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This report will focus on the needs of an older person using the ideas of developmental theorists. The subject of the case study will be a 70 year old female called Y and the key theories discussed will be Erikson’s life cycle model and Maslow’s Hierarchy of Needs.
I have based this study on a lady who I will refer to as Y. She is a neighbour who I have known for several years and is 70 years old. She had a fall recently which left her hospitalised for a short period with a broken shoulder. Her mobility is also waning due to arthritis and her shoulder injury has left her unable to drive and requiring physiotherapy. She also need short term help with aspects of personal care such as washing and dressing. She is a widow and I know her (adult) children fairly well. She and the family know that I am studying social work and one of the children had actually asked me for some advice recently about her mother’s situation and how they might access support services. I have had some discussions with the family and told them about this assignment during the course of these discussions; they have given me consent to discuss Y’s case. Y still has capacity to give consent this type of issue and she is also happy for me to use her details on the understanding that she will remain anonymous.
Once I had obtained consent for Y and her family and provided assurances that her information would be kept confidential, I met with her on three occasions to discuss her needs, her feelings about her situation and how her situation might be improved. I had access to her medical records; I also met with her son and daughter on one occasion to discuss their mother’s situation. The interviews lasted around thirty minutes and were relatively informal.
Developmental stage and psychological models
The development model that I am applying to this case study is Erikson’s theory of psychological development. It is a model that believes personality development is something that continues through the course of a person’s life and Erikson breaks this down into eight different stages of development. The early stages cover the first stages of a person’s life. Moving through adolescence into young adulthood and middle age. At each stage Erikson’s model explains some of the thoughts and feelings that are likely to occupy a person’s mind, and discusses how success or failure in work or relationships can impact on a person’s psychological well-being (Newman and Newman, 2012).
It is the latter stage of Erikson’s model that are most relevant to Y. She has passed through stage 7 which Erikson sees as a period often pre-occupied by careers and parenting to the final stage of the model which is labelled Integrity vs Despair. At this point people are often examining their lives and considering whether they have a feeling of contentment about what they have achieved in life or feelings of disappointment. They are often worried about the future and there is a gradual realisation that the end of life is imminent (Ryan and Coughlan, 2013).
Erikson wrote about the concept of ego integrity and that people analyse that opportunities they have taken or lost in life. If people feel that they have not made the most of life’s opportunities there can be a feeling of despair that they no longer have time to put it right (Ryan and Coughlan, 2013).
When I applied this theory to Y I found that she was a person who was on the whole happy with what she had achieved in life. She had enjoyed a career working in local government; she had been happily married and raised two children who seemed to be going on to live fulfilling lives. I did not feel that Y had regrets about the past but she was starting to worry increasingly about the future.
Any view of Y of course should take into account her wishes, feelings and needs as an individual rather than simply looking at her age and pigeon-holing her according to a theoretical model, Social work as a profession should avoid stereotyping (Zastrow, 2014) and this is something by social work codes and standards
Attitudes and belief systems
My discussions with Y have me an insight into her attitudes and belief systems. Returning to Erikson’s model, I found that she had a positive view of her life to date but was increasingly concerned that the period of her life where she is an active citizen is coming towards an end. This is a view that can be held by other in society about older people. Ageist views that older people are a burden to society rather than making a contribution exist (Thompson, 2003) and I felt that Y herself was buying into this outlook.
I also felt that Y was worried that her lack of mobility would prevent from achieving her goals of playing an active part in the lives of her young grandchildren. Again, Erikson’s model suggests that dissatisfaction in the later stages of life can lead to despair and this was a concern about Y.
I have given consideration to Maslow’s hierarchy of needs in looking at what psychological needs Y might have. Maslow argued that people are motivated to satisfy a certain level of need before being motivate to move on and meet the next (Mcleod, 2007).
Y has safety needs at this point. Her fall and her limited mobility are making her more vulnerable at home. My discussions with her established that she was concerned about having more falls or her mobility continuing to wane. She needs to be reassured in some way that her current condition is hopefully temporary, that she will recover from her shoulder injury and soon be as active and independent as she had been prior to her fall.
The next of Y’s needs from Maslow’s hierarchy that should be prioritised are her love and belonginess needs (McLeod, 2007). She clearly receives love from her family but her current lack of mobility, particularly the fact that she cannot drive until her should has healed, means that she is having less contact with family and friends; she is also reliant on people coming to her rather than being proactively able to go and make contact with friends and loved ones.
Maslow’s theory touches on the importance of self-esteem and this may well be a particular need of Y at the moment. She is feeling vulnerable due to a combination of age, declining mobility and a feeling that she is less able to look after herself than previously. She needs to get her confidence back and getting out and doing the social activities she has done prior to her fall will be central to her recovery both physically and psychologically.
I think that one of Y’s greatest needs over the next few months will be to remain engaged with the community around her. There is a concern that social isolation could lead her into depression; she will begin to overly dwell on the negatives of her situation and consequently move into a downward spiral both psychologically and physically.
Recommendations for holistic care needs
In the short-term, Y needs a carer to visit her once a day to help her get washed and dressed. She can make basic meals but a temporary frozen meals service might also be useful for her.
She will require ongoing physiotherapy for her shoulder. Monthly sessions at the local hospital should be a minimum but she also needs to take responsibility for doing her exercises each day.
A holistic assessment should also focus on her mental health; Y may be prone to some level of depression and this is something that professionals and family need to monitor. Counselling sessions should be commissioned if required.
Y should also be in touch with Age Action so she can use their information service, in particular in relation to social activities and travel whilst she cannot drive
There are a number of practical steps that can be taken immediately to make the home environment safer for Y and hopefully improve her overall well-being. One thing that she can do is identify current hazards in the home that increase her risk of falling and remove them. This might simply be furniture or ornaments in places that cause a problem. She can also invest in making the bathroom safer with rubbers mats and by installing hand rails around the bath and shower.
I would recommend that anyone caring for Y, whether this is a family member, neighbour, professional carer or volunteer, undertakes training with the HSE. Specific training courses such as 2Care in the Home” can provide guidance for carers on basic aspects of care such as feeding, washing and dressing.” In the short t-term, Y only needs assistance with dressing due to her injury and hopefully she will be able to manage her personal care in the medium term. If her abilities deteriorate however it is useful to have people with the correct skills on hand.
For Y’s family, this is the time in Y’s life where they may need to look for support as carers. Carer’s Allowance and Respite Care Grants may be some of the types of financial support open to them and I would recommend that they speak to their local Department of Social Protection office or research the help and support available to carers at http://hse.ie/eng/services/list/4/olderpeople/carersrelatives/Support_for_Carers.html
From a policy perspective, my experience with Y makes me feel that the government should have a focus on social inclusion for people in later life. Social care should not just be about the provision of personal services, it should also understand the psychological fears that older people have as they move toward the end of their lives and appreciate the importance of human relationships to them. Finding ways to allow older people to connect with others should be a central policy aim.
Long term consequences
The long term consequences of failing to meet Y’s needs are both physical and psychological. Failure to make her home environment safe could lead to further physical harm but a failure to meet psychological needs can also be damaging. Maslow’s theory stressed that the failure to meet one need leads to a lack of motivation to meet others (Moyle et al. 2014). Erikson’s theory also referred to the feelings of despair that can occur in later life (Moyle et al., 2014). If Y’s needs around contact and relationship are not met, her self-esteem will suffer and she will lose the motivation to do the things in life that make it worth living. Depression and despair may then follow.
Ethics and values
My engagement with Y and her family has been in line with the IASW standards; I have proposed solutions that are in Y’s best interests and acted in an honest and trustworthy fashion, ensuring confidentiality and essentially looking at ways to promote the rights of Y whilst ensuring that she does not take actions that might cause her harm (IASW, 2009). I am sure that Y is safe and looked after by her family but I think it is important that she understands her limitations at this point and does not allow her frustration to lead her to ‘run before she can walk’ in terms of long term recovery.
One of the key elements of the IASW Code of Ethic is that “truly valued, fully human life is generally realised by individuals living and acting interdependently in communities;” (IASW, 2007, P2) and I feel that my engagement with Y has been to encourage to get back to her life living interdependently in the community as soon as possible.
My reflection on my engagement with Y and her family was that I engaged with her in a respectful and person-centred manner. My prior knowledge of Y and her family made the situation a little easier; I knew that they trusted and there were no professional power barriers impacting on the interviews. I felt that I used my communication skills well and asked questions best suited to gathering the relevant information from Y and her family so that the best recommendations could be made.
I hope that my intervention has been a positive development for Y and that she will take on board the suggestions I have made. I feel that we developed a relationship based on trust and that she valued the knowledge and ideas that I offered. I do believe that she will benefit from my work with her.
List of References
- Age Action (2015) Information Service. [Online] Available: [https://www.ageaction.ie/how-we-can-help/information-service] accessed 2nd February 2016
- HSE (2015_ Support for Carers. [Online] Available: [http://hse.ie/eng/services/list/4/olderpeople/carersrelatives/Support_for_Carers.htm] accessed 2nd February 2016
- IASW (2009) Code of Practice [Online] Available: [https://www.iasw.ie/attachments/2eb7f6f6-ca51-4f38-b869-df7e0b411e91.PDF] accessed 2nd February 2016
- IASW (2007) Code of Ethics [Online] Available: [https://www.iasw.ie/attachments/8b37e75a-26f6-4d94-9313-f61a86785414.PDF] accessed 2nd February 2016
- McLeod, S. A. (2007). Maslow's Hierarchy of Needs. [online] Available: [http://www.simplypsychology.org/maslow.html] accessed 2nd February 2016
- Moyle, W., Parker, D. and Bramble, M. (2014) Care of Older Adults: A Strengths-based Approach. Cambridge University Press
- Newman, B. and Newman, P. (2012). Development Through Life: A Psychosocial Approach. Belmont: Wadsworth
- Ryan, P. and Coughlan, B. (2013) Ageing and Older Adult Mental Health: Issues and Implications for Practice. London: Routledge
- Thompson, N. (2003). Promoting Equality – Challenging Discrimination and Oppression, Palgrave Macmillan: Basingstoke
- Zastrow, C. (2015). Social Work with Group. Stanford: Cengage