Geriatric Psychiatry

Support Strategies, Psychological Intervention and Social Needs

 

Overview

Now a days more people are living longer lives as scientists and doctors discover new ways to cure illnesses. Egypt's population of people aged 65 and up was 5.3 % in 2020. Egypt's population aged 65 and up increased from 4.2 % in 1971 to 5.3 % in 2020, with an average annual growth rate of 0.48 %. This age group now accounts for roughly 40% of the world's elderly population. 

At any given time, less than 5% of the elderly population is institutionalized. However, 1 out of 4 elderly people will spend some of their final years in a long-term care facility.

carer

According to WHO Treatment Strategies of Communities and Medical Living which includes: 
Training of health professionals in the care of the elderly 

  • Preventing and treating chronic diseases 
  • Preventing and treating substance use disorders
  • Develop sustainable long-care policies.
  • Develop services and favorable conditions for the elderly.

Valid assessment tools:

  • UCLA Loneliness Scale (UCLA, LS),
  • Geriatric Depression Scale Short Form (GDS-SF)
  • Arabic version of short WHO Quality of Life Instrument Older Adults Module (WHOQOL-OLD-TR) 
  • Weschler memory 
  • Trail making A & B 
  • MINI mental examination

Through our national online plate-form , we provide strategies to help older people to cope with these changes and adjustments in form of online structured assessments, psychiatric and medical consultations and psychotherapy sessions according to their needs as the followings: 

Strategy 1: Developmental Tasks of the Older Adult (integrity Vs despair):

  • Staff members will work in assisting persons to find satisfaction and a sense of well-being in later life. 
  • Staff need educated caregivers to recognize their own attitudes toward aging have a great impact on those they care for their beloved elder.
  • Psychiatrist and psychologist should be trained dealing with depressed persons who see old age as a progressive decline leading to death may view old age as a “depressing, useless” period leading to helplessness. 
  • Staff help older person to understand that aging is a process in life development which is an opportunity to gain new satisfaction and understanding of themselves and others. This provides joy and a sense of purpose. 

The work of this stage is to accept one’s life as meaningful through supportive psychotherapy sessions which include the following topics:

  • Older person who reaches ego integrity looks back with satisfaction, and has an acceptance of life and death. 
  • Provide tasks for the older person to develop satisfaction from himself or herself as a person, rather than from an occupational role or as a parent. 
  • Provide tasks to adjust to the physical declines of aging, rather than becoming absorbed in health problems or physical limitations imposed by aging. 
  • Provide tasks to have satisfaction when reflecting on one’s past life and accomplishments, rather than dwelling on the prospect of death.

Strategies 2: Psychoeducation sessions for the patient about facing challenges and adjustments in response to life experiences such as:

  • Coping with losses and change
  • Establishing meaningful roles
  • Exercising independence and control
  • Finding meaning in life. 
  • Psychoeducation about how elder can find satisfaction in their-selves and their life when they successfully meet these challenges. 

Strategies 3: Therapy Session Help in Adjustments Occur with Aging (Growing old is not easy)

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  • Family changes: 

    Their role within the family has changed multiple times in their lifetime. In old age they are cared for by their children versus the other way around. 

  • Retirement

    This can be a difficult time because our society places so much emphasis on what a person does. 
    Often one’s work gives social position and influence, a source of social contacts, and provides satisfaction from productivity. 

  • Awareness of one’s own mortality: 
    • Not only do spouses die but friends do also. 
    • Older adults may also experience health decline. 
    • Encourage them to tell stories of life events. 
    • They often are faced with multiple losses at one time.
  • Widowhood: 

    This affects more women than men, as women tend to live longer.

    Adjusting to the loss of someone you have shared life with is often difficult. 

  • Declining physical reserves: 

    As all of us age, the wear and tear on our bodies causes fatigue and changes to occur. 

    Our responses become slower, and our appearance changes.

  • Chronic illness affects body systems: 

    The fear of loss of independence is great. Being independent is a strong value for most.

  • Changes in income after retirement: 

    Social security income for many is the main source of income. 

  • Shrinking social world for some: 

    Loneliness commonly occurs as a spouse or friend becomes ill or dies. 5 senses such as hearing and seeing, diminish, making communication difficult.

Strategies 4: help Caregivers Can Use to Bring Joy to the Older Adults through the following actions:

“Using humor to lighten the moment” 
“Remember, humor must be appropriate” 

humour
  • Learning care giver to know information about older person’s family and significant others, work, hobbies, achievements, and life- experiences.
  • Listening to your loved elder sincerely with interest.
  • Building on lifelong interests and offering new activities/experiences for pleasure.
  • Services via audio or video equipment are another alternative.
  • Older person’s pleasure is expanded by visiting with their family member or healthcare providers, attending activities of their choice, seeing children, and going to religious services in the organization. 
  • Encouraging memories of the past and encouraging families to reminisce.
  • Recognizing the unique gift of life each person has gained through his or her life experience.

Strategies 5: Help older person to adjustment to changes that occur in their 5 senses. 

How Decline in the 5 Senses Impacts Older Adults’ Ability to communicate 
“Facing special needs” 

As people get older, their senses decline. The five senses that we often think about are sight, hearing, taste, smell, and touch. Declining hearing and sight cause great problems for the older adult.

How many of these suggestions have you already tried? 

When you’re caring with older who have sight or hearing problems, keep the following tips in mind to help them lead fuller lives: 

  • Some medications and illnesses should be revised every fixed follow up can make the senses weaker. 
  • Health care provider should remind others to speak loudly enough to be heard. 

 

Sight
sight

Many changes happen to the eye with aging. The iris, hardens, the lens and ability to focus are not accurate. 

Because of these changes, even he or she who wear contact lenses or thick glasses may not see very well. 

So how you can help? 

  • Better lighting without glare, limited use of colors such as blues, greens, and violets, and greater awareness of heights of curbs and steps. 
  • Take care and give help for older persons may be unstable when first getting up, or may have problems with gait or balance due to vision changes. 
  • Identifying yourself each time you enter his or her room, because he or she may not be able to clearly see you.
  • Providing extra-large type on calendars or books.
  • Writing things down in large, clear lettering using a dark-colored pen on white or light-yellow paper.
  • Making sure that he / she wear their glasses when they are awake.
  • Telling your older when you move an object from a familiar place.
  • Describing the location of food on the plate as if it were a clock when   serving food.
  • Using color contrasts to make images stand out.
  • Identify curbs or edges of steps with contrasting floor color.
Hearing
hear

Hearing loss is often progressive with aging. 
High frequency sounds are the first to be lost. 
Some elders wear hearing aids. 
Some are totally deaf. 

These changes require the caregiver to communicate in different ways: 

  • If he or she can't hear at all, you'll need to figure out how to communicate what they want or need.
  • This can be done by pointing to items or by writing them down.
  • It takes patience to learn to work with each individual.
  • Hearing-impaired people may not be able to hear you enter their rooms, causing them to be startled.
  • They might have a harder time hearing conversation. 
  • Close the door and turn down the TV or radio while you're talking to them to reduce background noise. 
  • Look them in the eyes, lower your voice, and speak loudly and clearly but not yell.
  • If you have to repeat yourself, try not to get frustrated.
  • Use short, concise sentences when speaking. 
  • Only give one instruction at a time. 
  • Don't change the subject. 
  • You may need to question him/her at times to ensure that he/she understands what you're saying.
  • Make sure your elderly relative wears his or her hearing aids.
  • Check that the aids are in good working order as well. 
  • Learn how to increase and decrease the volume, as well as how to change the batteries.
  • Pay attention to your facial expressions and match them to your message.

 

Taste, Smell and Touch
taste

Taste and smell are diminished due to a decreased number of taste buds and a decrease in the number of cells for smell. 

  • This makes it even more important to allow our older person to eat foods they enjoy (and can taste) and whenever they wish.
  • Safety with food temperatures, food containers such as coffee cups, and warming appliances is crucial. 
  • Touch is diminished, it does not mean the resident has a reduced need for hugs and expressions of affection.

Meal Time and the Senses

“Meal time can be complicated if residents have problems with their five senses” 
If she/he appears perplexed about what's on her/his plate, find a polite way to assist her/him in figuring it out. 

Strategies 6: Tips for Communicating with elder:

There are ways to communicate and interact with elderly especially who has medical illness in order to maintain their dignity, which should include: 

1. Don't speak about them as if they weren't present. 
2. Talk to him or her as if he or she were an adult. 
“Even if their behavior is occasionally childish, they are still adults who will be offended if you speak to them in this manner.” 

3. If at all possible, sit next to them rather than across the table. 
“It's easy to feel threatened or unfriendly when you're seated across from someone.” 

4. Speak clearly and loudly so he or she can understand you.
“Don't yell, and watch your facial expressions.” 

5. Allow time for your loved elder to respond to questions. 
“Keep in mind that some people are easily confused, and some people take longer to complete tasks than others.” 

Strategies 7: Movement deterioration in the elderly

move

Mobility is the essence of the ability to perform the various functions necessary for life and survival. In order to move, you need common sense, motor skills, physical and cognitive competence, and health. 

Because when we get sick, the disease puts us to bed once and impairs our mobility for another time, and unless recovery and rehabilitation are done, we may not return to our usual motor competence. 

Older people are more likely to lose most of this movement after an illness or accident that forces them to stay for a while, even if it's a very short period... staying in bed for an entire week at a time so it should be: 

  • These should be the subject of ongoing early detection and rehabilitation programs.
  • This requires a multidisciplinary team includes: neurologist, physiotherapy, internal medicine, geriatric, nursing care, psychiatrist, psychologist, social worker and rheumatologist etc...

Are all elderly people at the same level of exposure to these serious complications? 

  • The most vulnerable elderly is those with low functional reserve.
  • Those who don't move often, always and enough.
  • Those who have lost all functional independence.
  • Some suffer from imbalances.
  • muscle weakness.
  • loss of skills.

Who are the most people at risk of loss of movement? 

O Rheumatic Patients 
O Heart Patients 
O Women 
O Chronic Neurodegenerative Diseases 

Strategy 8: Help Older Person to Overcome Feeling of Isolation or Solitude (Loneliness):

A balance of social time and time alone is important to the older adult just as in other stages of life. The amount of time a person wants to spend socializing or alone varies based on one’s personality or/ and sense impairment severity especially vision and hearing. 

Strategy 9: Tips In the face of retirement

Plan the role you will play in the new life, and decide for yourself that you can offer. There are many ways to take on new roles and practice giving, such as:
Volunteer 
Start a new business 
Keep working 
Take care of young children 
Familiarity with animals 
Hobbies 
Religious spiritual activity. 
It requires you to confront actual depression 

Strategy 10: Poor Self-Esteem in elder with neuro-cognitive disorders:

  • Chronic conditions like dementia and Parkinson’s can lead to fear and grief and negatively affect self-esteem.
  • Encouraging your loved one to take on new tasks and work on past goals could boost his or her confidence and quality of life. 
  • Your support could also reassure your loved one when it comes to changing treatments or accepting help from family members or professional caregivers

Strategy 11: Financial Anxiety and Retirement 

  • Older adults can experience a variety of psychosocial problems when aging, including anxiety caused by financial strain. Worries about finances could damage your loved one’s mental and emotional wellbeing.
  • To stave off anxiety and enhance your loved one’s quality of life, look for financial resources he or she might qualify for, such as free meal services, discounted prescriptions, reduced utility expenses, and transportation programs.

Home Care Assistance is here to help. Call us today at -------to learn about our high-quality in-home care services.?

Strategy 12: Supporting You as a Caregiver

You may not think of yourself as a caregiver, especially if the person with dementia is a partner, parent or close friend. But you and the person with dementia will need support to deal with symptoms and changes in behavior. 


If you care about someone, you can take an assessment to see what might help make your life easier.
This is called a caregiver assessment. 

  • Get a carer's opinion
  • If you are caring for someone, you can get an assessment to see what might help. 
  • Someone to care for you while you take a break 
  • Training in safe lifting 
  • Help with housework and shopping
  • Putting you in touch with local support groups
  • Anyone over 18 can request a free caregiver assessment.
  • Assisting with daily tasks

This can also help their self-esteem.

Many people with early dementia can enjoy life as they did before their diagnosis. As symptoms worsen, the person may become anxious, stressed, and fearful of losing things, losing conversations, or losing focus. It is critical to help the person keep skills, abilities, and a social life. 

Eating and drinking help 

  • Eating a healthy, balanced diet is important for everyone's health.
  • Dementia patients may not drink enough because they are not thirsty.
  • This puts them at risk for UTIs, constipation, and headaches. These can worsen dementia symptoms by increasing confusion.
  • If your elder refusing or spitting out food>>> asking for strange food combinations?

These behaviors can be caused by confusion, sore gums or ill-fitting dentures, or difficulty swallowing.? 

Incontinence and toileting help 

  • Toileting issues are common among dementia patients.
  • Urinary and bowel incontinence are both difficult to manage. 
  • It can be upsetting for both you and the person you love.
  • Urinary tract infections (UTIs) can cause problems, as can constipation, which increases bladder pressure.
  • Dementia patients may simply forget they need to go or where to go.

Washing and bathing help 

  • Some dementia patients may need assistance with personal hygiene, such as washing.
  • They may be concerned about: too-deep baths, noisy overhead showers, falling, or being embarrassed to undress in front of others, including their partner.

Sleep issues 

  • Dementia can disrupt sleep patterns and disrupt a person's "body clock."
  • Dementia patients may wake up in the middle of the night, disoriented. 
  • They may try to dress unaware that it is night.

Caring for dementia patients: Self-care 

  • Being a caregiver for a loved one with dementia is difficult and stressful.
  • Remember that your needs as a caregiver are as vital as the person you are caring for is.

If you are stressed out, 

  • Caregivers often struggle to express their stress. 
  • Do not feel guilty if you are struggling.
  • There is help and support.
  • You may benefit from online counselling or other talking therapy.
  • Talk to your doctor or, if you prefer, go directly to a psychologist.

dementia friendly home

 

retire