It can be of great experience working with the elderly people, and interacting with them can be quite knowledgeable, however, that work comes with its own unique sets of challenges. Rosa Calapari is an 80 year old married woman, with 2 children and 5 grandchildren. She has a history of arthritis). Seven years ago, she suffered an intracapsular hip fracture. I could also observe signs of irritability and anxiety and as she confessed to the feeling of being neglected by her caregivers. As we see, that degenerative diseases like arthritis can be common at old age (Innala et al., 2014). Also, weakening of bones, increases the chances of fractures, like the intracapsular hip fracture suffered by the patient (Hartel et al., 2016). A mini mental state examination showed a mild impairment of memory (Arevalo-Rodriguez et al., 2015). The most frequent challenges I faced working with the elderly are (Marksteiner et al., 2013) can be listed as below:
The biggest challenge I faced was an unwillingness to seek help at the right time: This can be caused by a number of different reasons. In few instances they might feel they do not need medical assistance, or may be too embarrassed to seek help. Sometimes they might have preconceived notions about the treatment, and how it might adversely affect their lives, and would neglect treatment, fearing that it would take away their freedom. It is important to be gentle in such circumstances, and make the patient feel comfortable to seek help. I would also clarify any doubts the patient might have about the treatment.
I also, faced challenges while dealing with mental health issues: Mental health conditions which are generally associated with old age like Dementia, Parkinson’s or Alzheimer’s can cause significant cognitive impairments (Birren et al., 2013). This causes a great difficulty in providing help for them, since their condition might impair them of their ability to take care of themselves, or even understand or accept the treatment given to them. I have observed patients with Dementia, who often would forget to take their medications on time, in such cases we can keep written notes for the patient to aid their memory (Hendriks et al., 2014). I would always strive to understand how the mental condition would underlie the behavior, and that proved helpful in dealing with such situations.
I have also noticed an increasing need for personal care: Sometimes with advancing ailment and age, the patient can get progressively debilitated, thereby needing more personal help like to go to the bathroom or to clean them thereafter (King et al., 2017). We must understand that it can be very embarrassing for the patient, and we ought to do all we can to make them feel as comfortable as possible.
Forming emotional attachment: sometimes working with the elderly, I have formed emotional attachments with the patients, and in some cases it helped me being more empathetic, and helpful, but in other instances, it was a heartbreaking experience to see them suffer. I learnt that an emotional attachment becomes an important tool to understand and help the patient better (Kokkonen et al., 2014). The attachment can help to reduce the feeling of loneliness and social isolation (Gierveld, Tilburg, & Dykstra, 2016). I have also seen that pets can be a remarkable tool to create a bonding with the elderly (Cusack & Smith, 2014).
Mistreatment of the elderly: One of the biggest challenges is the mistreatment of the elderly, which includes any harm done by caregivers by failing to provide the basic needs of the patients. I have interacted with several patients who feel that they are mostly neglected, and many showed confidence that they would feel much better, health wise, if the received proper care (Giraldo?Rodríguez, and Rosas?Carrasco, 2013).
Challenges I faced while dealing with physical disabilities: Often with advancing age, degenerative disorders (like arthritis) sets in, also fractures, or surgical procedures, can reduce or even impair the mobility. This can place them at a great disadvantage, and in constant need to help. Often these disabilities can lead to the feeling of being inadequate, and can lead to mental stress, and depression (Dillon & Fernando, 2016). We must understand the change a patient goes through with progressive complexities of the advancing age (like arthritis, dementia, diabetes, osteoporosis) to be able to empathize with their situation, and help them. Managing geriatric depression hence requires a multidisciplinary approach (Leontjevas et al., 2013).
I have also faced certain levels of difficulties when dealing with a grieving elderly, like an elderly woman, who lost her husband. The psychological trauma, makes them more prone to stress related disorders, and can adversely affect the health (Shear et al., 2014). In such scenarios, it becomes important to provide an emotional support and a feeling of comfort to the patient, which can foster good health and emotional well being (Walther & Ehkert, 2016).
With hindsight, I can therefore infer that with proper understanding of the life of the patient a proper way of dealing with a patient can be implement, through empathy and compassion. I would keep in mind that ageing is not a disease, but a state of being, that we all eventually arrive to, and providence of a proper care for the elderly is not just a professional, but a social responsibility (Ardeljan & Chan, 2013).
References:
Ardeljan, D. and Chan, C.C., 2013. Aging is not a disease: distinguishing age-related macular degeneration from aging. Progress in retinal and eye research, 37, pp.68-89.
Arevalo-Rodriguez, I., Smailagic, N., i Figuls, M.R., Ciapponi, A., Sanchez-Perez, E., Giannakou, A., Pedraza, O.L., Cosp, X.B. and Cullum, S., 2015. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). BJPsych Advances, 21(6), pp.362-362.
Birren, J.E., Cohen, G.D., Sloane, R.B., Lebowitz, B.D., Deutchman, D.E., Wykle, M. and Hooyman, N.R. eds., 2013. Handbook of mental health and aging. Academic Press.
Cusack, O. and Smith, E., 2014. Pets and the elderly: The therapeutic bond. Routledge.
de Jong Gierveld, J., Van Tilburg, T. and Dykstra, P., 2016. Loneliness and social isolation.
Dillon, C. and Fernando, E.T., 2016. Special Issue: Activity and Lifestyle Factors in the Elderly: Their Relationship with Degenerative Diseases and Depression. AIMS Medical Science, 3(2), pp.213-216.
Giraldo?Rodríguez, L. and Rosas?Carrasco, O., 2013. Development and psychometric properties of the Geriatric Mistreatment Scale. Geriatrics & gerontology international, 13(2), pp.466-474.
Hartel, M.J., Mandani, S.M., Nuechtern, J., Stiel, N., Lehmann, W., Rueger, J.M. and Grossterlinden, L.G., 2016. On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study. Archives of orthopaedic and trauma surgery, 136(7), pp.913-919.
Hendriks, S.A., Smalbrugge, M., Hertogh, C.M. and van der Steen, J.T., 2014. Dying with dementia: symptoms, treatment, and quality of life in the last week of life. Journal of Pain and Symptom Management, 47(4), pp.710-720.
Innala, L., Berglin, E., Möller, B., Ljung, L., Smedby, T., Södergren, A., Magnusson, S., Rantapää-Dahlqvist, S. and Wållberg-Jonsson, S., 2014. Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study. Arthritis research & therapy, 16(2), p.R94.
King, E.C., Boscart, V.M., Weiss, B.M., Dutta, T., Callaghan, J.P. and Fernie, G.R., 2017. Assisting frail seniors with toileting in a home bathroom: approaches used by home care providers. Journal of applied gerontology, p.0733464817702477.
Kokkonen, T.M., Cheston, R.I., Dallos, R. and Smart, C.A., 2014. Attachment and coping of dementia care staff: The role of staff attachment style, geriatric nursing self-efficacy, and approaches to dementia in burnout. Dementia, 13(4), pp.544-568.
Leontjevas, R., Gerritsen, D.L., Smalbrugge, M., Teerenstra, S., Vernooij-Dassen, M.J. and Koopmans, R.T., 2013. A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. The Lancet, 381(9885), pp.2255-2264.
Marksteiner, J., Jagsch, C., Psota, G., Rainer, M., Ruepp, B., Singewald, E., Fellinger, M. and Wancata, J., 2013. Geriatric psychiatry in Austria: Current status and new perspectives. Geriatric Mental Health Care, 1(4), pp.82-87.
Shear, M.K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C. and Ghesquiere, A., 2014. Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA psychiatry, 71(11), pp.1287-1295.
Walther, A. and Ehlert, U., 2016. Emotional support, depressive symptoms and age-related alterations in male body composition. Psychoneuroendocrinology, 71, p.24.
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