PSYCHOSICIAL ASPECTS OF ELDERLY

BY:- FIROZ QURESHIDEPT. PSYCHIATRIC

NURSING

INTRODUCTION

The psychosocial maturity of the elderly such as wisdom, creativity, spirituality

and emotional out growth have shaped the world we now live.

INTRODUCTION

• Elders are transmitters of tacit knowledge, of life experiences of history and of life crisis management and are also roots of our society.

INTRODUCTION• Retirement, altered relationships with adult

children, changes in housing, loss of valued possessions, loss of friends resulting from relocation or death, loss of spouse, loss of health and loss of independence are some of the psychosocial issues related to elderly

PSYCHOSOCIAL ASPECTS OF ELDERLY

• According to “Maslow’s Human Needs Theory”, the five categories of human needs, ordered from the lowest to highest are: physiologic needs, safety and security needs, love and belongingness, self esteem and self actualization. The older people are the self actualized people possessing the traits of autonomy, creativity, independence and positive interpersonal relationships.

• Sociological theories of ageing explain that the maintenance of social equilibrium is achieved by a mutually beneficial process of reciprocal withdrawal between society and older people. (Disengagement theory)

• The older people remain psychologically and socially fit if they remain socially active. One’s self concept is affirmed through activities associated with various roles that the loss of roles in the old age negatively affects life satisfaction (Activity theory)

PSYCHOSOCIAL CHALLENGES OF ELDERLY

• The psychosocial changes are challenges that demands lot of coping energy.

• Retirement: The consequences of retirements include loss of income, loss of identity or role, loss of status or authority, loss of structure or schedule, loss of purpose in life and loss of peer contacts.

• Death of friends: The death of friends make the elderly to become socially isolated and may lead to significant reduction in social activities.

• Widowhood: The elderly experience severe grief, emptiness, loneliness, changes in responsibility, dependency on others and decline in functional abilities to perform activities of daily living (ADL) as a consequence of loss of helper, loss of companion and loss of sexual partner.

• Relocation from family homestead: Leads to “relocation stress syndrome” with the psychological manifestations such as losses, fears, concerns, loss of independence, loss of personal possessions, loss of friends and neighbors and fear of unknown.

RISK FACTORS THAT AFFECT PSYCHOSOCIAL FUNCTION

• Poor physical health• Impaired functional abilities• Poor social supports• Lack of economics and resources• The occurrences of unanticipated events• The occurrences of several daily hassles at the same time• The occurrences of several major life events in a short

period of time• High social status and higher feelings of self efficacy in

situations that cannot be changed

• Sharma (2005) listed several social risks such as social isolation, impairment of cognitive functioning, widowhood, limited options for living arrangements towards life, poverty, inadequate housing, mental illness, bereavement and dependency due to physical or mental disease.

THE PSYCHOLOGICAL DISORDERS THAT AFFECT PSYCHOSOCIAL FUNCTIONS ARE

• Mood disorders (depression and mania)• Anxiety• Delirium• Dementia (Alzheimer’s is the commonest)• Aggression• Substance abuse• Sleep disorders• Pain• Eating disorders• Abuse and neglect

NURSES TO PROMOTE HEALTHY AGEING

• Healthy aging is the ability to continue to function mentally, physically, socially and economically as the body slows down its processes.

PRINCIPLES OF GERONTOLOGICAL NURSING FOR HEALTHY AGING:

• Continuous process of change and adaptation.• Self defined and individualistic.• Slowing down of body processes.• Acceptance and movement towards death.• Desire to continue to actively participate in life

processes.• Ability to function physically, cognitively and

socially.• Self assessment and redefinition of self and

abilities.

ADAPTATION

RESILIENCE

COMPENSATION

HEALTHY AGING

AUTONOMY INDEPENDENCE

(LINDA HANSEN -2005)

WAYS TO IMPROVE PSYCHOSOCIAL ASPECTS OF ELDERLY

To improve self esteem:• Allow elderly to make choices whenever possible.• Encourage elderly to do as much as possible for themselves.• Modify environment that suits elderly to perform self care activities

independently.• Avoid being over protective or directive to prevent the feeling of

impotent or child like.• Respect older adult’s rights to refuse.• Explore feelings and concerns to improve self worth.• Demonstrate acceptance.• Focus on abilities and not disabilities to promote self worth.• Absence of self worth leads to despair and hopelessness. Erickson

stressed the importance of seeing value in the life stories of older adults.

• Provide opportunities for reminiscence because it provides recognition of previous successes.

To strengthen familial roles and relationships:• Assess the interaction between family members.• Encourage family members to verbalize their feelings

independently and teach positive coping.• Assist family members in identifying personal and

family strengths.• Encourage the family members to assist in elderly care. • Assist families in identifying the factors that are

interfering with normal interactions.• Making the elderly a vital component of the family

system.

To cope with stress:• Encourage older adults to verbalize their feelings.• Assist in identifying the personal strengths and

previously successful coping strategies.

Explain a variety of stress reduction techniques:• Progressive relaxation: Tighten and relax muscles

starting at the feet and working upward through the body.

• Self hypnosis: Place oneself in a trance like state.• Imagery: To think of a calm, peaceful setting and

enjoying the experience.• Meditation: To shut out the external stimuli and

focus on calming the thoughts.

To encourage family to provide emotional support to the older adults:

• For e.g. Retirement :- develop new skills, use time for hobbies and personal pursuits and get involved with meaningful volunteer activities.

• Reduced income:-take advantage of discounts for seniors.

• Functional limitations:- adapt the environment to ensure safety and optimal functional status, take advantage of assistive devices and equipments and accept help when necessary.

NURSING IMPLICATIONS:

• Self help group for improving psychosocial wellbeing.

NATIONAL POLICY FOR OLDER PERSONS (NPOP,1999)

Objectives (E.g.):• To provide care and protection to the

vulnerable elderly people.• To promote research and training facilities to

train geriatric care givers and organizers for the elderly.

Constitutional provisions:

• Item 9 of the state list and items 20, 23 and 24 of the concurrent list relate to provision of old age pension.

• Article 41, Directive Principles of state policy has particular relevance to old age social security.

Legal provisions:• Priority in to the cause list to cases involving

elderly persons and ensure expeditions disposal of court matters.

Financial assistance• Pension, Grativity and Dearners relief to

government employees and their spouse later.

• National Old Age Pension Scheme (NOAP).

Travel facilities• Separate reservation counters.• Indian railway provides 30% concession

in all classes and trains including Rajadhani, Shathabdi etc.

• In Kerala, elderly, who are freedom fighters, can enjoy free travel in buses.

Health care facilities: • Sunday clinics.• Geriatric ward and OPD.• Free health care checkups.• National council for older persons.• Rs. 30 lakhs shall be provided to the eligible

institutions for construction of old age homes/ multiservice centers for older persons.

CONCLUSION• Gerontological Nursing interventions are

directed towards enhancing self esteem, promoting a sense of control, fostering self supports and assisting them with effective use of coping mechanisms. Nurses are providers of health education and other health promotional intervention to improve quality of life.

REFERENCE

1. Sreepriya, “Effectiveness of self instructional module on the level of knowledge and attitude of nurses towards care of elderly”, MSc in psychiatric Nursing dissertation, NIMHANS, Bangalore,2008.

2. Usha, “Seminar on issues in nursing care of elderly”, National consortium for PhD in nursing, NIMHANS, 2007.

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