It is complicated for an older person to deal with the loss of a loved one. According to experts, it is impossible to establish a time frame for treating such mental trauma. Most older people are unable to do anything after the death of a loved one. For some time, he may experience a lack of appetite, weight loss, insomnia, fatigue, distraction, obsessive thoughts (Domingue et al., 2021). Sadness leads to unpleasant emotions that negatively affect the health of the ward.
Questions about death begin to arise in the head of an older adult spontaneously. However, despite the loss, such people often find the strength to live on: they make friends, attend events, and engage in hobbies. This paper looks at the case of 96-year-old Annie, who was admitted to a local care facility for health reasons. An elderly care worker needs to look at the case to understand the client’s needs and improve her care by addressing complex issues such as near-death and old age.
Annie is 96 years old and was recently admitted to an elderly care facility after falling and unable to stand up. This incident caused this forced action to move Annie out of her home, where she used to cope with all her needs alone. The state of the client’s health as a whole is assessed as already unsatisfactory, and due to age, that particular problem that led to the fall can become fatal. Moreover, this problem can only be identified in such institutions, so Annie’s stay in this institution is essential. Joint arthritis and bone fragility that has developed over the past two years have likely contributed to the fall. Her activity helped her maintain a high level of health, but age takes its toll. Annie’s hearing deteriorated, but she did not use a hearing aid. She preferred live communication even to a loud phone with big buttons.
Annie’s family history is key to this story. First, the client experienced the loss of her husband thirty years ago and has dealt with the dire loss ever since. Annie studied newspaper reading, gardening and was interested in Gaelic football and religion. The client called up with neighbors, maintained her appearance, and often dressed up like a needle. Annie also attended Mass and observed religious traditions for health reasons.
The live communication with the neighbors saved her after the fall: one of the neighbors found her. Second, Annie kept in close touch with her grandchildren, who gave her much attention, played cards with her, and helped around the house. She could watch them grow up, was always happy with their help, and supported moving around in the care facility. However, the unspoken thought that Annie might not be able to return home already appeared in every family member.
Needs Being Met
Despite the loss of a loved one 30 years ago, Annie found the strength to live on: not just exist, but with interest to meet each new day. The client retained a lot of needs: social and cognitive in the first place. She enjoyed a life filled with gardening, religious activities, and socializing with her grandchildren and neighbors. Annie has successfully adapted to the lonely life by staying productive, maintaining a sense of order, cognitive abilities, and social needs. However, as soon as her health deteriorated, it became clear from Annie’s actions that she was not ready for her death. She denied using a hearing aid and a telephone, disagreeing with the fact that she was aging. Nevertheless, the client played by the new rules of life, content with communicating with her grandchildren and her way of life.
Physical needs were realized and maintained through the satisfaction of social and cognitive needs. According to the theory of aging and cognition, the action of protective life experiences and biological life processes associated with enrichment of the brain, cognitive activity can support physical activity (Bengtson & Settersten, 2017). Annie attended masses, maintained a well-groomed appearance and hygiene, and often moved through gardening. However, this category of needs came to the fore when her health deteriorated, and Annie could not stand up after the fall. The client was no longer able to maintain physical strength at the age of 96, but with humility, she accepted the need to sacrifice her lifestyle for the sake of moving to a particular institution for the care of the elderly.
Annie learned to accept the care of her family and permitted them to move to a care facility. She also understood that she now needed more help than she could give in return. The client’s sense of realism was reasonably high, except for the understanding of the “not eternity” of health. As a result, it can be concluded that the client’s development was at the right stage in his life. Kubler-Ross has identified five stages of the acceptance of the dying process in her work (Corr, 2020).
Judging by this case, Annie was just faced with the question of possible death, which is why she is now only experiencing the first stage of denial. This fact also manifested itself concerning their health – in the denial of using a particular telephone or hearing aid. Likely, Annie did not allow the possible proximity of her death due to an active and emotionally calm lifestyle.
As a result, Annie still has to go through four stages before accepting her death and is ready for it on a deep psychological level. However, in this institution, the appropriate specialists can help overcome several stages up to the very last. According to the theory of stability and change in emotional experience in adulthood and old age, positive emotional experience is a key aspect of adapting to any age-related changes in the social context (Bengtson & Settersten, 2017).
Annie won the kind support of close relatives, which partly immediately brought her to the stage of reactive depression, bypassing anger and bargaining. Moreover, such support is most effective in the case of reactive depression rather than preparatory depression (Corr, 2020). Due to her age, her wisdom, and the relevance of such issues in religion, there is a high probability that Annie will die in her new life rather quickly.
Needs Not Being Met
The basic needs of older people have several aspects. First of all, the need for belonging to family and society is critical in Annie’s case. The client’s need for respect was also realized within the framework of social processes that she supported throughout her old age. Finding safety and protection became less critical to Annie, as she coped with her life on her own. She realized self-actualization and the need for life through participation in religion and the life of society through reading newspapers and communicating with neighbors. In fact, Annie met all her needs as an older person until she entered this institution.
However, health needs have been violated at the biological level and, most likely, will not be replenished to the previous level. The point is that, according to the theory of stem cell aging, cell-inherent stem cell changes are observed with age, as well as non-cellular autonomic changes, which include the loss of factors in young blood that increase the harmful factors of blood aging (Bengtson & Settersten, 2017). As a result, it is more difficult for the body to recover from year to year.
Cognitive and social needs were most important to Annie, as identified above. Meeting these needs in care places does not seem to be problematic, but it is worth considering the specific needs of the individual. Annie is used to communicating with her grandchildren, who will not visit her so often in this institution, and spending time in a comfortable environment, cleaning the house, or playing cards. In addition, she kept in touch with neighbors, whom she had also known for a long time and had appropriate topics for conversation.
Often these topics of conversation were probably a discussion of their own life, hobbies, gardening, religious topics with those who could support them. The community in a care facility for the elderly, on the one hand, can bring new communication experiences, new topics of conversation. On the other hand, Annie was attached precisely to her life and environment, so the new experience may not bring appropriate social and cognitive needs.
Turning to theories, Maslow’s pyramid model may reflect this problem. If, before moving to the institution, Annie could realize herself right up to the highest step of the pyramid, then with the deterioration of her health, the basis of the physiological needs for movement and safety in the new environment was shaken (Wang, Lin & Chen, 2019). Consequently, the realization of higher needs is threatened, and motivation decreases, according to this model, if a person has to focus more often on the lower steps (Wang, Lin & Chen, 2019). Therefore, caring for Annie must be extremely delicate, which must at least partially compensate for the social and cognitive needs of the client.
The basic communication skills, in this case, will include the ability to listen while maintaining a sincere smile, eye contact, and not being distracted by anything else. Since the client requires delicate care, mindfulness will be required, which is also one of the most effective interpersonal skills. The social care context is about maximizing the employee’s impact, particularly in this situation, since the social needs matter most to Annie.
Demonstrating an attentive and compassionate attitude may include delivering newspapers that Annie usually read and the opportunity to discuss the news from them with her. Creating an environment for religious conversations or small events will also be pleasant for the client, especially a respectful and sincere conversation on this topic. Perhaps Annie will face new opinions and points of view in the new community and will be able to continue her cognitive activities in this area.
It is crucial to give Annie time to embrace the new environment and show empathy that fosters compassion and a down-to-earth approach. Empathy is not only the most critical skill of effective communication but also the ability to allow the interlocutor to speak out on topics that are difficult for him. As discussed above, accepting death is tricky and needs to be presented to Annie most gently not to trigger a stage of anger or bargaining (Odgers et al., 2018).
First, a mild and respectful discussion of topics such as religion and family, with the proper treatment, can be perceived positively by the client. Annie will be able to share her situation with a new person, tell and once again remember about her own family, without leaving the problem of lack of communication without attention. Secondly, the practicality of the approach will be to try to influence Emmy to use the phone more often to hear the voices of her relatives, as well as neighbors, who will remind her of her own life.
Family involvement will have a positive impact, so the strategy includes developing the client to communicate with the family at least by phone. First, the family will be able to keep abreast of Annie’s condition firsthand. Second, Annie will adjust to what she previously denied: hearing aids and a phone are just the first steps. Acceptance is the essential trait of understanding that needs to be achieved with social and health workers for a given client.
Government assistance would be relevant if Annie did not have such serious health problems. In this case, the authorities can provide more opportunities for involving older people in processes that are important for society so that they do not feel like a burden. Many of the psychological problems of older adults expire due to problems with recognition, lack of communication, and lack of attention. Consequently, engaging older people in socially helpful and feasible activities can provide new opportunities and reasons to maintain an interest in life (Costa & Esteves, 2020). Given Annie’s knowledge of horticulture, governments can fund these institutions to create flower plantations in the area that older people can tend to, ennobling the area.
Voluntary and community agencies can help support Annie’s cognitive needs. Volunteers can bring newspapers for a client, provide her with the latest news from her area. In addition, religiously-minded agencies can help support religious events in such facilities so that older people can continue to observe traditions that are important to them. Finally, in total, such an integrated approach will certainly not be able to replace Annie’s home life entirely, but it can create the most comfortable conditions for maintaining many of its essential aspects.
Conclusion & Recommendations
Annie’s client discussed in this paper found herself in a difficult situation where she had to leave her own home due to her health condition. The most critical needs for Annie were cognitive and social, and therefore, the main recommendations for care were to meet these needs. Taking her health and taking steps to maintain it can help maintain a bond with her family. Government and volunteer organizations can provide an opportunity to make up for some of Annie’s lack of home life and her gardening and religious hobbies. The qualifications of the employees should create the most comfortable conditions for a 96-year-old client with extensive life experience and a love of life. Research on communication skills offers great opportunities for improving client care, and in part, there is an opportunity to meet her social and cognitive needs.
Practicing communication about topics that are difficult for clients can increase self-confidence. Increasingly, getting people out of their comfort zone for delicate and peaceful communication, one can gain experience by helping those in need more often and more confidently. Prejudice and anxiety that the conversation may hurt the client will remain in the past since otherwise, a person can go through many more stages before accepting the problem, including negative emotions such as anger, denial, bargaining, depression. Breaking the silence stereotype can improve treatment outcomes – Annie’s case in this situation has been highly revealing.
Bengtson, V. L., & Settersten Jr, R. (Eds.). (2017). Handbook of theories of aging. New York: Springer Publishing Company.
Corr, C. A. (2020) “Elisabeth Kübler-Ross and the “five stages” model in a sampling of recent American textbooks”, OMEGA-Journal of Death and Dying, 82(2), pp. 294-322.
Costa, C. A., & Esteves, T. A. (2020) “The social inclusion of the elderly: the effect of social marketing on raising awareness among the Portuguese population to campaigns to support the elderly”, International Journal of Social Entrepreneurship and Innovation, 5(4), pp. 295-316.
Domingue, B. W., et al. (2021) “Short-term mental health sequelae of bereavement predict long-term physical health decline in older adults: US Health and Retirement Study Analysis”, The Journals of Gerontology: Series B, 76(6), pp. 1231-1240.
Odgers, J., et al. (2018) “No one said he was dying: families’ experiences of end-of-life care in an acute setting”, Australian Journal of Advanced Nursing, 35(3), pp. 21-31.
Wang, K. H. C., Lin, J. H., & Chen, H. G. (2019) “Explore the needs of the elderly with social awareness”, Educational Gerontology, 45(5), pp. 310-323.