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Lifelong Learning Assessment Eldercare


Introduction

Taking care of the elderly people is a task that calls for much learning and experience on the side of the care provider. As a process in an individual’s life, learning is a continuous activity that kicks on immediately someone is born. Learning is about acquiring knowledge on how to do different things in life. Because knowledge is a wide area, at no point will one ever learn everything. There are different modes of learning that different individuals go through to gain knowledge. One of them is experiential learning where people gain knowledge through the experiences they go through in life. They are able to make a meaning from these experiences as well as concrete decisions. Kolb’s experiential learning theory defines the process people undergo in such circumstances showing how they reach decisions. Caring for the elderly calls for experiential learning because each individual case is unique on its own. Therefore, one has to combine the education acquired in class together with the experiences he or she is undergoing in a bid to make proper decisions. The paper focuses of the lifelong learning elderly care.

Dealing with Physical Changes in Elderly Patients

When individuals grow up, they start with their motions from moving slowly in an imbalanced and less coordinated way to moving fast and in full control of their bodies. The situation will then change back to a slower movement, which now becomes more rigid and coordinated as the elderly progresses in age. Elderly people lie in this category. They even lose their mobility completely as they grow up while others may be able to retain it as their ages advance. Lose of mobility in elderly people is due to the weakening of their body muscles as they can no longer redevelop as before. Therefore, most elderly people tend to seek help or need in their movement as a way of making their lives normal.

Dealing with their Ambulation

Ambulation is simply the act of walking. When caring for the old, the caregiver has to consider how they (the old people) will be walking in their daily activities. In fact, elderly people tend to move slowly as their ages advance because of their gradual loss of their mortar abilities. Their muscles tend to contract and relax slowly in that any motions that occur happen at a very low pace. Elderly people will therefore need a lot of space in the places they are living to allow them space that is enough to make movements from one place to the other. Therefore, their places of living should not have many obstacles like chairs and tables allover because the obstacles can easily trip them as they move around. As a caregiver for the elderly, one needs to make observations on the movement abilities of the elderly persons in their care in an attempt to come up with the best ways to arrange their places of living. One arrangement that should come out as standard should be having most of the furniture in the living area placed at the edge of the room close to the walls so that there is enough space for free movement. Elderly persons tend to grow tired very fast thus limiting their movements.

This situation leads to most of them staying in single positions for so long, which further makes their muscles become rigid. Therefore, elderly persons need to be assisted to move outside the house by having them take a walk that would enable them exercise their muscles and or improve the reflexes of their muscles. As part of exercising, Rimbert et al. point out how ambulance enables the body of a person to increase its metabolic activities thus burning excess fats in the body while providing energy to the body to do other activities (2006, p. 322). A person working with the elderly needs to apply active experimentation and reflective observation in that, while helping the elderly, they have to watch them while thinking of a better way of doing the activity they are doing. Elderly persons should therefore be housed in houses where they will not need to scale stairs or have to climb over raised areas. The caregivers should be in a position to judge whether they can walk on their own, need a walking stick to support them, or need to be held by another person in their aid to walk.

Range of Motion

The range of motion is the maximum distance the joint of an average person can take towards a certain direction. In the elderly people, their range of motion is highly reduced due to weakening of muscles of their bodies as well as strength. This limitation affects greatly the movement of their joints in terms of how much they can stretch their hands in certain directions, how much they can bend, and how much they can turn. This case therefore requires that a caregiver puts measures in place to enable the elderly persons do their activities without many problems. Because of the loss of energy, their joints become weak. Therefore, they cannot hold their weight at certain angles or generally weights to a certain capacity. Therefore, a caregiver should ensure that the operating surfaces of the elderly are made to heights that will allow them to use them without so much struggling. Seats used by the elderly should be at a height that will not make them have to bend too low to sit on them.

They should be in a position that is high enough for them to sit comfortably as well as stand up without much struggle. Most of the furniture in the house should be at a height that will enable them reach out without much assistance. The elderly persons should be given exercise as a way of stretching their joints and or making them much more flexible. Surfaces such as toilet surfaces should also be raised enough to comfortable levels that will enable them use them contentedly. The bed of the elderly should be at a height that will allow them to climb without using a lot of energy or force them to bend so much. Very low beds will make it difficult for the elderly persons to stand up when sitting on the bed. They should use soft surfaces for things such as chairs because hard surfaces are too uncomfortable for them.

Use of Assistive Devices

Most assistive devices used by the elderly are meant assist them in their motion. They are mostly made as tools for leaning on or for creating balance to the elderly because, as they grow old, they tend to become weak easily thus losing their balance. Depending on an individual elderly case, the caregiver should find out the best tool for the elderly person to use. The caregiver can only find out the best assistive device for the elderly persons by observing them or talking to them to find out what is comfortable for them. The attendant will apply part of Kolb’s theory of reflective observation versus abstract conceptualization together with active experimentation. The caregiver should provide the elderly persons with walking canes that come in different ranges. The walking devices should be light in weight and strong enough to hold the weight or load to which they will be subjected. Stable elderly persons should have simple adjustable canes for walking while the next level of this group should have a four-base walking cane. Elderly persons who cannot walk properly on their own should be provided with adjustable walkers for holding when necessary. All these assistive devices should have a non-slip grip as well as a base so that there is no possibility of slipping while in use.

Bathing, Toileting, and Grooming

Elderly persons under care can do some duties for themselves depending on their mental as well as physical state. Those who cannot help themselves when it comes to taking a bath, going to the toilet, and grooming amongst others will have to be assisted in doing them. Elderly persons who cannot go to the toilet on their own should be assisted and be cleaned afterwards for hygienic purposes. Some elderly persons cannot control themselves. Thus, they have to be tied with diapers for the sake of controlling their toilet needs. Elderly persons who can help themselves in this area should have their bathrooms and toilets fixed with appropriate handles in the right places as for them to hold on to any time. They should also be supplied with special bath seats that will make them comfortable when having a bath.

How to Content with Mental Changes in an Elderly Person

Cognitive changes are known to happen to a number of people when they grow old. However, the changes alter them from the persons they are known to be. Mental changes in the elderly come in different forms with some being easily diagnosable while others take time to be diagnosed. Different elderly people suffer from different mental changes, which can occur in diverse combinations that can be challenging for a caregiver to understand. Because most of these mental changes are psychological, it is prudent for a caregiver to have a psychology background that will enable him or her to handle some of the cases. Changes in aging people can be found in the following areas: sensation, intelligence problem solving, perception, language, memory, and thought. Aging in elderly persons comes with medical conditions that would require constant medication as a way of controlling the situation in the elderly persons.

Mental changes in these people lead to slow decoding of information in the elderly persons, which further can lead to slow understanding or lack of it on particular issues thus translating to slow thinking. Some elderly persons suffer from such conditions like dementia, anxiety disorders, amnesia, and sleep disorders. Caregivers need to take their time to understand the condition of the elderly person they are dealing with to enable them come up with a way that will create a good understanding with the person they are taking care of. The first quality any person working as a caregiver needs to have is patience, which is the ability of one to take time to understand something that is happening without making any decisions before understanding anything. In the case of mental deterioration, the elderly persons will tend to change their patterns from what is normal to what can be described as abnormal.

They can also change from what is standard to what can be described as unique. It is therefore prudent for the caregiver to make an observation of the elderly person to establish a pattern that the elderly person has adopted in an effort to come up with a framework that will help the elderly person or enable caregivers to discharge their duties. The caregiver should apply abstract conceptualization versus reflective observation. Conceptualization will allow caregivers to think about a situation they are dealing with in a bid to understand it in the best way possible. It will make the caregiver have an opinion on what is going on and or how it can be approached. Reflective observation will make the caregiver watch the situation keenly, record any characteristics that may be happening, and come up with an understanding of a pattern that may be forming.

Mental changes in elderly persons may make them nice people. However, they may also make them very irritable to work with. The caregiver should always approach the person in a manner that makes him or her (the caregiver) retain control of the situation. The nurse should be devoid of emotions that might lead him or her towards losing control of the situation while dealing with the elderly person because a caregiver becoming emotional might impair his or her judgment thus leading them into taking inappropriate actions (Barbosa et al., 2011, p. 490). In this case, the caregiver should not use his or her emotional cognitive strategies because they are less efficient. A mental change in elderly persons under care is an aspect that all caregivers should be on the lookout for because it is seen to be most prevalent in elderly people who are under care. Most elderly persons tend to start experiencing mental changes at the age of 65 years old. At this point, most of them are not yet under care for the elderly.

Therefore, it means that most of the people under care are very old and vulnerable to mental changes at any time. The caregiver therefore needs to be very observant and keen on any telltale signs that some change is happening. They should not ignore any signs that they come across however mild they are even if the occurrence of the sign is wide apart because minor signs might lead to bigger underlying conditions that the elderly person might be going through. Caregivers should be strong enough mentally for them to withstand different changes that might be happening to the persons they are nursing. To cope with such situations, caregivers need to have other engaging interests outside care giving to engage their minds and bodies and or make them forget some of the incidents they might have experienced. Too much engagement with care giving might lead to breakdowns to the caregiver.

The Need to Change the Environment for Safety and Accessibility Needs

There is a need to change the environment where the elderly persons live for ensuring their safety as well as their accessibility within their areas of operation. The need to change the environment for the elderly is necessary because their body systems change with time. As they age, their systems tend to become weaker and weaker. Elderly persons need to live in areas where there are no hazardous components in the whole environment, be it air or soil, because their immune systems tend to grow feebler as they advance in age. Thus, they become more allergic to many pollutants that can be found in the air, which can be withstood by people of younger ages. Most elderly persons tend to suffer from respiratory problems whenever they are exposed to pollutants. It is prudent for a caregiver to ensure the location where the elderly persons are living is environmental friendly.

There is a need to change the environment where the elderly live so that it fits their daily schedules and movements. In this case, all raised areas should be smoothened while those with steps should be made in a ramp form so that they do not have sharp gradients. Raised edges on the paths where the elderly move about can be fatally dangerous in case of a fall. They should therefore be evened out to reduce chances of falling. Elderly persons are delicate and brittle. Any fall can lead to fractures, which may take time to heal. Elderly persons’ reaction or reflexes are too slow to stop them from falling. Thus, it is prudent to avoid situations that may expose them to any types of falls as much as possible. The floor surfaces that the elderly are supposed to walk on should not be too smooth like tiled surfaces. Such surfaces can lead to an individual slipping.

Therefore, they should be changed for the sake of the elderly person. In case of their abode having smooth surfaces such as tiles, such surfaces should be covered with floor stickers that give them a coarse surface or provide more grip to the person walking on the surface. Walking surfaces in the rooms where the elderly persons live should also be covered with soft materials like carpets that should act as a cushion in case of a fall. On the other hand, carpet materials on the floor act like insulating materials against cold and hence a surface that preserves warmth in the rooms the elderly stay. Due to their deteriorating health, hearing, seeing, and other senses, the elderly persons should be located in an area where there is minimal noise so that their communication is not hindered. The area where the elderly persons operate from should be well lit for proper vision.

The lighting should not be too bright for their eyes to the extent that the light blinds them. Old people’s vision is usually diminished. Too much lighting or too dimmed lights can lead to temporary blindness. The outside environment for the elderly should be a peaceful environment that can allow them to have peaceful moments as they age. Too much noise can lead to insomnia because it ends up disturbing the peace that they need in case they want to have a nap. Pavements within compounds where the elderly live should be well paved. The pavements should be wide enough for their easy movement. Elderly persons require more space to move around compared to much younger persons. Most elderly persons use walking aids some of which are wide and hence requiring more space. Walkers and wheel chairs need space for maneuvering. Therefore, the environment where the elderly are living should have large spaces enough to allow movement. Areas where the elderly live should have rails all over along the wall to offer support to them as they move around.

The environment where elderly persons live or operate from should be set up in such a way that, at any one moment, the elderly persons should have something to lean on when they need it. The general topology of the compound should be flat so that the elderly persons can move about without the risk of falling down or without the problem of laboring. Raised surfaces can make it difficult for the elderly persons to walk on due to their diminished energy levels. Therefore, there is a need to fashion the general environment where the elderly persons will be operating from so that it can suit them and their movement as well as safety. The caregiver will therefore need to apply abstract conceptualization as well as reflective observation, which are part of Kolb’s theory to come up with the best ways possible for each individual case. This strategy will be dependent on the caregiver’s observation and judgment on what is the best for the elderly individuals.

Challenges to Nutrition, Feeding, and Eating for the Elderly

Nutritional Needs for the Elderly

Nutrition and feeding comprise one of the greatest challenges that caregivers for the elderly have to face everyday due to the complications that come with age. Elderly people’s bodies tend to be choosy with the nutrition that is required for them thus calling for specific diet requirements for them. According to Weetch (2007), elderly people need a nutritionally sound diet that will provide their bodies with the specific needs that the bodies require (p 60). Weetch further states that up to 40% of acute elderly patients are malnourished. Therefore, they are very weak because of dietary problems and not because of lack of feeding. As such, the elderly persons should be fed on specific foods that will provide them with specific nutrition that is fundamental to their bodies. Due to their advancing age, many body functions of the elderly tend to slow down thus leading to slow processes in their bodies.

For instance, the metabolic rates of the elderly persons tend to slow down with age thus affecting the amount of food they eat, the type of food they eat, as well as the specific nutritional requirements that their bodies need. Therefore, elderly persons are required to have a nutritional diet full of vitamins, proteins, minerals, and fluids. These nutritional elements are essential for the rebuilding of the body cells. In addition, due to their slow rebuilding, most of these nutrients are required especially proteins. Due to their diminished immunity and high rate of infections, vitamins become essential to their bodies because they are a source of immunity to their bodies. Malnourishment in the elderly has been known to lead to many other problems such as pressure and ulcers developing in the elderly persons that slow down the healing of wounds on their bodies as well as leading to higher rates of infection.

Feeding the Elderly

Feeding the elderly is a big challenge because of a myriad of problems that the elderly develop as they advance in age. It therefore requires that each case be treated according to its needs because different people have different complications as well as needs. The care provider will therefore be required to observe each individual case in an effort to come up with a mode of operation that will suit the individual elderly person. Feeding for the elderly person will depend on whether the persons can feed themselves, or should be fed. Some cases, which are not too dependent, will not require the care provider to feed them but only to supervise them as they eat. This strategy is meant to ensure that the elderly persons have eaten well the food that they are supposed to eat in the right period. The care provider will therefore need to be there to keep them company and or encourage them to eat the right amounts of food to the finish. In the case of an elderly person who cannot eat on his or her own, the care provider will be required to feed him or her the food he or she is supposed to eat.

While eating, the elderly person needs to be placed or seated in the right position to avoid incidents of choking or food reflux. The amounts of food portions they take per mouthful should be considered so that they have just enough food in their mouths to chew and swallow. Too much food in the mouth can lead to tiring of jaw muscles, which will then lead them to eat very little meals while too little mouthfuls lead to a lot of time being spent on feeding. Feeding times should be strictly observed so that they do not overlap. The care provider should ensure that the food the elderly persons are eating has fiber most of times so that the soft food they eat most of the time do not lead to constipation. Due to teeth problems experienced by most elderly persons as well as their inability to chew, it has been observed that most of their foods are mostly soft for easy chewing and swallowing. However, this soft food is responsible for constipation.

Eating for the Elderly

Eating can be a big challenge to the elderly because advanced ages come with different complications. This situation calls for the application of the three Kolb’s learning styles, which are reflective observation, abstract conceptualization, and active experimentation. The care provider should observe the elderly persons as they eat. From there, he or she should deduce the best way they (elderly people) can eat the food that they have been given because most elderly persons have problems with eating due to different problems. For instance, most elderly persons have lost most of their senses and specifically the senses of smell and taste. This loss leads to them feeling that their food is flat and tasteless thus reducing their appetite. Eating time should be scheduled at the best time possible when the elderly persons are fully awake and alert so that they feed optimally. Eating can be a problem to many of this category of people because of their teeth situation. This situation should be put into consideration because it affects the way they eat and the speed of eating. The position of the elderly person while eating also matters because old age leads to the weakening of the gastro-esophageal sphincter, which leads to frequent reflux of the gastric acid and food. To control this situation, the speed of eating should be moderate and that there should be enough rest after eating.

The Need to Transition the Elderly

At times, in the life of the elderly, there is a need to move them from one place they are staying to the next stage. This strategy usually leads to problems because of the way the elderly persons will react to such moves. Schumacher et al. (1999) describe it as “a passage between two relatively stable periods of time” (p. 2). Due to mental changes that happen in their brains, their understanding of situations tends to be limited. They might fail to understand straightforward situations that lead to whatever is happening in their lives. Transitioning the elderly persons is necessary for making them more comfortable. Simply, transition helps to meet certain obligations that would make them move. Transitioning of elderly persons depends strongly on their physical as well as a mental state because these factors will dictate how the transitioning will occur.

Rooney and Arbaje (2013) find, “transitioning can be a vulnerable time for elderly adults and for people with complex needs because it is a problem that remains common, costly, and complicated” (p. 63). The need to transition the elderly is because they are less flexible to changes due to their old age. A change in the set up where they stay can easily lead to confusion in their lives thus becoming a source of frustration into their daily routines. Therefore, in case of any changes to where they have been living, there is a need for a proper transition period that should allow them to adjust according to their mental and physical capabilities. They will therefore need to be guided through the transition patiently having in mind that their brains may take a lot of time to re-adjust and fit fully in their new environment. Transitioning should also happen at a psychological point in that the elderly person should be prepared psychologically for the changes that are going to happen. Elderly people tend to be psychologically fearful of being abandoned or being disenfranchised thus making them fearful of any intentions that the people around them might be having for them.

They will therefore be emotional to any idea that suggests they be moved. They can thus fall into depression, which might lead to other health complications. Transitioning will prepare them psychologically for the move. In fact, it should be done in a way that will make them embrace the idea on their own. Elderly people have an attachment to different things that they have. The attachment can easily lead to them resisting ideas of having their homes sold or just them moving out. They therefore have to be convinced on the importance of moving so that it does not influence them negatively. The importance of transition on one hand is to enable the elderly person change their routine albeit slowly. Many elderly persons have established specific routines that they religiously follow in their everyday activities. This case creates a sort of pattern in their movement within their areas of stay. Therefore, any disruption of this pattern can lead to lots of confusion. Part of the transitioning program should involve close supervision by the care provider for directing them and explaining to them what they should do as well as answering some of the questions that the elderly might need answers for.

Transitioning allows the caregiver to make observations on the different changes that might occur and come up with the best way of dealing with them. This strategy will allow the care providers to come up with decisions with regard to the observations they have on the elderly persons. Because different persons have different challenges, the care providers will have to deal with each case individually because there is no standard manual on how to deal with the different problems that they might encounter. This situation therefore calls for reflective observation and active experimentation on the side of the caregivers. Reflective observation according to Kolb will involve watching whatever is happening and or thinking about it in such a way that the care providers weigh options to be applied to the challenge that is unfolding before them. Active experimentation according to Kolb will involve taking action that the care providers deem appropriate as a solution to the problem they are facing.

It might take heuristics for the care provider to come up with a solution because some challenges that will emerge will require him or her to think fast on what to do. On the other hand, the care providers should be flexible enough to change options if the one they had applied fails. Therefore, transitioning is a way of enabling the elderly to adjust to changes that they face. The changes are known to have a significant impact on the lives of the elderly. A poorly managed transition or lack of it has been found to have very grave effects on the elderly because such situations lead them into mental breakdowns that might lead to deterioration of their health. The person doing the transitioning must be one who has been working with the elderly persons, and who the elderly persons trust because a person who does not understand the person he or she is dealing with can easily make assumptions, which can lead to grave mistakes.

Family Homecare as the Best Living Arrangement

Family homecare is the best living arrangement for the elderly persons especially those suffering from old age ailments like Alzheimer. Alzheimer is a mental condition that affects elderly persons. It can lead to them being forgetful to the extreme level. Persons suffering from Alzheimer tend to forget many things at particular times. They therefore need to be cared for because they no longer have total control of their lives. In many cases, it does not necessarily affect the physical health of an individual elderly person. Rather, it affects the elderly people’s memory to the extent that they can even forget who they are. Such persons therefore require close supervision in everything that they are supposed to do and a constant reminding of the same. Without close supervision, such patients might end up doing wrong things like toddlers or forget completely to do what is necessary. Therefore, most families tend to take them under the care for people with Alzheimer from where their needs are catered for by caregivers.

Alzheimer can be either mild or extreme depending on the individual case. Different care options can be applied depending on the individual case. Although such persons tend to lose memory, they can also have lucid moments in that their conditions can improve and or get them back to their normal selves. Such persons should be placed under home care with measures being put in place to monitor them so that they are well taken care of when they relapse. The family members of a person living with Alzheimer are best placed to understand their patients’ conditions more than any other persons. They can collaborate with doctors to provide medication to the elderly persons because Alzheimer being a medical condition can be controlled through medication and therapy as a way of alleviating it so that it does not lead to extreme conditions.

The writer has a first experience dealing with an Alzheimer case in her family. She has come up with flexible arrangements that allow her to take care of her patient while doing her daily chores fulltime. The writer and her sister opted to provide homecare for their mother who sufferers from mildly severe Alzheimer. They two had to device a way of balancing between taking care of their elderly mother who is physically fit and working full time. Their mother is able to do most of the activities on her own. Therefore, she cannot be said to be extreme as long as she is supervised and directed accordingly. Therefore, the arrangement adopted in this case was home care and daycare combined. Many elderly persons loath the idea of being taken under institutional care since it makes them feel that their own families have rejected them for being a burden due to their old age. A similar experience applies to persons with Alzheimer because they tend to feel abandoned whenever they are taken under the care when they have their lucid moments. The thought of being abandoned leads to deterioration of their health due to factors such as depression.

Homecare for such a person is prudent because it helps them to recover or stop them from falling further into the condition. Homecare combined with daycare allows family members to take care of their own without them having to change their schedules so much as Patrick and Wendy (2009, p. 53) confirm. It is cost effective economically. For the case of the writer, the arrangement made with their sister was that their mother be taken to a daycare where she is picked in the evening. The writer and her sister would take turns to look after her. The two also arranged for doctor visits so that the doctor would come to attend to their mother at home. This strategy has enabled them to take better care of their mother as compared to when she would have been taken to an institutional care where she would be given general care. Homecare on the other hand is only good if the relatives of the elderly person are committed to taking care of the person because it takes sacrifice to dedicate their time and resources.

Reference List

Barbosa, A., Figueiredo, D., Sousa, L., & Demain, S. (2011). Coping with the Care Giving Role: Differences Between Primary and Secondary Caregivers of Dependent Elderly. Aging & Mental Health, 15(4), 490-499.

Patrick, F., & Wendy, M. (2009). Cost and Caring: Policy Challenges of Alzheimer. Generations, 33(1), 53-59.

Rimbert, V., Montaurier, C., Bedu, M., Boirie, Y., & Morio, B. (2006). Behavioral and Psychological Regulation of Body Fatness: A Cross-sectional Study in Elderly Men. International Journal of Obesity, 30(1), 322-330.

Rooney, M. & Arbaje, A. (2013). Changing the Culture of Practice to Support Care Transitions-Why Now? Journal of American Society on Aging, 36(4), 63-70.

Schumacher, K., Jones, P., & Meleis, A. (1999). Helping Elderly Persons in Transition: A Framework for Research and Practice. School of Nursing Departmental Papers: University of Pennsylvania.

Weetch, R. (2001). Feeding Problems in Elderly Patients. Nursing Times.net, 97(16), 60-68.

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