Table of Contents

1. Introduction…………………………………………………………………………………….2

2. Healthy Physical Aging…………………………………………………………………….2 – 3

3. Mental Aging……………………………………………………………………………… 3 – 4

4. Maslow’s Hierarchy Of Needs…………………………………………………………………5

5. Activities Of Daily Living………………………………………………………………….6 – 7

6. Global and Nations Trends In Aging……………………………………………………….7 – 9

7. Cultural Influences On Aging…………………………………………………………………10

8. Social Impact On Aging…………………………………………………………………11 – 13

9. Current Care Provisions………………………………………………………………………14

10. Future Care Provisions………………………………………………………………………15

11. Needs Of The Older Person……………………………………………………….……15 – 17

12. Preparation for Retirement…………………………………………………………………..17

13. The Multidisciplinary Team…………………………………………………………………18

14. The Role Of The Healthcare Assistant………………………………………………………18

15. The Needs Of The Dying Person……………………………………………………….19 – 21

16. Personal Recommendation…………………………………………………………………..21

17. Personal Reflection…………………………………………………………………………..21

18. References……………………………………………………………………………………22

1. Introduction

This assignment will show my understanding of the topic.  I will discuss the following to support my knowledge of the topic.

• Healthy physical aging
• Mental aging
• Maslow’s needs
• Activities of daily living
• Global trends in aging
• Cultural Influences on aging
• Social impact of aging
• Current care provisions
• Future care provisions
• Needs of the older person
• Preparation for retirement
• Multidisciplinary team
• Role of the carer
• Needs of a dying person

The information for this assignment has been sourced from the internet, class notes and my experience working in healthcare.  I will finish with a conclusion and a personal reflection.

2.  Healthy Physical Aging

As we get older these are some of the changes happening in the body.

Outside the Body

Inside the Body

3. Mental Aging

As the body gets older the mind also deteriorates for example: we might forget where we put something or to switch off the heating.

It might be more difficult to learn new things as our mind is slowing down for example difficulty learning new technology (smartphone, TV or computers).

Loneliness

If you were married and your partner dies after being together for a long time you may find yourself alone in your home with no family, friends or neighbours to visit.  If mobility is poor or deteriorating if may be difficult to get out and this could lead other issues such as depression.

Dementia

Dementia is a term which describes a number of conditions that cause damage to brain cells.

‘Those with dementia are still people and they still have stories and they still have character and they are all individuals and they are all unique and they just need to be interacted with on a human level’. (www.alzheimers.net)

Dementia is an umbrella term for a family of mental illness these include the following;

Alzheimer’s disease:  A build-up of protein in the brain which forms a plaque and stops the brain functioning normally.

Vascular Dementia: The brain is hit by lots of little strokes with no chance of recovering.

Mixed Dementia: Parkinson’s like problems.

Huntington’s Picks: This is a hereditary condition that is passed from a parent.  A parent with Huntington’s has a one in three chance of passing this on to a child.  Huntington’s disease strikes at a young age.  It affects memory; balance etc. and ultimately the person will lose all body control.

Korsakoff’s syndrome: This condition is mostly commonly caused my alcohol misuse and poor diet which create a vitamin B1 deficiency.  People with this condition experience loss of short term memory.

Creutzfeldt – Jakob disease or CJD:  This is a rare degenerative and fatal disease caused by consumption of infected brain or nervous tissue.

(Class notes and http://www.alzheimers.org.uk )

Dementia Statistics for Ireland

There are currently more than 40,000 people over 65 and 38,000 under 65 years old diagnosed with some form of dementia.  This is expected to rise to 104,000 by 2036.  Dementia affects 1 in 12 people over 65 and 1 in 5 over 85.  It is the fourth largest cause of death in Ireland over 65%.

The longer a person lives the more likely they are of getting Dementia.  It is said between the ages of 65 – 70 years 8% of all people will have dementia of some form.  From 75 – 84 years this increases to 20%with the figures increasing further to 30 – 47% of people aged 85 and over.

(Class notes)

4. Maslow’s Original Hierarchy of Needs

Maslow’s hierarchy of needs is a theory in psychology first developed in 1943.  Maslow believed that a person must satisfy a lower basic need before progressing on to meet a higher level of growth.  At the time the hierarchy of needs model comprised Five Needs. (Class notes).

1. Biological or Physiological Needs.  These are the primary needs of a client e.g. air, food, water, shelter, warmth, sleep.

2. Security and Safety needs.  The need to feel safe and secure e.g. home security, legal rights, financial security, employment security, healthcare.

3. Social Needs.  The need for love, affection, relationships, a sense of belonging, socialising e.g. being with family, loved ones, social or religious groups.

4. Esteem Needs.  The need for things that impact personal self-esteem, sense of worth, social recognition e.g. independence, status, social achievement, responsibility in life.

5. Self-Actualisation.  This needs is less concerned with the opinions of others and addresses the need for personal growth e.g. personal account of achievement, strong moral code (I know I am a good person), realising their own potential, keeping positive.

5. Activities of Daily Living

Activities of daily living (ADLs) are basic self-care tasks developed by three nurses Roper, Logan and Tierney.  The model promotes maximum independence and uses 12 activities to assess a client’s condition.  From this assessment a clear view of the client’s needs can be noted from which a care plan can be established.  A care plan is a legal document written by a qualified person e.g. a nurse and it outlines the care a person will need. (Class notes)

The 12 areas of assessments are as follows:

1. A Safe Environment: Locks on doors, alarms installed (smoke alarm, carbon monoxide alarm etc.), gas boiler maintained.

2. Communication: Listening/hearing aid, can they speak and understand, can they read and write, how is body language particularly non-verbal.

3. Breathing:  Is an inhaler, nebuliser or oxygen tank needed?

4. Eating and Drinking: Can they shop for themselves, can they cook (would meals on wheels help), Do they have difficulty feeding themselves or using cutlery, is assistance needed to eat, Is a specialised diet needed – reduced portions, pureed food etc.

5. Elimination: Can they use the toilet by themselves, is there any incontinence (would a pad help or is it more serious?), is there bowel control is a bag needed (stomach bag, colostomy bag, catheter tube etc.).

6. Personal Dress:  Is there any difficulty bathing, showering, shaving, brushing teeth, washing hair?  Can they dress themselves?

7. Controlling Body Temperature:  Can they tell if they are hot or cold?  It is important to take care when assessing as nerve damage might cause a delayed reaction hot and cold which could result in injury.  Ensure windows are closed and extra layers are worn during cold weather.

8. Mobilising:  Can they walk independently or is a walking aid needed, is support/assistance needed to sit or stand or get up or down stairs.

9.  Working and Playing:  Some people are introverts and some are extroverts but it is important that there is some level of social interaction as this will maintain self-esteem and a sense of worth.  The level of social interaction can vary depending on the person (and there physical abilities) from meeting up with friends to volunteering.

10. Expressing sexuality: Is there a partner or friend? Are they sexually active/interested in being sexually active?

11.  Sleeping:  Is assistance needed to sleep comfortably e.g. has a doctor prescribed medication or an inhaler?

12. Death and dying:  Is the person spiritual or religious?  Have they made a will, Have they discussed palliative care?  Have they discussed their preferences for end of life care (resuscitation orders and who their decision maker/next of kin is)?

6. Global Trends In Aging

The following are some statistics in relation to the global trends of the older population:

• In 2013 the average life expectancy at birth of the global population was 71 years
• The healthy life expectancy (HALE) was 62 years
• The global population could expect to live another 20 years on average

(www.who.int)

National Trends In Aging

The following are some of the statistics in relation to the aging population of Ireland:

• In 1990 in Ireland the life expectancy at birth of both sexes was 75 years
• By 2013 this had increased to 81 years. From this we can see that people were living, on average, an extra 6 years.
• In 2000 the healthy life expectancy at birth for females was 70 years and for males it was 66 years. In 2013 this had increased to 73 years for females and 69 years for males. From this we can see that women stay healthier for longer and in the last 13 years both genders have increased their HALE by 3 years.

(http://apps.who.int)

We can contribute a number of factors to these statistics. Some of these are the following.

Environment Factors

There are a variety of environmental factors which will impact the older person in Ireland.

• Medical – On average Ireland has good medical care compared to other countries and provides free medical care to the elderly.

• Government – The Irish government provides a certain level of support for the elderly such as a state pension and a fuel allowance
• Housing – Most of the elderly in Ireland are living in a house, but some of these buildings are old and suffer from problems such as damp or poor insulation.
• Food – Older people in Ireland have access to good, nutritious food whoever the cost of this may be a factor for them.

Socio-cultural Factors

Social factors such as smoking and drinking have a huge impact on aging.

Smoking and Drinking – The older generation would have started smoking at a very young age and would have smoked most of their life. In their younger days cigarettes would have been a lot cheaper than they are today and as they get older the price of cigarettes goes up. The older generation might not be able to afford them anymore. Alcohol would have been a lot cheaper also and not they find they can’t afford to go out for a drink and socialise, or even to go to an off licence and they might have to give it up as their money won’t stretch that far.

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Care In The Home – Ireland as a nation would love to keep family members in their own homes. They might not be possible for a variety of reasons. If there is an upstairs they might not be able to climb the stairs. Their health might be deteriorating. Their other half might have passed on and they are afraid to stay on their own especially if they live in rural Ireland and are isolated. Their family might not be able to afford to keep them at home as they may need someone to stay with them at night or the house might be too big to keep warm for just one person.

The following are three services which are unique in their own different ways, all providing different services for our elderly to give them resources or somewhere to go for advice on things such as health or money worries:

Fit for Life

They are specialists in helping older adults to live a full and independent life and to maintain the best possible quality of life. They provide extensive health based services to over 5,000 clients in nursing homes, day centres, hospitals, communities and to private individuals on a weekly basis. (http://fitforlife.ie/)

Age Action

They promote positive aging and better policies and services for older people. Every year Age Action’s Care and Repair Programme helps thousands of older people by providing a visitation and DIY service. Their volunteers enable older people to continue living at home with dignity and independence. (http://www.ageaction.ie)

Alone

Alone’s befriending service provides companionship for isolated older people. Every older person who goes to them for help receives a direct service from them or are referred on to an organisation who can provide them with the support they require.  (http://alone.ie/)

Political and Financial Factors

In my opinion the pension in Ireland for the elderly is not enough and once they have paid their groceries, bills etc. they do not have much left over for themselves.

The following details some of the political and financial factors that affect the elderly.

• The state pension (contributory) is paid to people from the age of 66 years who have enough Irish social insurance contributions. It is not means tested and you may have other income. This pension is however taxable. As the social insurance conditions are very complex someone should apply for a contributory state pension if they have ever works and have any contributions/stamps paid at any time.

• Budget 2016: It was announced in the most recent budget that the weekly rate for people getting the state pension will increase by €3 per week. This change will take place from January 2016 and is subject to legislation.

• Aged 80 years increase: Anyone in receipt of an Irish social welfare pension will automatically get an increase in their pension when they reach 80 years of age.

• National Fuel Scheme: The elderly can avail of a fuel allowance. This is a means tested payment to help people who cannot afford their own heating costs. This increased by €2.50 per week in the most recent budget.

• Water Charges: This is a new tax with is being placed on the water usage in our homes.

• Household Benefits Package: this includes the electricity or natural gas allowance and a free TV licence. If you are aged 70 years or older you qualify for this regardless of your income or who you live with.

• Children Staying At Home: due to the recession along with high rental rates, there is an increasing number of adult children living with their parents. This often proves to be an additional cost or financial strain on older people.

(www.citizensinformation.ie)

7.  Cultural Influencing on Aging

As a culture we in Ireland used to put our loved ones in a nursing home, provided we could find one we liked and it was not to far away and our loved ones were happy to be there (our loved ones used to make this decision for themselves).

Also we put our loved ones in a nursing home if we could not look after them ourselves at home.  Since the government brought in this new rule (fair deal scheme) if you loved ones goes into a home they have to sign over there house to them and when they pass everything goes to the government.  Personally I think it is a disgrace as they have worked their whole lives to provide for their families and paid their own mortgage so they could pass there home on the a loved one.  The circle of life (like a wheel) they looked after and cared for us now we must take our turn and look after them.  It’s like they are a burden to us and the government don’t want that burden but they are forgetting that one day they will be old themselves. Our loved ones while they are still mentally fit are gifting these possessions to friends and family and insuring that it is legally documented.  This is similar to a will but it is carried out while the person is still living.  There is also a scheme called senior options, an older person that does not need a nursing home and would like to stay in their own home.  The government will give them money and in return when they pass their home is sold and the government get back the money they gave that person while alive and a percentage from the house, the loved ones get the balance.

It is also worth looking at other cultures views on how they treat their older people for example

Native American nations each have their own traditions and attitudes towards aging and elderly care.  But in many tribal communities elders are respected for their wisdom ad life experiences.  Within Native American families it is common for elders to be expected to pass down there learnings to younger members of the family (source: university of Missouri, Kansas City, USA).

Korean elders are highly respected.  Young members of the family have a duty of care for the aging members of the family ad even outside the family unit Koreans are socialised to respect and show deference to older individuals as well as authority figures.

Chinese children care for their parents in old age ‘placing your parents in a retirement home will see you labelled as uncaring or a bad son’.  ‘To abandon ones family is seen as dishonourable’.  However this tradition is starting to break down in China due to the country’s one child policy rising life expectancy and aging population nursing homes are beginning to become more socially acceptable option for elderly care.

In India the elderly are often the most religious and charitable members of the family.  Disrespecting the elders of the family or sending them to an old age home has a social stigma in India.

(www.huffingtonpost.com)

8. The Social Impact of Aging

You may look at the lives of your elderly loved ones and think that they haven’t a care in the world.  Their education is complete.  Their children are raised and they no longer must slave away at a job every week.  At first glance it seems that the average senior citizen is free to pursue leisure interests and generally enjoy life unencumbered by former responsibilities and aggravations.  While these things are true to a degree, it is important not to overlook or discount the many stresses a person faces when he or she begins to age.

Major Life Changes

As your loved one grows older the familiarity that he or she has come to rely upon in life will gradually or sometimes very abruptly transition.  Major changes can be scary and may lead to feelings of insecurity and or loss of self-worth, for example while you may think your retired mother is the luckiest person in the world because she has not longer to get up early to drive to work much of Mums identity may have been wrapped up in her work and she may no longer feel needed or valuable.

Likewise your may envy the fact that your father gets to play with his grandchildren all day and relaxes with a book in the evening while you are at home organise bedtime and set up for the next day, but he might miss being a person that his children rely upon for his care and support.

Elderly individuals must accept that their role in life will change as there former lifestyles are replaced by new routines and relationships.

Fear of the Future

As a person ages they inevitability of death becomes more real and can often be a source of uncertainty and dread.  But many seniors also struggle with anxieties linked to pre-mortality – concerns such as;

• Will my life lose its meaning if I am no longer useful?
• How will I be able to care for myself?
• Will I lose my mental faculties?
• If my physical health deteriorates will I have to give up the activities I enjoy?
• Can I cope with losing my loved ones?

These are questions with no definite answers and wondering what the future may hold can be can be a great source of anxiety for your senior loved one.

Memory and Learning

It is a widespread belief that as the brain grows older a person’s capacity for reasoning begins to decline; there is very little truth in this.  A senior citizens intellectual capacity remains the same will into old age and as little as 1% of the population will live long enough to be affected by senility.  (http://www.seniorhomes.com)

While the elderly are just as intelligent as younger people the sometimes process information more slowly or must repeat a new skill several times before the step becomes second nature.  Anybody who has received emails from an elderly relative is well aware that the saying ‘can’t teach an old dog new tricks’ is completely untrue!

If you feel that your loved ones forgetfulness is interfering significantly with his or her ability to function you should research the signs of early onset dementia.  Also be aware that certain reversible conditions affect the memories of people who are both young and old, some of these may be;

• Lack of sleep
• side effects of medication
• depression or apathy for life
• High stress
• Treatable conditions such as thyroid problems, a vitamin B12 deficiency, a UTI.

Loss of Independence

As elderly people become less physically able to engage in favourite hobbies, drive themselves to appointments or take care of things around the house they often mourn the loss of their independence.  At times it is difficult to rely on others for essential care or even to ask for small favours particularly if it is from people that once relied on them for daily assistance (e.g. a now adult child or spouse).  Some seniors find themselves losing their freedom as they become caregivers for spouses, siblings or other elderly friends whose health has declined more rapidly than their own.

Grief and Loss

Some seniors must face the fact that the longer he/she lives the more friends and family members will pass away ahead of them.  Losing the people they care about can leave seniors feeling abandoned, vulnerable and scared.

Ageism and Discrimination

Ageism is defined as discrimination based on an individual’s age.  Although there were more people above 65 years counted in the 2010 census that in any previous census ever conducted our seniors still struggle with stigmas placed on them by a youth orientated society. (www.seniorhomes.com/) Sadly, older people are commonly perceived as unsuitable employees, part of a demographic that is not worth advertising too because they are already ‘set in there ways’.  This neglect by the workplace and the media leads to widespread misconceptions about the lifestyles and usefulness of our elderly citizens.

Helping your Loved Ones Cope

The best thing you can do to help your senior loved one live a worry free life is to listen to them and to be vigilant about detecting any problems that he or she may not feel comfortable sharing.  Be sensitive to your loved ones feelings and fears, initiate conversations about the concerns of later life.  Socialising and relationships are very important to a human’s wellbeing.  If you notice your elderly loved one withdrawing from social activities encourage them to join a senior centre, attend church or participate in any event that may be of interest.  Transportation is often a problem for seniors who no longer drive their own vehicle but you can help your loved one by arranging for public or private transport assistance.  You can help your loved one cope with memory loss by using these helpful tips

• Stay mentally active
• Socialise regularly
• Get organised
• Focus
• Eat a healthy diet
• Do physical  activities daily
• Manage chronic illnesses

Remind your loved one that the aging brain is as capable as anybody else’s when it comes to creativity and learning new skills.  The alliance for aging research suggests these 10 ways to keep the brain young:

• Playing games that challenge your mind.
• Explore new hobbies or craft possibilities
• Take a class or course
• Write your autobiography or create a family history scrapbook
• Work as a volunteer in a non-profit organisation
• Consider starting a new part time career
• Visit a new place
• Organise an activity for a group of friends or family members
• Write letters to your loved ones
• Keep a dream journal

(http://www.agingresearch.org)

Combat the negative effects of ageism by researching and discussing this troubling social problem with your loved one.  Make sure that he or she does not buy into the stereotypical images.  Be prepared to act as an advocate for your loved one if his or her life if ever directly influenced by ageism with the benefit of your concern, live and dedication your elderly friend or relative will be better able to face the challenge of growing older and to enjoy a healthy thriving late adulthood.

(www.seniorhomes.com)

9. Current Care Provisions

There are 3 different types of care in Ireland.

1. Primary Care – GP, Family Planning, chiropodist, dentist

2. Secondary Care – X-ray department, haematology, accident and emergency

3. Tertiary Care – Diagnostic care services provided by hospitals eg. Coronary care dept.

The Health Service Executive (HSE) is Ireland’s state healthcare service provider.  The HSE provide public health and social care services to everyone living in Ireland.

The current minister in charge of the Department of Health is Leo Varadkar.  The goal of the department of Health is to assist the people of Ireland live better for longer by providing the care and treatment they need with the compassion, respect and dignity they deserve.

The Health Information Quality Authority (HIQA) is an independent authority established in May 2007 to drive continuous improvement in Ireland health and social care services.  (www.hiqa.ie). HIQA is an independent body who govern themselves. They set standards and policies for residential healthcare ie. Nursing homes, hospitals, days centres etc. They then communicate those standards, and give recommendations or a list of requirements. Their first inspection of a premises will be announces, however after that they do not have to tell you when they will be coming.

Reporting directly to the Minister for Health and the Minister for Children and Youth Affairs their role is to promote quality and safety in the provision of health and personal social services for the benefit of the health and welfare of the public The Authority has four core activities or functions aimed at achieving these outcomes

• Regulation
• Supporting Improvement
• Assessing Health Technologies (HTA)
• Improving outcome through information

(www.hiqa.ie)

10. Future Care Provisions

In the future we will need more nurses and carers so that we will be able to give the care that is needed to our elderly and sick.  At the moment we only treat the physical needs of a person and then move on to the next patient.  But we need to care for the whole person and to see them as a whole person not just a patient or a diagnosis.  Holistic nursing care involves healing the mind, body and soul of our patients.  It involves thinking about and assisting patients with the effects of illness of the body, mind, emotions, spiritually, religion and personal relationships.  Holistic care also involves taking into consideration social and cultural differences and preferences.  As every person is their own individual the care of each patient should be individualised.  We need to be on a one to one with our patients or clients and give them the care and attention they need.

11. Needs Of The Older Person

We have already discussed the ADLs and how these are used to identify the needs of the older person e.g.:

• Eating – Adaptive cutlery
• Mobility – handrails, walkers
• Elimination – catheter, pads
• Working and Playing – coffee mornings, community events.

However, as people age more specific needs may occur as the result of a particular illness. One of the most common illness for an older person to develop is Alzheimer’s.

What Is Alzheimer’s?

Alzheimer’s is a type of dementia that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and progress over time, becoming severe enough to interfere with daily tasks.

• Alzheimer’s is the most common form of dementia and accounts for 60 to 80% of all dementia cases.
• Alzheimer’s is not a normal part of aging, although the greatest known risk factor is age and the majority of people with it are aged 65 and older. However up to 5% of people with the disease have early on-set Alzheimer’s and develop it in their 40s or 50s.
• Alzheimer’s is a progressive disease and the symptoms gradually worsen over a number of years. In its early stages the memory loss is mild but during late stage individuals lose their ability for carry on a conversation or to respond to their environment.
• It is the sixth leading cause of death in the USA
• Those affects by it live on average 8 years after their symptoms become noticeable to others, but survival can range from 4 to 30 years depending on their age and health conditions.
• There is no current cure but treatments for symptoms are available and research is ongoing. Current treatments do not stop the disease from progressing but they can temporarily slow the progression of symptoms and improve quality of life. 90% of what we know about this disease has been discovered in the last 15 years.

(Class notes and www.alz.org)

What Are the Symptoms of Alzheimer’s?

• The most common early symptoms of Alzheimer’s is difficulty remembering newly learned information. Memory loss and confusion are signs that the brain cells may be failing.
• Disorientation
• Mood and behavioural changes
• Deepening confusion about events, time, and place.
• Unfounded suspicions about family, friends and caregivers.
• Later stage symptoms include difficulty speaking, swallowing and walking.

People with memory loss or other possible signs may find it hard to recognise that they have a problem. It may be more apparent to family members of friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.

(http://www.alz.org)

Care Requirements of Someone with Alzheimer’s

The care needs for a client who has Alzheimer’s, in relation to their ADLs, are as follows:

• Mobility – they may need a walker, stick or wheelchair. They need to be familiar with the route they are taking or else they may get lost.
• Eating – they may need adapted cutlery, a cup with handles, or may need to be shown how to eat. Pictures can be put on press doors and cutlery drawer to show contents so they can find them. Unfortunately in the late stages a sufferer can forget how to eat and swallow and may pass away from this.
• Working and playing – they need stimulation. Tasks that exercise the muscles and bones. Tap into previously developed and learnt skills. Ensure they had a sense of identity and that games etc. are age appropriate (for the age they feel they are).

• A person who has Alzheimer’s may have great muscle memory, for example, they could sit down at a piano and play a whole song, knit, crotchet, sewing/dress making, shuffling cards, gardening etc.

Emotional Needs – these can include the need for love and affection, a sense of security, freedom from fear or loneliness. Often the client will remember their long term partner’s name but not that of their grandchildren and they may not even recognise them.

Carer’s Duties – a carer’s role is to try and help their client to the best of their ability in any way they can. They can put the memory pictures in place, accompanying them to the shops and also keep them stimulated in both body and mind.

12. Preparation for Retirement

Ideally there should be a plan for retirement.  This will assist with the transition from full time work to a meaningful retirement.  Everyone has some idea of how they would like to spend their retirement it may help to write out your plan this should help to explore options and see what is affordable and possible.

Some possible thing to include on a retirement plan

• Courses:  Lifelong learning is the process of keeping your mind and body engaged at any age by actively pursuing knowledge and experience through hobbies, evening courses.
• Joining a dating website.
• Passport for leisure for the over 65’s: This offers a wide range of activities including, cultural events, sports, gyms, shopping, arts and crafts, music, theatre and cinema, travel, golf, swimming, dining out and many more. (http://www.passportforleisure.ie/)
• Travel: using the free seniors travels pass local day trips and traveling around Ireland are great options.
• Joining the local library and getting involved with book clubs or the classes offered e.g. how to use a smartphone is a short course offered in a lot of local libraries.
• Organisations for Senior Citizens: Age Action Ireland and Alone are wonderful organisations that have been set up to improve the quality of life for senior citizens.
• The HSE offer Meals on Wheels Service for older citizens.

Health is an important issue for everyone however as we age managing and maintaining good health becomes more of a priority.  There are lots of health promotion campaigns to encourage and facilitate good healthcare.  Leaflets and printed information is widely available from doctor’s surgeries, community centres, the public health nurse and most public health offices.

• Medical Cards/subsidised medication (prescription) charges
• Health screening for woman, Breast Check and Cervical Check
• Diabetic Retina Screen
• Bowel Screening
• Eyes Tests
• Hearing Tests

13. The Multidisciplinary Team

The multidisciplinary approach to caring for the elderly is becoming more important and a more effective way of managing the care of elderly patients.  This method involves many different healthcare providers ranging from family members to trained professionals depending on the ever changing requirements of the individual.  The following are some examples of the different supports available:

• Home Help: a healthcare assistant comes to the house of the elderly person in the morning and evening to assist with getting up and going to bed.
• Meals on Wheels: provide daily meals to ensure a balance diet is being provided with minimal effort on the part of the elderly person.
• Local health nurse: makes regular visits to ensure all is well medically and environmentally well.  Assess the clients ADLs and draws up a care plan.  Ensuring family and or neighbours can check in and help with shopping etc.
• G.P:  The local GP fills prescriptions and can give medical advice.  The local GP is also a primary carer position.
• Chiropodist Foot Care:  including toe nail cutting, corns and arch support.
• Speech and language therapist assess speech, swallowing (may need thickener).
• Physio assesses client’s mobility and may suggest exercises.
• Occupational Therapist makes recommendations for aids – walker, wheelchair, adapted cutlery, hand rails.

Each of these people working together ensures that holistic care is being provided.

14. The Role of the Healthcare Assistant

A homecare assistant can be a healthcare assistant.  Healthcare assistants attend to tasks such as bathing, dressing, grooming, cooking and light housekeeping.  Additional responsibilities include organising a client’s schedule, grocery shopping, helping a client enjoy recreational opportunities and providing valuable companionship for someone who may live alone and have no family who can help provide care for them.

A carer should be kind gentle, caring, have good communication skills, look professional, ideally be qualified and garda vetted be discreet and keep matters private and within the family.  An act of privacy between client and care provider is in keeping with the best practice for the client’s health.

15 The Needs of a Dying Person

A dying person may need increased care assistance in each of these areas and with their also in their ADLS.

• May need 24 / 7 care
• Decreased mobility
• Toileting assistance (Wetting)
• Turning due to bed sores
• Pain management
• Increased fear and worries

The stages of mourning and grief are universal and are experienced by people from all walks of life.  Mourning occurs in response to an individual’s own terminal illness, the loss of a close relationship or the death of a valued being, human or animal.

The five stages of grief as defined by Elisabeth Kubler-Ross (http://psychcentral.com)

Denial and isolation.

The first reaction to learning of a terminal illness or death of a cherished loved one is to deny the reality of the situation.  It is a normal reaction to rationalise over whelming emotions.  It is a defence mechanism that buffers the immediate shock.  We block out the world and hide the facts.  This is a temporary response that carries us through the first wave of pain.

Anger

As the masking effects of denial and isolation begin to wear off reality and it pain re-emerge.  We are not ready so the intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger.  The anger may be aimed at inanimate objects, complete strangers, friends or family.  The anger may be directed at our dying or deceased loved one.  Rationally we know the person is not to blame.  Emotionally however we may resent the person for causing pain or leaving us.  We feel guilty for being angry and this makes us angrier.

Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control.

• If only we had sought medical attention sooner.
• IF only we got a second opinion from another doctor
• If only we had tried to be a better person towards him

Secretly we may make a deal with God or our higher power in an attempt to postpone the inevitable.  This is another type of defence to protect us from the painful reality.  This often takes the form of prayer.

Depression

Two types of depression are associated with mourning.  The first one is a reaction to practical implications relating to the loss, sadness and regret predominate with this type of depression.  We worry about the cost and burial, we worry that in our grief we have spent less time with others that depend on us.  This phase may be eased by simple clarification and reassurance.  We may need a bit of helpful cooperation and a few kind words.

The second type of depression is more subtle and in a sense perhaps more private.  It is our quite preparation to separate and to bid our loved one farewell.  Sometimes all we need is a hug.

Acceptance

Reaching this stage of mourning is a gift not afforded to everyone.  Death may be sudden and unexpected or we may never see beyond our anger or denial.  It is not necessarily a matter of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace.  This phase is marked my withdrawal and calm.  This is not a period of happiness and it must be distinguished from depression.

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Loved ones that are terminally ill or aging appear to go through a final period of withdrawal this is by no means a suggestion that they are aware of their own impending death only that physical decline may be sufficient to produce a similar response.  Their behaviour implies that it is natural to reach a stage at which social interaction is limited.  The dignity and grace shown by our dying loved ones may well be their last gift to us.

Coping with loss is ultimately a deeply personal and singular experience – nobody can help us go through it more easily or understand all the emotions that you’re going through, but others can be there for you and help comfort you through this process.  The best thing you can do is to allow yourself to feel the grief as it comes over you.  Resisting it will only prolong the natural process of healing.

Palliative Care

It is very important to have trained staff as they would be able to reassure the family of the dying person that they have everything under control and when the time comes they will respect the persons wishes and carry them out as he or she wished and do so with dignity and show empathy to the family who are left behind grieving.

When a person is dying you need to know

• What religion they are if any
• Would they like to be buried or cremated
• Would they like and open or closed coffin
• Is there any particular person they would not like at the funeral
• Would they like any particular songs played
• Would they like any special readings
• Would they like any particular family member to read or say a few words in general
• Do they have a specific dress code
• Have they made a will
• Did they leave money aside to pay for the funeral and if yes where is it
• Where would they like to be laid to rest

16. Personal Recommendation

The best way forward for our healthcare services is to open up new healthcare facilities in all the different areas but especially the areas that are in short supply and employ more nurses and carers as we don’t have enough staff to give our elderly and sick the one to one care and attention they need.

17. Personal Reflection

From attending the classes I have picked up some new tips.  It has been such a long time since I have done an assignment.  Working full time and attending college two nights a week I have found it very challenging and found it difficult to find the time to study, research and put it all together.  I enjoy doing the assignment as I found once I got started it became easier and even found that when I was not working on the assignment I was thinking about it and the different ways to approach it.  It is a good refresher course as some things done in the past may have slipped my mind.

References

• http://www.alzheimers.net/2013-11-05/carey-mulligan-dementia-quote/ – accessed 29/09/2015
• http://www.alzheimers.org.uk/Facts_about_dementia/What_is_dementia/ accessed 29/09/2015
• http://www.who.int/gho/mortality_burden_disease/life_tables/en/ – accessed 02/10/2015
• http://apps.who.int/gho/data/node.main.688 – accessed 02/10/2015
• http://www.ageaction.ie/objectives-activities – accessed 06/10/2015
• http://alone.ie/about-us/ – 06/10/2015
• http://fitforlife.ie/ – 06/10/2015
• http://www.citizensinformation.ie/en/social_welfare/social_welfare_payments/older_and_retired_people/state_pension_contributory.html – 06/10/2015
• http://www.huffingtonpost.com/2014/02/25/what-other-cultures-can-teach_n_4834228.html – 09/10/2015
• http://www.seniorhomes.com/p/impacts-of-aging/ accessed – 09/10/2015
• http://www.agingresearch.org/newsletters/view/203 – accessed09/10/2015
• http://www.hiqa.ie/about-us – accessed 13/10/2015
• http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp accessed 13/10/2015
• http://www.passportforleisure.ie/  – 09/10/2015
• http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/ – 16/10/2015
• Class Notes