This assignment will discuss how one is aged gracefully from physiological, psychological and social aspects. It will include the theories related to the case study and establish the concepts of independence and autonomy within the process of ageing. Moreover, evaluating the significance of collaborative interdisciplinary and inter-agencies involvement within elderly care and lastly concluding current issues regarding health and social care concerning the elderlies.
During the discussion, verbal consent was taken from Rabia to maintain confidentiality rights from the Nursing Midwifery Council section 5 (NMC, 2019). Rabia is a 65yrs old female, widow and mother of eight children with multiple medical conditions. Forty-eight years ago, Rabia moved to the UK after marriage with no spoken English or educational background; however, she managed to assist people with physical and mental support. Encouraging moral support through pregnancies, writing letters in Bengali for family abroad and going to hospital appointments with many; Arranging charity events and raising money for the local mosque; Trending a knitting contest within the society, also working from home sewing professional uniforms and packing cards for factories. Rabia is a very active woman and enjoys cooking, household chores, shopping, knitting, going on walks and travelling independently abroad. Rabia suffers from cardiovascular diseases with stents fitted in her arteries, with high blood pressure, angina, type 2 diabetes, asthma, cholesterol, arthritis and one functional kidney.
Ageing is a process where one is not recognised chronologically, instead of how they are shaped biologically, psychologically and socially . Although ageing is inevitable, the process of ageing is not established by a particular age or time, hence being different for everyone, with the influence of genetic, lifestyle and environmental factors .
Physiologically, ageing with time deteriorates the organs to slow down in losing their ability to function, the process of ‘wear and tear’ begins to appear through visual appearance of an individual . Which can be recognised when an individual’s skin loses elasticity and becomes wrinkled, with grey hair and reduced movements, also developing poor visions in eye sights. Homeostatic variations gradually reduce and becomes less effective, even though all systems become affected with time, the primary indication of health deteriorating is identified within the renal and cardiovascular system. As with age, people have osteoporosis where one’s muscle and bone density decrease causing bone diseases and breakages, therefore the body becomes less resistant to diseases and pathology and is unadaptable to physiological stress
Rabia, in her thirties, suffered from hypertension and became dependent on medications. However, this does not identify that age is one of the factors .
Further, she developed heart conditions and high cholesterol; this could be due to lifestyle and genetic factors . After menopause, Rabia was diagnosed with a low level of vitamin D and mild osteoporosis and is dependent on Vit D and calcium tablets . Later into her age, she developed rheumatoid arthritis in her left hand and carpel and is taking a natural analgesic for a pain reliever. However, this does not stop her passion for cooking and knitting.
Furthermore, she was diagnosed with type 2 diabetes and is on diet control will medications. Recently Rabia has been suffering from mild damage to her nerves, hence using modern technology has become challenging with the loss of sensation in her fingers. Despite her medical conditions, it does not discourage Rabia from managing her daily chores. Lastly, Rabia suffers from asthma and uses regular inhaler; every winter, she requires a flu jab to protect her from viral infections. However, according to British lung foundation statistics indicates that diseases related to the respiratory system have no link with ageing . Therefore, physical factors related to diseases does not associate with ageing, except researchers identify that reduced activities increase risks of diseases and ill health at any age.
Whereas, the Psychological aspect of ageing structures, the impairment of physical and cognitive capabilities, resulting in one’s slow reaction to self- efficacy, self- resilience and emotional state . Rabia psychologically was affected by the sudden death of her husband, whom she lost via the medical procedure. Although suffering from bereavement, she maintained self - resilience to provide for her family, regardless of her medical conditions. As a widow working from home, Rabia’s positive behaviour diverted negativity from trauma and depression to continue with life, by spending quality time with grandchildren, which regenerated emotions of feeling young and blissful, which links to the activity theorist Atchle. A few years later, Rabia lost a healthy kidney due to cancer, which did not quiver her competencies to be immobile, moreover striving to be actively involved with her lifestyle. Hence, linking to Costa & McCrae (1980), who identifies the Continuity theory in older people allows one to preserve personality and behaviour they attained in earlier years, which can be associated positively with Rabia in ageing gracefully.
Conversely, the Continuity theory contradicts Cumming & Henry’s (1961) Disengagement theory, stating that ageing withdraws one from the society to be socially isolated and become self-focused. In contradiction to the disengagement theory, Rabia is actively involved with local charities in raising funds for mosques and socialising, furthermore independently travelling abroad to engage with family members. Likewise, Atchley (1980), states that being socially adequate is a symptom relating to ageing within the older society, besides that older people contribute a significant amount of support to charities and their families which is invaluable, for which Rabia values to be socially active in engaging with family and society.
Additionally, defining independence is where one can individually control physical functioning to organise a full day routine independently (Independence, 2019). Likewise, autonomy is to have the freedom of making choices and decisions for oneself without the influence of others (Autonomy, 2019).
Similarly, the Self- Determination theory (SDT) identifies that one needs to have three basic needs: to make independent decisions, to be competently autonomous and must be relevant (Dattilo, Mogle, Lorek, Freed, & Frysinger, 2017). Doyle & Gough (1991), discusses that good health and autonomy are two basic needs for all individual requirement, which disproves Rabia’s situation, although with multiple health conditions she still holds the capacity to make independent choices. Conversely, Sen (1992) advises to focus on one’s capabilities, hence claiming that achievement of capabilities or autonomy is essential for individual freedom, Rabia can live independently, which is achieved by her competencies. On the other hand, Marmot et al. (1997); Hemingway and Marmot (1999) identifies how lack of autonomy and independence can lead to poor health outcomes. Therefore, lack of liberation in ageism can lead one to be dependent on caregivers, services and family. Thus, Rabia values her independence, but fears with ageing her health may deteriorate to become dependent on family and health services.
Subsequently, the Mental Capacity Act (MCA, 2005) allows one to make autonomous decisions, Rabia has the choice to live independently in her house with her youngest daughter and grandchildren, which demonstrates her freedom and competencies to live according to her choices.
Additionally, the MCA (2005) legally protects vulnerable people who lack capacity in making decisions, protecting and safeguarding them through the process of decision-making. Furthermore, unpredicted circumstances may cause one to lose the ability to make autonomous decisions. Thus, the MCA (2005) consents individuals to prepare in making future decisions, whether to accept or refuse treatments (MCA, 2005). Equally, one must abide by the legal framework of Lasting Power of Attorney, which authorises one to appoint a trustworthy person to make autonomous decisions on behalf of them (Make, register or end a lasting power of attorney, 2019). However, Rabia is yet undecided of who will make future decisions regarding her care but does believe her daughters will decide in her best interest when she lacks capacity.
Additionally, the Care Act (2014) safeguards vulnerable adults from mistreatment and enhances the quality of life; the caregivers must abide by the principles which emphasise on human needs being met via protection from abuse and neglect. Although Rabia demonstrates her capacity for not planning her future care, the daughters consider it as an unwise decision. Furthermore, the health professionals and carers can observe for changes within Rabia’s capacity (Care Act, 2014). As a result, the crucial part of successful ageing in elderlies is to empower independence and autonomy, maintaining these principles encourages elderlies to continue their independence and autonomy extensively, which is essential for the current healthcare system (Reed, Clarke, & Macfarlane, 2012).
Moreover, the healthcare system has modified from medicinal to preventative strategies, for which collaborative methods embeds the health systems to effectively work closely with organisations and professionals from private, public and third sectors (Miles & Trott, 2011). World Health Organisations (WHO, 2010) outlines interpersonal, collaborative practice (IPC) delivering highest possible care across the settings, multiple health workers from different professional backgrounds work closely to provide comprehensive services to patients, carers and communities to enhance cost-effective care. Accordingly, interdisciplinary and interagency collaboration provides quality and adequate provision which advances resources in delivering holistic care and person-centred approach for those in need associated by social and health services (Practice development: Collaborative working in social care, 2010).
In the UK the Kings Fund and Richmond group of Charities collaborate to identify in reducing unplanned and lengthy hospital admissions, highlighting the significance between primary and social care by supporting elderlies to remain in their own homes (Baylis & Perks-Baker, 2017).
For which in Rabia’s circumstance, multidisciplinary teams assessed her well-being around her home, identifying she is unable to climb stairs due to medical conditions, therefore with the collaborative team they arranged a room downstairs with a walk-in shower and toilet to enhance her quality of life. The National Health Services (NHS) policy allows Rabia to be monitored routinely for cancer and retinal screening due to diabetes (Priorities for the Plan, 2018). The GP authorises the nurses to schedule Rabia for an asthma review, cervical screening and flu jab. At the same time, Social Services and Department of Work for Pensions (DWP2019) has systematised her financial support including a blue badge to support in long distance travelling and is entitled to winter fuel allowance (GOV, 2019; DWP, 2019). Which identifies the relevance of collaboration of organisations and health professionals delivering holistic care in support to Rabia’s care plan, however, without the collaboration Rabia would have been on a long waiting list with delayed care.
Nevertheless, the significance of effective interpersonal collaboration in health and social care organisations is increased due to a high level of co-morbidities, increased prevalence of intricacy and modified care, an upsurge of chronic diseases and shortages of global staff with tireless working hours (de Silva, 2014). Consequently, these issues have been raised within long-term care in older people, resulting in difficulties to fund for future treatment due to people living longer than usual (Martikainen, Einio, Moustgaard, Metsa-Simola, & Murphy, 2012). Due to the misconception of free NHS treatment has also increased pressure on social care to arrange funds, thus, impacting tremendous challenge for the government to tackle in providing long term care in organisations (NHS, 2017). According to The King’s Fund, the Health Foundation and the Nuffield Trust, these organisations have studied how NHS lacks resources to maintain quality in patient care (Davies, Nick; Campbell, Lucy; McNulty, Chris, 2018). Moreover, to reduce the gap, the government has raised taxes in food, student loans, increased cooperation tax and council tax to fund for NHS services (Torjesen, 2018). However, raising taxes on sugary foods, cigarettes and alcohol was also a method to prevent ill health and diseases, as this will discourage one from spending (ONS, 2017).
However, the main concern for elderlies to receive long term care and support, one needs to be mean tested with the assets holding less than £17,000 if over £23,500 one does not qualify for financial support and would need to pay for their future care (Teale, 1996). For some elderlies, their house is the only asset they hold, to sell that for future care would be difficult for one to let go (FirstStop, 2013). Hence, in Rabia’s case selling her house to receive future care would be unacceptable for her, due to the attachments she holds with the house, which will affect Rabia’s long term care in future and will have an impact on her family members to support financially. However, due to Rabia’s cultural background, families tend to look after their parents until the end of life, supporting parents in their own home.
In conclusion, this discussion identifies the importance of autonomy and independence, which is vital for all individuals of any age. If one has the autonomy and independence, they have the freedom to live a happier life and age according to their conditions, despite one’s medical conditions. Although the UK has a growing ageing society, it also increases concerns of funding for long term care, even though the collaborative organisations speed up care services regarding elderlies, raised taxes fund for social care and NHS which is discouraging for older people who have no asset including impacting on Rabia’s future care (DOH, 2001)