Entering the late stages of life is far more sobering than you might have realized. Late life is usually a time marked by transitions (eg, retirement, relocation) and a coping with the necessary adjustments to profound loss.
Retirement is often the first flag that you are entering a major transition faced only by the elderly. It has long-term effects on both physical and mental health and will differ from person to person. These transition outcomes have myriad of effects. Much of the effect is dependent on the individual’s attitude toward and reason for retiring.
At least one third of retirees have difficulty adjusting to certain aspects of retirement. It begins with a reduced income, an altered social role and entitlements. Some people have chosen to retire, having looked forward to quitting work - while others are forced to retire (because of health problems or job loss).
The emotional adjustments of losing work, income and health can be devastating to someone who has spent the entirety of their lives providing for others while working to make an appropriate preparation for retirement. It is at this juncture that counseling for retirees and families who experience difficulties may help.
Relocation is also a significant life trauma. Most of us plan to live in the home we build with our families - and yet more often than not, moving has proven to be common and may even occur several times during old age. Our children pushing or a fear of burdening them usually ends up the deciding factor for moving into retirement housing, hopefully with desirable amenities, and into smaller quarters to reduce the burden of upkeep.
Not becoming a burden to those we love - is a major factor for elders viewing the natural slow-down of aging as a problem - or a burden on the greater culture. This message permeates western culture - and is unhelpful to the many elders who still have much to contribute.
Many elders are moved to the homes of siblings or adult children, or into residential care facilities once their ability to care for themselves has been compromised by the aging process. Physical and mental status are significant predictors of relocation adjustment, as is thoughtful or adequate preparation.
People who respond poorly to relocation are most in danger of being found living alone, socially isolated, poor and depressed. Men respond less well to change, than women. Women and daughters tend to be the ones who care for our aging and elderly. Whereas women have been largely culturally scripted into lower paying roles and jobs - they are often relied on to give up careers in order to become an unpaid caregiver to an aging parent.
When an elder perceives a lack of control over their own lives - as when children start dictating to the parent what their options are - and the less predictable the new environment seems - the greater the stress of relocation. Elders need to become acquainted with the new setting well in advance, especially for the cognitively impaired. Stress almost always produces a cognitive decline that the elder rarely recovers from.
Here is where most of us fall down: a move away from familiar surroundings may exacerbate functional dependence and even cause disruptive behavior. Elders decline when change occurs. Because of this - financial, social, and other complications, will cause some older adults to feel they must remain in problematic homes or neighborhoods, despite their desire to relocate.
Bereavement also affects many aspects of an elderly person’s life. For example, social interaction and companionship decrease and then the shock of a depleted social status further marks the change. The death of a spouse affects men and women very differently. In the two years after the death of a wife, the mortality rate in men tends to increase, especially if the wife’s death was unexpected and as is with many men - his reliance on her for care was significant.
For women who lose a husband, the data is less clear. Generally, it has not indicated that there is an increased mortality rate. The freedom of a lowered level of responsibility and caretaking can feel like a significant freedom. With normal bereavement, some sleep disturbance and anxiety are normal. The effect of this usually resolves within months without drug treatment. Pathological bereavement, on the other hand, needs to be tracked and monitored to avoid inevitable tragedy such as suicide.
Elders can fall into unhealthy depression due to the loss of control - and significantly perceivable differences in how they are treated socially, within family systems and by the greater culture. Lack of meaning and feelings of worthlessness can become overwhelming for elders in western cultures.
Caregivers and health care practitioners should look for symptoms and be aware that bereaved patients are especially at high risk of suicide as well as a significantly declining health status. Appropriate screening for depression with suicidal ideations is essential. Counseling and supportive services (ie, support groups for widows) will often facilitate a difficult transition. Short-term use of anxiolytic drugs also helps patients with excessive anxiety.
Self-neglect implies not caring for self. This includes;
•ignoring personal hygiene
•not paying bills
•not maintaining the integrity or cleanliness of the home
•not obtaining or preparing food (leading to malnutrition)
•not seeking medical care for potentially serious symptoms
•not filling prescriptions or taking drugs and skipping follow-up visits
Risk factors for self-neglect include;
•Disorders that impair memory or judgment (ie, dementia)
•The presence of multiple chronic disorders
Differentiating between self-neglect and someone who is just choosing to live in a way that others find undesirable can be challenging. Laws determining legal adulthood and independence status make it so that social workers are often in the best position to make this determination.
Adult Protective Services or the state unit on aging (whose numbers are available through the Eldercare Locator at 800-677-1116) can help. This is done by coordinating in-home safety assessments as well as by helping the elderly obtain counseling services, emergency response systems, referrals to additional support services, and, if necessary, temporary hospitalization - but remember - hospitalization is a major change and stress factor.
Consider in-home nursing programs before assuming that skilled nursing or hospitalization are truly the best approach for a stressed elder depending on you to make a life-altering decision.
The information in this article was contributed by Daniel B. Kaplan, PhD, LICSW, Assistant Professor, Adelphi University School of Social Work ; Barbara J. Berkman, DSW, PhD, Helen Rehr/Ruth Fitzdale Professor Emerita, Columbia University School of Social Work
Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website, www.homeinstead.com/sonoma to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’s love to hear from you at 586-1516 anytime