Holistic Family Health

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Holistic Family Health

• Jenny Wilson
• Wilsonj1_at_hope.ac.uk

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Normal Abnormal Changes in Ageing

• It is old age, rather than death, that is to be
  contrasted with life. Old age is life's parody.
  
• Simone de Beauvoir

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Are we living longer?

• Life expectancy has continued to rise over the
  years.
• Average expectancy if born in 1901 (47.5yrs)
• If born in 2002, (77.5)
• Slightly lower for males and higher for females
• implications?

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Does a longer life expectancy mean a healthy
longer life?

• Healthy life expectancy HLE expected years of
  life in good or fairly good health.
• Unfortunately, extra years lived have not
  necessarily been lived in good health.
• People can expect to live approximately 9 years
  in poor health.

And in the end, it's not the years in your life
that count. It's the life in your years. Abraham
Lincoln
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Consequences of ageing
Think of an elderly person. In what ways is that
person different from someone who is younger?
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What changes occur as we Age?

• Physical changes
• Psychological changes
• Social changes
• How do these changes impact on the individual and
  the family?
• How can we age healthily?

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What do we mean by the term Old?

• Ageing fundamental part of human life. We age
  from conception to death.
• Inevitable process affects biological, social and
  psychological aspects of the individual.
• Despite the ubiquity of the term, its definition
  is fraught with ambiguity. few researchers
  using the term aging define what they mean by
  it. (Birren Cunningham, 1985 p.5)
• In society term old applied at many ages,
  depending on job, diversity, legal requirements
  and personal attitudes.
• In scientific research tend to site 60 years as
  old but this is arbitrary.
• The important issue about ageing is not the
  age, but how we accept and prepare for these
  life changes.

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Physical changes The Senses

• Sensory changes do not occur at the same age for
  each person, nor do all changes occur at the same
  time and at the same degree.
• Studies have shown changes accelerating at these
  approximate age ranges
• Visionmid 50s
• Hearingmid 40s
• Touchmid 50s
• Tastemid 60s
• Smellmid 70s

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Vision

• Eye shape changes
• Lens and cornea less transparent
• Field of vision changes
• loss of clarity, focus, problems seeing in low
  light levels, problems with colour intensities
  judging distances

How might changes in vision affect everyday
living?
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TOUCH

• The sense of touch also includes awareness of
  vibrations and pain.
• The skin, muscles, tendons, joints, and internal
  organs have receptors that detect touch,
  temperature, or pain.
• Touch decreases as we age. Skin loses
  sensitivity.
• Touch is beneficial to wellbeing.

How might loss of touch hamper daily life? How
would getting a pet help?
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Taste Smell

• Taste and smell closely interact.
• Smell begins at nerve receptors high in nose
  membranes.
• We have about 9000 tastebuds.
• Tastebuds decrease in number around about age 60
  size (atrophy)
• Loss of saliva
• Loss of smell conflicting evidence.
  (environmental factors rather than age)

What the physical dangers of loss of smell
taste? What social problems might occur?
Wellbeing?
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Hearing

• Ear structures deteriorate.
• The eardrum often thickens and loses elasticity
• Decreased ability to hear high frequencies.
• Background noises from TV or radio difficult to
  filter out, problems with normal conversation

Consider how hearing loss affects social
interaction and psychological wellbeing
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Physiological Changes

• Aerobic capacity decreases 10 per decade.
• Pulmonary function decreases.
• Maximal cardiac output decreases.
• Muscular strength is reduced.
• Substantial loss of muscle mass.
• Movement time and reaction time decrease.
• Bone mass decreases.
• Body fat increases

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Psychological Changes

• Changes in Cognition
• Memory
• Language
• Reasoning Judgment problem solving
• Changes in Emotional state

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Cognition and Everyday life

• Cognitive processes are essential for successful
  independent living
• Age related decline in a number of cognitive
  processes
• What are the implications for everyday behaviour?
• How might failure in cognition impact upon family
  and social relationships?

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Dementia. How common is it?

• Demographics
• Dementia currently affects over 750,000 people in
  the UK
• 18,500 people with dementia are aged under 65
  years
• Dementia affects one person in 20 aged over 65
  years and one person in five over 80 years of age

Briefly consider the wider social consequences of
these figures. What impact this might have on
social services.
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Alzheimers Disease

• Single most common cause of dementia is
  Alzheimers disease
• Can occur from age of 45
• typically an age-associated disease,
• Prevalence up to the age of 65 years, only 1
  person in 1000 is affected.
• This figure increases sharply to 1 in 20 over
  the age of 65.
• 1 in 5 over the age of 80 years

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Stages of Alzheimers Disease

• Forgetfulness
• - misplacing objects
• Early confusion
• - performance declines
• Late confusion - confabulation, judgment
  declines, withdrawal

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Stages of Alzheimers disease

• Early dementia
• - forget familiar names, disorientated
• Middle dementia
• - forget childrens names. Most cognitive
  abilities decline
• Late dementia
• - lose verbal abilities
• Ability to care for self

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What it feels like to have Alzheimers

• 'To me, it's like knitting with a knotted ball of
  wool. Every now and again I come to a knot. I try
  to unravel it but can't, so I knit the knot in.
  As time goes by, there are more knots.' 

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Caring for someone with dementia

• In view of increasing life expectancy, and
  associated increased prevalence of dementia,
  consider the issues (physical, social
  emotional) a care giver must deal with
• Who will care? Family member? Spouse? Child?
• Demands on Time
• Space
• Finance
• Psychological Stress
• Physical stress
• 7. The decision to place a parent in residential
  care

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Why Care? What Motivates Carers?

• Psychological Bonding
• Blood is thicker than water. Our Fundamental
  psychological attachments involve close loving
  relationships between family members e.g.parent
  and child, husband and wife. From this we develop
  sense of self and duty.
• Societal Norms
• Moral, ethical religious norms influence and
  regulate relations between generations.
• Reciprocity
• Give and take frail elderly parents have given
  care and assistance to children in past.
  Expectation that care will be returned.

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Who Cares?

• Just over half of carers in the UK are spouses
• About one third of carers are children.
• The majority are women.
• A third of carers surveyed were aged between 51
  and 60.
• The average age of the person with Alzheimer's
  disease receiving care was 77.

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Cost of caring

• Carers save the government 34bn a year,
• More carers of Alzheimer's disease sufferers have
  to give up work in the UK than other countries.
• Unpaid carers deliver most of the care to people
  with dementia in the UK.
• Younger carers who give up work at risk of
  further financial disadvantage, as their time out
  of the labour force while caring, makes them less
  attractive to employers.

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Cost of caring

• Higher levels of stress and depression among
  carers.
• Half of carers now suffer from chronic fatigue.
• Almost one third report back problems

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Managing Guilt

• Feelings of Guilt are very common for carers
• Consider what factors might lead to guilt
  examples include
• Making mistakes
• Unpleasant thoughts/resentment
• Feeling of anger
• Dealing with conflicting demands
• What do/can we do as a society to reduce these
  problems?
• Respite care
• Counselling
• Financial support

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Thoughts from carers

• I have always felt that my responsibility to my
  parents was to ensure they were well cared for -
  but that it was not necessarily me who should
  undertake the practical aspects of caring. I have
  never agreed with the assumption that a single
  daughter should give up her career to look after
  aged parents. This may appear selfish but, in
  fact, I have my mother's best interests at heart.
  I would feel frustrated, irritated, trapped, lack
  patience and rapidly lose my sense of humour. I
  do not have any family with whom to share the
  caring as my brother and father have died ....
• My role is to be vigilant about ensuring the
  standard of my mother's care remains high and
  appropriate to her needs. I visit each week and
  we go for walks, visit the cathedral or listen to
  her favourite music. They all bring her a kind of
  peace and tranquility.
• When I leave I know she will be well cared for
  and safe.

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• Today I wept for my mother for the first time
  since she died six years ago. The catalyst for
  this surprising rush of grief was opening her
  sewing box - something I had not done since I
  brought it from her empty house and stuffed it at
  the back of a cupboard.
• ... She had this box for as long as I can
  remember, and opening it today took me back to
  the years before Alzheimer's disease claimed her
  life and mine, too.
• ... The practicalities of balancing life were so
  great that I couldn't give the emotional support
  and demonstrative love she craved. I was never
  cruel but, to protect my sanity, I became
  emotionally detached. She longed for comfort but
  I was on the edge myself and couldn't give it.
  This is my major regret.
• She died in her sleep on Tuesday night. I
  discovered her body the next morning. The shock
  was intense because I had expected a gradual
  deterioration probably resulting in admission to
  a home ... My overriding feeling was one of
  relief that it was over and the knowledge that I
  had managed to see it through ...
• ... Crying for your mother six years after her
  death is cathartic. I recognise that I failed
  her. Not in a practical sense but in an emotional
  one and I hope that, wherever she is, she knows
  that I finally recognise this and that I'm sorry.

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Conclusion

• Although a variety of mental health problems are
  associated with ageing, they are deemed abnormal
  not everyone will develop dementia, Many
  individuals retain a level of mental health well
  into old age.
• Successful ageing is a combination of biological
  factors (health) psychological (good coping
  strategies) and social (support, economic)
  factors.