Читать книгу Survival Manual for Elders: Encouraging Elders' Resiliency Potential - Melanie J.D. Adair - Страница 6

Have you ever been a patient in a hospital? Or have you ever visited a medical office where no one really knew you? Have you experienced being in a situation where others told you what you had to do and made decisions about your life without explaining their opinion and getting your input? Have you experienced what it is like to have someone talk to you in a condescending way and act as if you are simply an object and not a person?

If you are in a serious, life and death situation, in which you are dependent on skill and technology, then being treated largely as a non-person may not be important, as long as your life is saved in the process. Living out your life primarily as a patient, though, is no way to live. It takes away your personal identity and sense of purpose. Living as a patient results in a constant focus on one’s pain or disorder, which researchers consistently find makes the pain worse. It also creates a sense of hopelessness, depression, and despair because it seems like life, as you have known it, is over.

Treating others like patients instead of people causes very serious problems that could be avoided. John’s physician, who didn’t really know him and what was meaningful in his life, made a cavalier judgment and told his family that John needed to be in a nursing home and using a wheel chair. After all, John was 95 years old. The physician couldn’t be bothered to really take the time to look at exactly how and why John was having trouble, and then help John and his family figure out options to solve the problems and maintain those things in life that were important to John.

John’s family was wise enough to realize that the physician didn’t have John’s best interest in mind. Instead, John’s family found a nurse practitioner who, after taking the time to get to know John, recognized that John didn’t need a nursing home. He was simply having trouble bathing and dressing himself. Temporary help to assist John, along with 90 days of work with an occupational therapist, renewed John’s independence. Most people who are placed in a nursing home don’t need “nursing” care; they simply need some help.

The nurse practitioner also took the time to determine why John was falling. The solution certainly was not to confine him to a wheelchair, which in the long run would make him weaker and more likely to fall. The solution was some physical therapy to strengthen his legs. Most importantly, she took him off the prescription medication that was making him weak and a little confused. She substituted a medication that was equally effective without the harmful adverse side-effects.

Part of the Ageist attitude that permeates our society is that older people become “walking medical basket cases.” Party shops are full of cards and party paraphernalia that equate growing older with bladder problems, memory loss, confusion, difficulty walking, vision and hearing problems, and a host of other medical disorders. We are frequently encouraged to make fun of these disabilities. We would never think it appropriate to make fun of someone who was blind from birth, or a soldier who had lost a limb, or a child with learning disabilities. Yet, we are not hesitant to make fun of older people with the same problems. This attitude contributes to our willingness to blindly accept the notion that older people should live out their lives as “patients.” This negates the elder’s Resiliency Potential.

When elders are helped to see themselves as empowered people, resilient and able to bounce back, they are much more likely to experience good outcomes. When family members and health care professionals also have an attitude of resilience, they are much more likely to find creative strategies to help elders stay fully involved with life, even in the presence of medical challenges.

One example of resilient creativity comes from Bill Thomas, M.D. and the Eden Alternative.

Nationally, there is a massive movement under way to help end the institutional attitudes and approaches to care that make elders into permanent patients. Known as the Culture Change Movement, it is being led by the Eden Alternative and by the Pioneer Network. Dr. Thomas, an internist and geriatrician, has studied what happens to elders who end up in nursing homes. Rather than thriving because of the care, he has found that too many elders simply become a “non-person” with their bodies warehoused and their spirits often broken. These elders spend their days filled with loneliness, helplessness and boredom which Dr. Thomas calls “the three plagues.”

Dr. Thomas believes that in the years to come, nursing homes as we now know them will disappear, because no one thrives as a permanent “patient.” For those who need help, even nursing care, there will be small group homes or assisted living type settings. Medical care will come in and go out – much like the “house calls” physicians made years ago. The “person” (formerly known as “the patient”) continues to focus on living life in personally fulfilling ways, which, in the long run, helps assure better health and increased happiness.

Older people may experience medical problems that must be treated. The concern arises when life, itself, becomes centered around those problems. In those circumstances, elders do not thrive but become anxious, disengaged, and depressed which often makes the medical condition even worse.

It is vitally important to stay focused on helping elders have the most meaningful and full life possible, regardless of their health issues. An injured athlete stays involved with the team, attends practices and is continuously working to get back in the game. In a similar way, it is vitally important to help older adults stay in the game of life. Treatment for any medical problem needs to happen around the edges of life, not become its central focus.

Although it may sound comforting to have a loved one in an institution, unless they have serious, chronic medical problems such as a colostomy, permanent catheter, feeding tube, or respirator they do not need 24 hour nursing care. Help with medications, blood pressure checks, and other monitoring can effectively occur around the edges of life. Staying engaged with the most normal life feasible not only results in happier, better satisfied elders, it also actually increases the likelihood they will be able to bounce back from illness or injury. They are also likely to live a longer and healthier life. No one thrives as a “permanent patient.”

Helping elders “bounce back” instead of becoming permanent patients also greatly reduces the cost of elder health care, keeping medical services available to those most in need. Building a system that promotes the Resiliency Potential in elders increases their quality of life and functional independence while also reducing the costs of care.