reinforcement, challenge negative thoughts, facilitate exploration of community resources/amenities

LILY

Said she needs: to be more confident using her mobile; to be able to use her microwave to cook chicken pieces; forgets times of the buses; feels lonely

Assessed using appliances; demos & practice, she has written instructions. Bus timetable highlighted. Agreed to be referred to memory club & Age Cymru befriending project

TOM & ELIZABETH

They have different issues, abilities & needs but these have to be looked at together

Tom finds that forgetting day and date undermines his confidence. He does use a diary but not effectively.

Elizabeth – would like Tom to be able to recall what he has to do in the day and not have to worry about him when she goes out or visits family who live away. She would like him to have more structure and intellectual stimulation.

The couple are aiming to move closer to family

To help Tom recall day and date – calendar clock; set up “information hub” & routine for checking & taking medications. A dictaphone/memo minder may be useful for recording events when out. Strategy leaflets given to Tom & potential activities discussed.

Elizabeth signposted to local caregiver & community resources and discussed potential resources in new locality; caregiver issues discussed as well as general safety & driving

MAIR

Has a genuine sense of wellbeingShe feels her memory problems do not

significantly affect her life as she can: Carry out most of her daily activities, her

daughters visit frequently with their children who she helps to look after. She attends chapel and a local club and has friends who visit.

She had a good marriage and has happy memories that she enjoys sharing.

Mair did not wish to have any OT interventions as she feels her family provide any reminders and no safety issues were reported or identified at the time of the assessment.

HOW DO THEY RELATE TO WELLBEING?

Person centred – according to the individual, their situation & environment

Identify realistic goals Aim to optimise independence & wellbeing

through use of meaningful activity & occupation

Practical problem solving Affirmation & reinforcement

REFERENCES

Dodge R, Daly AP, Huyton J, Lalage DS: The challenge of defining wellbeing. Intl Journal of Wellbeing 2 (3) 222-235, 2012

Rogers C: On Becoming a Person, 1961; Constable new ed 2004

Doble SE, Santha JC, Occupational well-being: Rethinking occupational therapy outcomes. Canadian Jnl of OT no. 3 vol 75 June 2008

COT website CMOP accessed off

www.munchkinandflan.com

CHEERS & THANKS FOR LISTENING!