Elderly Quality of Life - Dr. Zivoni - 2007-8

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Elderly Quality of life

Tzivoni

studies show that you got older for taking this class.

28/1/2008 

Several questions:

  1. what would you most want in your elderly age
  2. what would most not want in your elderly age – there is a lot of abuse of elderly = physical/economic/emotional
 

expectation of the elderly?

-the elderly have a tendency to "tell" their story (over and over) àsome geriatric therapies are based on this

àa common theme is to try to convey to the listener that everything is alright w/ me –that I am not dependent/old/I am still functioning

      àbased on fear of age (sickness)

-the general tendency is for increasing % of geriatric people in the society –"geriatric boom" 

Ageism =butler/louis ="can be seen as a systematic processes of stereotypization/prejudice against people b/c they are of elderlyness (foggies), as gender stereotypes does to gender. The stereotypes are that old people are: senile, rigid in their thinking, old moral values and old skills àthis stereotype by the younger population puts the "blame" on the "other" so that they do not deal w/ their own fears of sickness/age/death. Sometimes, the stereotypes is based on lack of acquaintance with the elderly population. This stigma simplifies how the elderly is seen in order to not deal w/ own fear 

 

-we have to deal w/ the elderly person on the individual ability level and not on the general myth level 

Consequences of those myths about the elderly on the caregiver:

 

Consequences of those myths about the elderly on the actual elderly:

 

Monk:

 
 

Definitional question: who is an elderly person?

Legal: 65 for women and 67 for men. (used to be 60 for women) – today's trend is to extend the work age even beyond that. Social policy is also influenced by other social factors like current unemployment rate -->this definition is based on chronological and biological/social/emotional/awareness/functional ability 

2 kinds/categories of "elderly"

 

rabinovitz:

-we have to differentiate between elderly – is he: 

 
 

So, main question is: in what is he old? "How much" is he old ?

      àpartial or fully elderly? He could be 80 years old functioning as a young adult? 

Another Ranking – based on ADL

 

3/2/2008

The elderly in the modern world

-in traditional/primitive cultures

 
 

Role theory

-every system has roles, and there are mutual expectations to complementary roles

àpeople have roles in society which are supposed to advance the society

            àthus, the elderly lost their role in society as esteemed head of family 

-in history/traditional societies, the economy is based on agriculture. In modern times, there is urbanization/industry-based economy. This led to increased mobility àthen the collective identity based on territory is reduced. ànow, family lives in nuclear family settings [only parents and kids] and not in extended-family settings. Thus, family institutions became societal and not familial –courts/schools/knowledge/care for the needy and elderly

      àalso less kids  

Professionalization

-another element of modern society – what was cared for in the home is now in the society. There was a development of a profession

      àalso took away many of the elderly's roles

            àincreased stigma and marginalization of the eldery 
 

handout

 

Are the elderly a social problem or a social phenomenon

-Hazan: it is a phenomenon since a social problem infers that it is the elderly's fault 

Hazan: how do we identify and map the elderly in the modern society

àin some communities, the elderly is not a "needy" population  
 

Axis:

  1. Integration vs. segregation –structural axis
  2. Humanization: To which extend is the elderly treated humanely/holistically vs. de-humanizing (disrespecting)
 

-the Ethiopian immigrants to Israel/religious societies/tribal, agricultural societies integrate the elderly even in modern times

àin Arab societies in Israel, the family cares for the elderly 
 

There is a negative correlation between modernization and caring for elderly

àindividualism means less caring for elderly  

Arab society

àusually 1 caregiver – but up to 5, since they live in extended family home 

-in modern times – there would be a lot of identity searching  - the modern times "emptied" the individual of an identity – so there was a move t/w post-modern – reaccepting in new ways 

Post-modern times –good for the elderly

1) in the modern times, there is a tendency to look at "real" knowledge

-in post-modern times, there is an acceptance of the subjective. i.e. accepting the narrative. i.e. holistic medicine. Accepting the past/accepting the elderly

      àmore listening to the elderly and his needs 

-new accepting of the past/tradition àthere is more eclectics –integrating the past into today 

2) more respect for time 

3) hierarchy – more social gaps – in postmodern times there is an attempt to break the social gaps and accept variance

4) social relations – less social/group relations – no real dialogue/more estrangement

Family:

-lower birthrate and higher life expectancy

      àmore multi-generational families – "pea families" few in a line

epidemiology

-people die of acute diseases – since chronic diseases are livable 
 

Family life-cycle

Differentiation in developmental stages – segregation b/w generations 

New forms of households

ànew phenomenon – "old" youths return to living with their old-foggie parent

      à"cluttered nest"

            ->no longer fully "nuclear family" 

Accepting the difference

More acceptance of solidarity àconverging of values b/w generations àelderly gets more acceptance 

the stereotypes are decreasing

-today, the economy is more service/consumption

-agricultureàindustryàservices 

àmore acceptance of free time

àthe elderly are consumers – part of economy 

Family status: in our age, since the family is family apart (divorces/etc…), the elderly gets a new role in keeping the pieces together ("family watchdog") 

Summary: In postmodern times, the elderly is doing better b/c:

  1. more economic resources – so the market is also focused on them
  2. health - can contribute – i.e. volunteer -
  3. family – can contribute to family
 
 

test

mostly class notes

barzilai ada is one article we can start reading 

-- 
 

Last class, we spoke about the elderly in various

Today, we will speak bout: Demographics/Theories which explain the elderly's disposition

Demographic projections

-today, we speak about the gerontology boom

-because of the increasing quality of life/better medical technology

      àless death +less birthrate = gerontology boom 
 

World life expectancy:

76 –for men

80.4 – for women 

In Israel

-you also have to account for immigration – nowadays, it is proportionally more the elderly who immigrate that younger population. The immigrant elderly make 16% of the elderly in Israel. 10% of the population in Israel are elderly 

21% of people live in cities – 28% of elderly =Israeli urban centers are proportionally old live

In beginning of state -4% are old. Today, 10% 

Chance in elderly population in israel

Upto 75 – "young old"

Over 75 – "old old" – also increased proportionally o the elderly population makeup – nowadays -38% 

--

makeup

 

Demographic projection

 

Medical projection

Social question

 

4 levels of challenges

  1. influences the pension and social security systems
  2. work-force: changes the pension age upwards in order to decrease their dependency and easy the overload of the social security
  3. social intervention – do we only focus on medical help or also social intervention and empowerment – do we only do tertiary prevention?
  4. integrating the elderly in civics – today's elderly has more resources – more health/economics/education+knowledge – the trick is to integrate them into society –this decreases stigma and social ๎้ใๅ๘  - and increases social integration – i.e. a volunteer program for them in  kindergarten systems to help the kindergarten teachers
 
 

dependency within the family – part of the social intervention question

-there is a longer but thinner generational line – more generations are alive but less people in each generation – so you can be less dependent on family. Family is increasingly demanding the state to care for the elderly, while the state still demands the family to care for the family. This means for the social worker, that the intervention is also geared t/w the family. 
 

Gerontology sciences

-theories started being worked on from the 19 

theories

 

Social theories

Disengagement theory – Coming and Henry – 1961

-studies in Kansas 

-each person has a limited amount of energy. With time, the energy decreases – so death is inevitable. In older age, people try to use less energy/reduce activity, and then disengage from society. People choose to disengage. There is a correlation b/w disengagement and moral/life satisfaction. The more disengagement, the more the elderly's moral/life satisfaction rises 

2 study groups"

 
 

Measures:

 

criticism: hochschield+neugarten

  1. physiological death = social death?!?!? ~It Ain't Necessarily So~
  2. some elderly aren't happy about their disengagement – we have to see on the individual level – it seems that most are not happy about it
 

activity theory- hochschield+neugarten -1965

-the link b/w physiological death and social death is not true!!!! Society is the one who throws out the elderly 

-use more objective tests – Rorschach tests and observations 

Basic assumptions of the test:

  1. besides biological/medical stuff, there is no diff. b/w the adults and elderly
  2. decrease in activity is b/c they are forced to do so b/c of society
  3. satisfactory/successful aging =when the elderly person remains as active/functioning as the adult ài.e. find alterative activities to those he had as an adult
 

àsocial work is not only about talking bullshit –you also need activity stuff – especially according to this theory. But this has to be done in social-work ways – you have to do it out of respect – i.e. help them choose their activity – can't decide for him. And you have to do it out of respect – can't baby-talk to the old 
 

Continuity theory – atcehly

-we all have our internal self-structure which is stable over time.

But! Our life's dispositions (i.e. age) force us to change of our stable traits and behaviors in order to maintain function 

So, there is 2 forces

  1. assimilation – ไ่๎๒ไ – deal with it internally – didn't have to make changes in her life
  2. accommodation – things that require chances in life – i.e. a wheelchair – a person who needs it needs to accommodate it – if not (i.e. b/c of embarrassment), their will not be mobile
 

-so, if social workers want to maintain elderly's quality of life, he should helpd he elderly maintain continuance to their life:

  1. internal continuity: continuity of the self – i.e. still feel he is successful, as he was successful as a manager before his pension – so he speaks of prior successes
  2. external continuity: people have their familiar tasks – the known gives security. So you have to find parallel tasks he can do
 
 

-internal/external continuity helps the self – and protects the "loses" due to aging.  Thus, as social workers, we should find ways to help him maintain self (internal) and find alternatives (external). This requires planning ahead of time 

25/2/2008

-test is multiple test

17/3 is a movis-class

Today, we will speak of

Sociological theories of the aging

 
 

Gaining benefit

 
 

Symbolic interaction theory – continued

-this is similar of the psychological theory of the Self

-each person's "self" develops throughout life. This development has 2 processes:

  1. intra -psychic – relationship w/ self
    1. I – how do I perceive myself subjectively
    2. Me – perspective of self based on how others see me
  1. inter-psychic – relationships w/ others
 

-for the elderly, they receive negative feedbacks from the context (Me) and will internalize it, and perhaps even amplify them 

Brody's syndrome: overdoing the inability. Some will still thing that they are young. They will react w/ ageless self–some elderly can't accept the downside of aging and we have to help them accept it. feeling young is nice as long as there is no denial 

 

erikson – speaks about the self

Erikson speaks of development through the lends of his context. He has 8 stages 
 

-8th stage: integration vs. despair

q) what is expected of the elderly?

 

Clark and Anderson

5 developmental stages of adaptation in the elderly

1) perception and acceptance of aging – i.e. spend energy in doing something productive and not in the despair

2) redefining the physical space – if I know my space then I can control it better – i.e. the aged should know what his space is – i.e. b/c of sight, he can't drive – that limits his space. If he has a hard time accepting this, he will have a harder time to adapt

3) re-evaluating self-evaluating tools – accepting that I can't do things the same as I once use to be able to

4) finding alternatives to satisfy needs – i.e. also Frankl speaks about this

5) reestablishing/reinstating goals and meaning  in life – its important that it comes from him and not from the social worker 
 

3/3/2008

Harella Levenstein – social theories

 
 

Victor Frankel – "the will to meaning" – existentialism/logo-therapy

-one measure of elderly quality of life is that there is a meaning to life

-the assumption is that there will be "neo-dynamics" – i.e. the dynamic b/w what I have and what I still need – this is what gives energy to life. Without this, we have existential emptiness – seen in boredom/no meaning in life/no reason to wake up in life. So we can help people find some meaning to life. This can be done by helping people find activities: i.e. social relations/etc… -so sometimes even suffering can give meaning to life, and this meaning lets one survive 

Rocker/Peacock/Wong – studied finding meaning to life in the context of the elderly - LAP 

Life attitude profile – LAP – measures of meanings in life

  1. life purpose (LP)
  2. existential vacuum (EV) – negative correlation with Life Purpose me
  3. death acceptance (DA)
  4. will to meaning (WM)
  5. goal seeking (GS)
  6. future meaning (FM)
  7. life control (LC) – also seen in other theories!
 

The researchers tried to study:

  1. is there a relation b/w age and each of those measures?
  2. What is the relationship b/w psychological wellbeing and each one of these measures
 

Conclusion

  1. there is a correlation b/w age and some of the measures
    1. b/w age and (increased) life purpose and death acceptance
    2. w/ age –less Goal seeking and future meaning
    3. age has an influence of existential vacuum – in a u shape – youth feel the vacuum, and then in decreases, and in elderly – it increases again
    4. life control and will to meaning is constant in life [this finding supports frankel's theory].
  2. there is a correlation b/w:
    1. psychological wellbeing and future meaning and life purpose
    2. Existential vacuum and Death acceptance is correlated with psychical and psychological wellbeing
 

Mekolsky – 2nd generation theory

Elderly's needs:

  1. autonomy – not to become dependant – so we need to give the tools – even physical
  2. expressive – i.e. expressing emotions – i.e. through music
  3. the need to be needed/helpful
  4. the need to influence
  5. transcendental [meaning] needs
 

3rd generation theories

Successful ageing theories -balts

-based on positive psychology – speaks of people's strengths 

Principles:

  1. aging has increased heterogeneousness between people
  2. you have to differentiate b/w normal and pathological aging. For most, it is normative – in that the elderly can function well and independently
    1. normative aging is defined by the elderly succeed in maintaining health and psychological wellbeing, given the context and their age disposition.
  3. In aging, there is a reserve of developmental potential [aging is not only about degeneration]
  4. With age, there is a decrease in fluid intelligence – i.e. the fluid mechanical elements of the brain – or in plain words, the cognitive elements [i.e. memory] of the brain is reduced due to neural aging
  5. Integrative intelligence – those experiences in life which help the elderly through his period in his life.
  6. With age, people try to make a balance-sheet of losses and gains in life, and they try to keep the positive balance of things, especially when their body is degenerating, yet age is also giving them positive elements [i.e. more experience in life]
 

Formula for successful aging

 

Rift and singer – along the lines of successful  aging theories

6 measures of positive aging

  1. Accepting oneself and his past [sounds like erikson]
  2. Positive close relation w/ at least one person
  3. Feeling of autonomy/decision-making
  4. maximal control over context
  5. clear meanings in life [frankel]
  6. sense of continual development [balts]
 
 

Context-ecological theories – 3rd generational theories

Basis: Helen Pearlman

Behavior (b) = function of Person (p) and Environment (E) 

-the elderly has to adapt to the demands to the environment, but the environment also has to adapt in order to help the elderly function.

-- 

Kahane – congruence theory – ๚้เๅ๘้ๅ๚ ไ๘๖้๔ๅ๚ ไ๑แ้แ๚้๚

-there is a relationship b/w context and its stimuli and the person

àtoo much [oversupply] or too little stimuli [undersupply] from the context, then it influences the elderly's life 

Context: the system in which the individual's behavior happens-it gives or doesn't give the person the resources for person to fulfill person's needs. When there is too much, then it is "noise" and for the elderly, with decreasing cognitive ability, it is confusing 

Change of context - it is hard for everyone. For the elderly, it is harder [i.e. even move to live with their adult kids/old age home]

      àrelocation stress 

10/3/2008

We are still talking about context issues

Today, we will speak about old age homes 

-any moveof environment is hard. For the old-age moving to an old-age home, he needs a lot of adaptation

àkahanaman: you need contextual continuity – perhaps some similar/same objects, whether moving to his kid's home or to old age home 

There needs to be a matching b/w context and stimuli

-don't have oversupply (confusing!!!! Too much info!!!) or undersupply (too boring!) 

Rowles' models –context ranges

-we have many contexts – i.e. as a student/family member/etc… àthe more contexts we have, the more enriched our lives is. So if we have a trip, it increases our contexts.

àfor old people, the context ranges get reduced – i.e. so wheelchair reduces his range/stairs/etc… his only range ma be the window in his room. Others need help to mobilize in neighborhood 

A person also has a imaginary context – i.e. memories/fantasies

àso according to this model, we need to attempt to increase the range of contexts for the elderly, who by virtue of age, gets their context reduced. The idea is that psychological wellbeing and quality of life will automatically improve 

Lauten/Nahemow – competence model

-there is an interaction b/w environmental press (X axis) and personal competence (Y axis)

Campbell: - links the environmentfunctioning/health

-the link b/c physical environmental control, and cognitive control over the environment 

input

 

=

 

liberman/tubin

compared 3 groups

 

dependent variables:

  1. self-identify
  2. mood
 

àconclusion: the more the continuity gap b/w original home and old-age home, the psychological stress is higher. They were more depressed/their self-concept was low – seen as unworthy. The people in the waiting list was somewhere in the middle 

Another study – those on the way to old-age home – the question was if they had preparation, how did it affect them?

The preparation helped them  

Resilience from relocation stress

 

contexts which are helping for the old guy: high levels of:

 

-end of heories section 
 

old-age homes

Gofman – totalitarian organization – term coined in 50s

      àdeinstitutionalization/"normalcy" process started at this period

        1. aspects of the elderly's life –i.e. sleep/eating – is in the same place
        2. all activities are organized by staff – no resident involvement àneed democratization of activities
        3. no differential treatment – everyone gets the same relationship
        4. the organization tries to get economic/other organizational benefits, at the expense of the residents
 

-in old age homes, the old-foggie's independence is low – more totalistic than a "protected residence" – in the residences it is more expensive than old-age homes, and thus the better off go there. Better treatment (hush-hush – don't tell anyone). 

 

territory

Primary space: his own private space

Secondary space:

Public space: people try to increase their space by "incursion" into here 

àterritory behavior is seen in old-age homes 

-->people try to protect their space w/ defensive behaviors and even violence 

Reasons for going to old-age home

 

Old-age decision process – needs process

 

2 decisions:

        1. to leave the house
        2. to where
 

tzivoni's article

assumption: family will try to keep the old-granny at home. 

Personal variables -àIntergenerational relationship àrelationship to home vs. old age home àdecision to or not to go to old age home 

17/3/2008

Today we saw a movie about the experiences of old age home residents. The conclusion of the movie was that the residents are old.

The following is the lecturer's ramblings after the movie: 

Social worker in old age homes:

Entry:

 

Process

 

Types of work

 

Levels of work

 

-intergenerational relationships should be promoted to promote health of elderly

 

-social workers also have the job of accompanying the elderly when moving department/institution 

-social workers are also responsible for:

 

24/3/2008

today, we will speak about

        1. loneliness
        2. family
        3. deinstitutionalization – an approach stared in 1950s to fight gofman's "institutional neurosis" – the idea being that people need to learn to live normally as possible, in the community àmake "community care" programs
        4. services continuity: a term referring to having all the options in the same place: i.e. an old age home with different departments for different level of functioning àto reduce the moving/adjusting processes. Continuity includes [in decreasing order]:
          • negotiable environment
          • social services
          • social clubs
          • advise centers/volunteering programs of/for the elderly
          • home treatment- ็ๅ๗ ๑้๒ๅใ
          • elderly centers
          • support networks
          • supportive neighborhood
          • day-center for the elderly
          • protected housing
          • Old-age home
          • Pension centers
          • Hostels
 

supportive networks/supportive neighborhoods

-includes individual/group/community social workers 
 

Loneliness

-modern lifestyle increases loneliness issues

  1. people live longer
  2. family b/c more nuclear
  3. elderly b/c more isolated by society
  4. elderly internalize this social isolation
  5. introspection: trend around age 55-60 to look inside themselves –๔๐้๎๚้ๅ๚
  6. fear to create social relationships
    1. their friends will die – they are also old
    2. they won't be understood
  7. handicapped – i.e. wheelchair
  8. retirement – reduces social contact
  9. loss of friends to age
  10. language skills are reduced –b/c age/culture
 

programs which answer the elderly's social needs

-everyone has basic social needs –even the elderly

  1. to be included
  2. to love and be loved
  3. the need to control
 

à and also the need to pass this course's test 

-the need remains even though the resources available to the elderly are reduced. With time, when their social needs are not met, the elderly b/c even more enclosed in themselves 

Bowlby: spoke about the need for contact - attachment figure needs, even at and aged age.

  1. those figures provide security/psychological welfare
  2. we need those attachment figures in times of distress.

-attachment is also seen in animals: people attach to animals. "skin hunger" – there is a human thirst for contact with skin (EVEN ANIMALS!) 

Group work

Advances the elderly's social needs [parallel to above – elderly's 3 social needs

  1. gets attachment figure [loved and be loved[
  2. feels included
  3. the elderly in the group can decide what to do in it [control]
 

social isolation/loneliness of the elderly

2 types:

  1. objective: less contact w/ people - แ้ใๅใ
  2. subjective: the sense of loneliness, regardless of actual # of social figures - แใ้ใๅ๚
 

question: what is the relation b/c objective and subjective loneliness

 

Informal support systems/supportive neighborhoods

-this is as true for elderly as it is for other populations 

Informal support system: it is similar to social networks. It is defined by people who are not paid to support: i.e. friends/family/neighborhoods 

Informal support -definition

a set of human contacts through which a person fulfills his social needs

  1. receives emotional support àemotive needs
  2. actual needs [i.e. info]/ àinstrumental needs
  3. acceptance àsymbolic needs
 

-as the informal support of the elderly is more tight-knit, his situation would be better – he will remain in the community for longer. 

Shoval: studied elderly's support system: more network = stronger elderly = less institutionalization 

-an elderly who's informal social support network which includes family members, it increases his resilience and this maintains him in the community 

Litwack: studies essential parameters of certain functions in the support network. Those parameters include

  1. amount of obligation – i.e. who can do a certain action – i.e. can I ask a friend to shower me? I can't ask everyone – only close people – asking people b/c of their level of obligation
  2. elderly's lifestyle – asking people based on the lifestyle of the elderly – i.e. if he is  religious, take that into consideration when asking someone to help
  3. closeness vs. distance – some things can be done by phone, others nee a closer proximity in order to help with
 

Litwan: speaks of 3 supportive elements of social network

  1. affective
  2. instrumental
  3. affirmative

àparallel to the aforementioned 

-we need to look at support network in several ways:

  1. structural: size/makeup/density [how much do they meet]?
  2. Interactions – the dynamics w/I the network – how long do network members meet/mutuality and help received by the elderly
  3. Content: is it instrumental/emotional
 
 

-when the structure and dynamics are varied, then the psychological welfare of the elderly is better 

Litwan: quotes a study [organization=ALE] -of elderly using a day-center for the elderly. The purpose was to see the differences b/w formal and informal supportive networks.

Today: we can also speak about support neighborhoods: a person is in charge of dealing w/ a number of elderly's houses/whole neighborhoods

-Eshel organization has 13 by 1996. gives support for those elderly still wanting to live in the community

  1. each such neighborhood has a person who helps with house-chores
  2. follows and helps in medical emergencies
  3. contact infrastructure for emergencies
  4. social visitations to reduce isolation
  5. warm/cold meals handed out by volunteers
  6. social worker helps the neighborhood people, including promoting their rights/benefits
  7. volunteers also help out with chores [i.e. follow to the bank]
  8. enrichment program/off-hours medical visitations
 

-such a community will also try to undo obstacles for daily living in the neighborhood – i.e. add benches/etc… 
 

-the biggest informal network is the family. In the past, family unit was incredibly central and important to one's life. The norms of filial obligations [i.e. norms of the kid's behavior t/w parents]. Today, we have a modified extended family: the family is no longer nuclear, but there is some contact with a main family caregiver. So you can also have distance intimacy: the closeness is also with a distance – i.e. more phones/less visits. Even such a relation improves the elderly's life by improving his social interactions [reduces loneliness]. 

Class – 31/3/2008

Family theories

In the past, the family was multigenerational/extended/traditional. The elderly has a respected place in the family. In the modern world, the family has a:

-study shows that the myths of detachment from elderly family –are not true – there are relationships/mutual support – but different than the traditional families 

Intergenerational family solidarity

A theory which tries to analyze the intergenerational family solidarity today

Measures:

 

-this theory mirrors the exchange theory. Solidarity means that also the younger generations receive something and not only give. This is the basis of any kind of solidarity. 

You need 3 elements

        1. instrumental/material exchange
        2. emotional exchange - expressive
        3. symbolic exchange – the ace[ting of his meanings/symbols – traditions
 

àthere needs to be a balance:

Question: nice theory, but what happens in reality?

Answer: in families when age changes the regular activities of the families, there is a normative crisis 

Normative crisis – [from family theory]

  1. homeostasis is disturbed
  2. new balance of borders
  3. new family roles
 

àsuch changes burn up a lot of emotional energy. It adds stress to the family's life 

Sherf: said the same thing in different words:

-you have 3 dilemmas of change, when the elderly's needs change:

  1. individual responsibility vs. collective responsibility
  2. closeness vs. distance
  3. individuation vs. mutual dependency
 

àthe family needs to emphasize different things in different times in the lifecycle.

ài.e. in more individuality in adolescence. More closeness/collectiveness w/ aged person 

Implication of family

 

Kaplan: who spoke of the distress situations – condones support systems for elderly- especially for childless – i.e. adopting grandkids 

-when in distress, how do the kid react to the aging parents?

àDurkheim – reverse hierarchy –the kids are on top of the parents 

 

possible issues:

 

possible conflicts b/w elderly and kids:

 

kinds of conlict:

 
 

kid's reactions

  1. over-active kids – i.e. the guilty kids stated about –they might break down b/c of their over-activity w/ their aging parents. Their own family life might also fall apart
  2. constantly avoidant – hiring a helper is not enough o answer emotional needs of the elderly
  3. move b/w extremes – i.e. those parents who press the already helping kid – make the helping kid's task harder – and sometimes to the point that they b/c avoidant for a while, before guilt brings them back – it becomes zigzag of help/avoid
  4. constructivity – a kid showing familial maturity – which means the adult child is able to get over the unfinished business and help the parents in a decent way, but not at the expense of their own life.
 

Intergenerational family solidarity: benefits

 

next class gender diff/็ๅ๗ ๑้๒ๅใ/empowerment 

April 7, 2008

Mechanisms influencing our lives in dealing with events

 

Gender differences of the caregiver

Example: Flora – an elderly woman who lives in a staircase because the child who she was living had some unfinished business w/ her àshows that it could lead to abuse 

Kinds of elderly abuse:

 

-a woman in mid-life has a special relationship w/ elderly mom 

Neugarten; this mom represents the bridge b/w the young girl (daughter) and the elderly (her mom). She has internal representations of both of them. The females seem to have a more of a main caregiver/kin keeper role 

Why do girls take the caregiver role more?

-boys are less into the family relationships thingy.

      àwith age, males become more care/family-minded 

Gilligan//Karen Horney: spoke of women's development of identity is more positivistic terms than Freud 

Freud: in oral and Anal stages, both genders go through similar stages = and mother is there for a significant model of trust and security 

But! In oedipal stage, daughter competes with mother and boy competes with dad. The boy resolves the oedipal conflict by identifying with father, and girls resolve the oedipal conflict by identifying with mother. In oedipal resolution, the boys distances himself from mom and femininity (that same familiar/constant figure that they had since birth), while the girls do not distance themselves from the mother. Instead, as part of the oedipal resolution, the girls work on maintaining that same constant figure. Reminder: Karen Horney, a psychoanalyst specializing in women's issues would see the female development dynamics much more positivistic 
 

In adolescence: boys tend to seek large groups for their developing identity. They focus on activities ("sharing by activity") – i.e. sports, gangs, etc.... Girls on the other hand seek smaller groups based more on emotive interaction. In adolescence, there is tension between the girl and the mother since the girl is becoming more of a woman/sexuality/etc… à and this is hard for the mom ("post-oedipal tension") 

When girl marries/her own 1st baby

-the mother/daughter relationship improves. Daughter accepts her mom's dispositions as a mother since now, as a mother herself, she sees them too.  Unfinished business gets resolved. 

When the daughter becomes middle age (and fat/ugly – just like the men), her mom is by now approaching elderliness. And because of her disposition of emotional sharing, she becomes the kin keeper – a bridge to both her own daughter/mom – women try to be at center of social web (while men try to be "at top of pyramid" –top of hierarchy) 

When the woman's mother gets old

-had for the now woman, since her mom was a source of support – she hasn't "left"/detached from the mom relationship, as the boys did

àCassandra conflict = conflict b/w loyalty to kids and to own mom 

Elderly nurture law – ็ๅ๗ ๑้๒ๅใ

-this Israeli law was passed in 1988. the philosophy of the law was that the elderly need to live well and in their communities for as long as possible before being taken to institutions. In past, the elderly's children took advantage of the government pension plan and took their money. Nowadays, they don't get $ - they get services 

Actual law;

 

àsome elderly can't do the basics (shower, etc…) – so they get 15.5 hours of weekly help – or – diapers – or – transport to social club 

-often the elderly is too ashamed/self-concept is too rigid to report that they need help. Social workers could help with that 

Doctors/social workers/nurse come as part of the procedure to get this service – they see the elderly's needs. Sometimes also a Bituach Leumi agent (the National Insurance of Israel) 

Empowerment:

Definition of empowerment: process of movement from helplessness to control over life/environment – improvement of control/actual usage of control in their life is good against stigmas/social segregation of the elderly. Empowerment has greater emphasis lately 
 

3 psychological elements of empowerment

  1. locus of control the need for full control over life
  2. self-efficacy: sense of contribution/ability vs. self and others
  3. self-concept: belief in oneself = self-efficacy + locus of control
 

levels of empowerment

  1. personal environment – empowerment of  the individual =by getting him involved in his processes
  2. social (collective) empowerment: getting organized to advance a group's common interests – in Israel, every city has a volunteer program with the aim of helping the elderly empower themselves. For empowerment to really happen, the elderly has to be involved. Social empowerment is the move from collective helplessness to more control over situation
  3. practice empowerment – working with the elderly is hard. You need to empower them so they can work better
 
 
 

case management

-works well for elderly – they have many needs and many different institutions involved. Therefore, they need someone to help the elderly get organized with the services 

Factors:

  1. usually done in long term treatment
  2. many concurrent needs
  3. cases which need coordination
 

Elderly need Social workers for:

  1. identification
  2. evaluation
  3. defense –๑๐โๅ๘
  4. Advising
  5. Treatment
  6. Coordinator
  7. Mediator
  8. negotiator
 

-a case manager needs to map out an ecological map of all the relationships and which kinds of relationships (good/weak/bad)

-tip for test: study
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