combined units

Combined Units

Provide support to an older person

Provide support to meet the emotional and psychosocial needs of the older person

Provide support to maintain independence

RespectRespect

• To hold in regard.To hold in regard.

• Avoid degrading, insulting, injuring or Avoid degrading, insulting, injuring or interfering with or interruptinginterfering with or interrupting

• Treat with considerationTreat with consideration

CourtesyCourtesy

• Polite or considerate in behaviour or Polite or considerate in behaviour or wording.wording.

• Courteous behaviour (kindness)Courteous behaviour (kindness)

TrustTrust

• Firm belief in a person or thing which may Firm belief in a person or thing which may be relied upon.be relied upon.

• Feel sure of the loyaltyFeel sure of the loyalty

• Without fearWithout fear

PrivacyPrivacy

• Not open to the public domainNot open to the public domain

• Seclusion, keeping matters to themselvesSeclusion, keeping matters to themselves

• Only shared in confidence with ones they Only shared in confidence with ones they can trustcan trust

DignityDignity

• Claims to respect one wishes, rights and Claims to respect one wishes, rights and privacyprivacy

• Suitable behaviour which does not Suitable behaviour which does not degrade anotherdegrade another

ConfidentialityConfidentiality

• To keep private unless it impinges on To keep private unless it impinges on another’s health or safetyanother’s health or safety

• Keeping a secret, unless it is required Keeping a secret, unless it is required to be disclosed by law or above.to be disclosed by law or above.

Ensure self-introduction occurs Ensure self-introduction occurs appropriatelyappropriately

• Self introduction is important when working with Self introduction is important when working with anybody, anybody,

• Our culture and indeed many cultures consider it rude, Our culture and indeed many cultures consider it rude, so be aware that clients you work with will have an so be aware that clients you work with will have an expectation that you greet them in a way that is expectation that you greet them in a way that is respectful to them. No one wants to be treated with respectful to them. No one wants to be treated with intentional or unintentional disrespect. intentional or unintentional disrespect.

• No matter how busy you are or how hectic it gets there is No matter how busy you are or how hectic it gets there is no excuse for rudeness and disrespect.no excuse for rudeness and disrespect.

Ensure self-introduction occurs Ensure self-introduction occurs appropriatelyappropriately

• You will probably find that over time as You will probably find that over time as you get to know the clients better, you may you get to know the clients better, you may change the way in which you greet them.change the way in which you greet them.

• The best you can always do is maintaining The best you can always do is maintaining the respect of the person at all times. the respect of the person at all times.

• If you feel uncomfortable in being If you feel uncomfortable in being respectful, respectful, that’s your problem!that’s your problem!

Principles of Effective Principles of Effective CommunicationCommunication

• Maintain courtesy in all your interactionsMaintain courtesy in all your interactions

• Listen and respond with empathyListen and respond with empathy

• Observing and listening actively at all timesObserving and listening actively at all times

• Respect the individual differences of each Respect the individual differences of each personperson

• Maintain a non-judgemental attitude in all care Maintain a non-judgemental attitude in all care situations.situations.

• Most of the breakdowns that occur in Most of the breakdowns that occur in relationships and in communication do so relationships and in communication do so as a direct result of people choosing to as a direct result of people choosing to ignore these principles. ignore these principles.

• The principles that will apply when you are The principles that will apply when you are communicating with people are communicating with people are maintaining self esteem, listening and maintaining self esteem, listening and responding with empathy and involving the responding with empathy and involving the other person.other person.

Maintain self esteemMaintain self esteem

• Our self esteem is made up of all the attitudes Our self esteem is made up of all the attitudes and beliefs that we have about ourselves. and beliefs that we have about ourselves.

• It is the total picture we have of ourselves, or the It is the total picture we have of ourselves, or the way in which we see ourselves.way in which we see ourselves.

• Interactions with others shape our self esteem. Interactions with others shape our self esteem.

• From the way that other people treat us we learn From the way that other people treat us we learn if we are liked or not liked, a success or failure, if we are liked or not liked, a success or failure, acceptable or unacceptable.acceptable or unacceptable.


• A person’s self esteem also affects the way they A person’s self esteem also affects the way they communicate with others. communicate with others.

• A positive self esteem is necessary for healthy A positive self esteem is necessary for healthy and satisfying interactions. and satisfying interactions.

• A person with poor self esteem may feel A person with poor self esteem may feel inadequate, inferior or unworthy. This often inadequate, inferior or unworthy. This often results in difficulties in communication, results in difficulties in communication, expressing their feelings and voicing opinions expressing their feelings and voicing opinions different from those of other people.different from those of other people.


• People have the best chance of developing an People have the best chance of developing an effective message when they understand the effective message when they understand the other person’s point of viewother person’s point of view

• Since many people have difficulty clearly Since many people have difficulty clearly expressing their thoughts and feelings the ability expressing their thoughts and feelings the ability to imagine how things might look from the other to imagine how things might look from the other person’s point of view is importantperson’s point of view is important

Listen and Respond with EmpathyListen and Respond with Empathy

• People have the best chance of developing an People have the best chance of developing an effective message when they understand the effective message when they understand the other person’s point of viewother person’s point of view

• Since many people have difficulty clearly Since many people have difficulty clearly expressing their thoughts and feelings the ability expressing their thoughts and feelings the ability to imagine how things might look from the other to imagine how things might look from the other person’s point of view is importantperson’s point of view is important


• Some people say that empathy is listening with Some people say that empathy is listening with the heart as well as the head. the heart as well as the head.

• When you listen and respond with empathy you When you listen and respond with empathy you do more than just absorb the other person’s do more than just absorb the other person’s words. words.

• You also try to put yourself in the other person’s You also try to put yourself in the other person’s shoes, to see the world through their eyes and to shoes, to see the world through their eyes and to experience their feelings.experience their feelings.


• Even if you disagree with the other person’s Even if you disagree with the other person’s position, responding with empathy is likely to position, responding with empathy is likely to boost your knowledge of what the other person boost your knowledge of what the other person is communicating. is communicating.

• Empathic responding also maintains the other Empathic responding also maintains the other person’s self esteem. It suggests that the person’s self esteem. It suggests that the listener is willing to accept the speaker as they listener is willing to accept the speaker as they are, without judgement. are, without judgement.

• This in turn tells the speaker that their This in turn tells the speaker that their communication is worthwhile and encourages a communication is worthwhile and encourages a relationship of trust.relationship of trust.

• Have you ever experienced a conversation Have you ever experienced a conversation where you couldn’t get a word in? where you couldn’t get a word in?

• Or perhaps felt left out of the Or perhaps felt left out of the conversation? conversation?

• How did you feel?How did you feel?

• As a carer you will be involved with many As a carer you will be involved with many short and long interactions with your short and long interactions with your clients such as;clients such as;

Short interactions will includeShort interactions will include

• When you are assisting with morning and When you are assisting with morning and afternoon tea you may be expected to afternoon tea you may be expected to bring in the light refreshments and check bring in the light refreshments and check to see if the clients are able to manage,to see if the clients are able to manage,

• Obtaining the clients selection from the Obtaining the clients selection from the menu for the following day etc.,menu for the following day etc.,

Longer interactions will includeLonger interactions will include

• Assisting the client with their ADL’s in the Assisting the client with their ADL’s in the morningmorning

• Preparing clients for bedPreparing clients for bed

As a carer you need to be aware of how a As a carer you need to be aware of how a person’s disability can affect a person’s disability can affect a person’s ability to communicate.person’s ability to communicate.

DementiaDementia

• They have trouble remembering names of They have trouble remembering names of familiar objects or peoplefamiliar objects or people

• They can describe an object but not be They can describe an object but not be able to name itable to name it

• They have difficulty saying the right word, They have difficulty saying the right word, substituting a similar word. substituting a similar word. E.g. saying walk instead of wakeE.g. saying walk instead of wake

DementiaDementia

• They may quickly forget what has been They may quickly forget what has been saidsaid

• They may not understand because the They may not understand because the words so not have ant meaning to them. words so not have ant meaning to them. E.g. discussing television when they do E.g. discussing television when they do not remember what a television is.not remember what a television is.

• Unfortunately communication difficulties Unfortunately communication difficulties can often result in frustration and the can often result in frustration and the person becoming more withdrawn and person becoming more withdrawn and isolated.isolated.

• To improve your interactions when To improve your interactions when communicating with people with dementia, communicating with people with dementia, try the following approachestry the following approaches

• Make sure you have the person’s attention. Touch them Make sure you have the person’s attention. Touch them lightly, or call their name. lightly, or call their name.

• Obtain eye contactObtain eye contact

• Speak slowly and use simple words.Speak slowly and use simple words.

• If the person cannot think of a word ask them to describe If the person cannot think of a word ask them to describe or point out the object.or point out the object.

• Allow plenty of time for a response. Allow plenty of time for a response.

• Ensure eye contact if you need to repeat the question.Ensure eye contact if you need to repeat the question.

• Present only one question or idea at a time. The person Present only one question or idea at a time. The person may forget the first part of the question if you ask more may forget the first part of the question if you ask more than one thing at a timethan one thing at a time

In additionIn addition• Always assume that the person can understand Always assume that the person can understand

more than they can express.more than they can express.

• Never talk about somebody in front of themNever talk about somebody in front of them

• Treat the person with respect and as an Treat the person with respect and as an individualindividual

• Non-verbal cues such as photographs or objects Non-verbal cues such as photographs or objects may assist the person to understand. E.g. may assist the person to understand. E.g. bringing the fruit bowl over when asking if they bringing the fruit bowl over when asking if they would like a piece of fruit.would like a piece of fruit.

Generating a Trusting RelationshipGenerating a Trusting Relationship

• Trust is a difficult thing to earn. Trust is a difficult thing to earn.

• It can take ages to be accepted by the It can take ages to be accepted by the people you work with and also the people people you work with and also the people you work for.you work for.

TrustTrust

• Trust is often established after a period of time Trust is often established after a period of time where interactions between people have gone where interactions between people have gone well enough for each party to be comfortable well enough for each party to be comfortable with each other. with each other.

• Fast familiarity and respectful interactions may Fast familiarity and respectful interactions may not lead to the acceptance of each person. not lead to the acceptance of each person.

• It is your job to ensure that the interactions you It is your job to ensure that the interactions you have with everyone is based on sound principles have with everyone is based on sound principles that lead to the generation of trusting that lead to the generation of trusting relationships.relationships.

Generating TrustGenerating Trust

Is usually based on democratic principles of Is usually based on democratic principles of interaction which includeinteraction which include

• CourtesyCourtesy

• Listening and responding with empathyListening and responding with empathy

• Non-judgemental interactionsNon-judgemental interactions

• Observing and listening with empathyObserving and listening with empathy

• Respecting the individual differences of Respecting the individual differences of each personeach person

BarriersBarriers to Generating Trustto Generating Trust

• Barriers to generating a trusting Barriers to generating a trusting relationship are quite obviously linked to relationship are quite obviously linked to interpersonal interactions and in particular interpersonal interactions and in particular communicationcommunication

Physical barriers to effective Physical barriers to effective interpersonal communication may interpersonal communication may

includeinclude

• NoiseNoise

• TemperatureTemperature

• TimeTime

• DistanceDistance

• LightLight

• Positioning of furniture etcPositioning of furniture etc

While barriers in communication can generally be seen as While barriers in communication can generally be seen as either you or the older person not understanding each either you or the older person not understanding each other, this can take the form ofother, this can take the form of

• Difficulty understanding the language being usedDifficulty understanding the language being used

• Difficulty with non-verbal gestures and signsDifficulty with non-verbal gestures and signs

• The emotions of both you and the other personThe emotions of both you and the other person

These factors affect how we attend to the These factors affect how we attend to the speaker or message deliverer.speaker or message deliverer.

Attending consists of a number of skills or Attending consists of a number of skills or behaviours, including behaviours, including

• facing the person, facing the person,

• giving them your full attention, giving them your full attention,

• adjusting your speech and non verbal adjusting your speech and non verbal behaviour in line with their feedback etc.,behaviour in line with their feedback etc.,

• to show you are listening and not just to show you are listening and not just hearing. hearing.

• One very important factor to deal with is One very important factor to deal with is emotion. emotion.

• If you ignore this, what message are you If you ignore this, what message are you sending?sending?

• Face the person and watch their body Face the person and watch their body language for non verbal signs, as they language for non verbal signs, as they convey many things. convey many things.

• Body language is complex and is a topic in Body language is complex and is a topic in itself. itself.

• But by maintaining an open position we But by maintaining an open position we can provide encouragement to the other can provide encouragement to the other person.person.

• Don’t forget that older people may have Don’t forget that older people may have the perception that you may not do what the perception that you may not do what they want or need, or you may remind they want or need, or you may remind them of a bad experience so may fear you. them of a bad experience so may fear you.

• They may also have altered perceptions, They may also have altered perceptions, as is often the case with people with as is often the case with people with dementia.dementia.

• You will need to consider the barriers on an You will need to consider the barriers on an individual basis in order to ensure you can be individual basis in order to ensure you can be effective in building up a trusting relationship effective in building up a trusting relationship with the people you are supportingwith the people you are supporting..

• At times you may not “gel” with the person and At times you may not “gel” with the person and that can’t be helped. Not everyone gets along that can’t be helped. Not everyone gets along with everyone, it’s a fact of life. with everyone, it’s a fact of life.

• Don’t take it personally if you don’t get alongDon’t take it personally if you don’t get along

Taking into account the physical Taking into account the physical changes associated with ageing when changes associated with ageing when delivering servicesdelivering services

Aides and SupportAides and Support

Advancing yearsAdvancing years

• The decline in strength and muscle ability is long The decline in strength and muscle ability is long and gradual; there are even gratifying plateausand gradual; there are even gratifying plateaus

• At the age of 50 a man still has about 4/5 of the At the age of 50 a man still has about 4/5 of the muscle strength he had when he was 25. muscle strength he had when he was 25.

• Although physical abilities may decline, mental Although physical abilities may decline, mental abilities may actually improve during the middle abilities may actually improve during the middle years, and the ability to learn can remain keen, years, and the ability to learn can remain keen, provided the person is in the habit of learningprovided the person is in the habit of learning..

Advancing yearsAdvancing years

• It is especially important in later years to have It is especially important in later years to have regular medical and dental check ups, sufficient regular medical and dental check ups, sufficient exercise, adequate rest, nutritious food and a exercise, adequate rest, nutritious food and a positive mental attitude. positive mental attitude.

• Sensible moderate exercise in line with physical Sensible moderate exercise in line with physical capacity can give a sense of general well-being. capacity can give a sense of general well-being. It is important on these occasions to do some It is important on these occasions to do some easy stretching, pulling and rotating exercises easy stretching, pulling and rotating exercises during the warm up period.during the warm up period.

Certain needs remain constant throughout life, needs such Certain needs remain constant throughout life, needs such asas

• Security good health, income and a recognized role in Security good health, income and a recognized role in societysociety

• Recognition as an individual with you own abilities and Recognition as an individual with you own abilities and personalitypersonality

• Belonging as a member of a family, social group and Belonging as a member of a family, social group and communitycommunity

• Self-expression by developing abilities and talents in new Self-expression by developing abilities and talents in new areas at new levelsareas at new levels

• Adventure new experiences, new sights and new Adventure new experiences, new sights and new knowledgeknowledge

The typical physical changes that occur but not The typical physical changes that occur but not necessarily always present are generally well necessarily always present are generally well known and can be identified by physical features known and can be identified by physical features such assuch as

• Wrinkles, grey hair, thickening torsoWrinkles, grey hair, thickening torso

• Decline in senses (taste, poor nutrition) sight, Decline in senses (taste, poor nutrition) sight, hearing recognition timehearing recognition time

• Arthritis- painful, limiting movement can lead to Arthritis- painful, limiting movement can lead to disabilitydisability

• Declining elasticity in body tissuesDeclining elasticity in body tissues

• As a care worker your role requires you to As a care worker your role requires you to provide support to older people and provide support to older people and maintain their quality of life. maintain their quality of life.

• To do so you need to be quite clear with To do so you need to be quite clear with what you mean by quality of life in the what you mean by quality of life in the broadest and most objective sense. broadest and most objective sense.

• To assist you in delivering an optimum To assist you in delivering an optimum service you will need a deeper service you will need a deeper understanding of a number of critical areas understanding of a number of critical areas such as understanding the physical and such as understanding the physical and psychosocial aspects of ageing and psychosocial aspects of ageing and knowing what strategies may be required knowing what strategies may be required to to

• promote healthy lifestyle practicespromote healthy lifestyle practices

• You will of course need to be aware of what the You will of course need to be aware of what the physical changes associated with ageing are physical changes associated with ageing are when delivering services and supporting. when delivering services and supporting.

• This will have a huge impact on care choices This will have a huge impact on care choices and decisions; however should not interfere with and decisions; however should not interfere with the person’s interests and life activities which the person’s interests and life activities which should be at all times be accommodatedshould be at all times be accommodated

• There will be times when the older person will There will be times when the older person will need to be assisted to recognize the impact of need to be assisted to recognize the impact of the physical changes associated with ageing.the physical changes associated with ageing.

• Physical changes associated with ageing may Physical changes associated with ageing may have an impact on their activities of living. We have an impact on their activities of living. We should however remember that it is a service should however remember that it is a service provider’s role to ensure measures are put into provider’s role to ensure measures are put into place to minimize the impact through the use of place to minimize the impact through the use of adaptive equipment and environmental adaptive equipment and environmental modification.modification.

• Discuss the care needs of the aged person with Discuss the care needs of the aged person with them. them.

• Encourage them to look beyond the definition of Encourage them to look beyond the definition of just personal carejust personal care

There are many different support requirements There are many different support requirements people have such aspeople have such as

• Physical, sexual and emotionalPhysical, sexual and emotional• Support and careSupport and care• FinancialFinancial• Household assistance and maintenanceHousehold assistance and maintenance• Religious Spiritual and CeremonialReligious Spiritual and Ceremonial• CulturalCultural• RecreationalRecreational• SocialSocial

Assisting in Maintaining LifestylesAssisting in Maintaining Lifestyles

• Assistance is promoting and maintaining an Assistance is promoting and maintaining an older person’s healthy lifestyle can be achieved older person’s healthy lifestyle can be achieved in many ways. in many ways.

• The most important is to have a clear The most important is to have a clear understanding and belief that an older person understanding and belief that an older person deserves a healthy and fulfilling lifestyle just as deserves a healthy and fulfilling lifestyle just as you believe you so. you believe you so.

• Avoiding negative labels and stigmas about the Avoiding negative labels and stigmas about the older person provides a positive approach and older person provides a positive approach and this in return supports equality and respect this in return supports equality and respect within your relationships.within your relationships.

• The older person must become aware that they are The older person must become aware that they are consumers of community services and have choice in consumers of community services and have choice in selecting services that suit themselecting services that suit them

• With the focus on the older person as the consumer and With the focus on the older person as the consumer and not as a welfare recipient people will begin to see that not as a welfare recipient people will begin to see that they have equal rights as any other consumers have. they have equal rights as any other consumers have.

• This will provide an opportunity for the person to This will provide an opportunity for the person to maintain their lifestyle with greater confidence. maintain their lifestyle with greater confidence.

• Providing guidance, personal assistance and Providing guidance, personal assistance and participative activities can encourage a healthy and participative activities can encourage a healthy and positive lifestyle, with choices and participation in the positive lifestyle, with choices and participation in the community.community.

Benefits for Benefits for EEncouraging ncouraging HHealthy ealthy LifestylesLifestyles

• The benefits to a person in being engaged in meaningful The benefits to a person in being engaged in meaningful healthy activities and habits are immensehealthy activities and habits are immense

• Most importantly a person has the opportunity to Most importantly a person has the opportunity to maintain a normative lifestyle, continues to interact with maintain a normative lifestyle, continues to interact with the rest of the community, continues to learn through the rest of the community, continues to learn through their personal choice of education and participates in their personal choice of education and participates in leisure and sporting activitiesleisure and sporting activities

• The successful involvement in activity must be based on The successful involvement in activity must be based on their choice and not that of the service that is involved in their choice and not that of the service that is involved in supporting themsupporting them


• Sound; mentally and physically from their Sound; mentally and physically from their participation in activities of their choice can participation in activities of their choice can be maintained and supportedbe maintained and supported

• A workers role is to encourage A workers role is to encourage independence and choice and to facilitate independence and choice and to facilitate or provide services so that a person may or provide services so that a person may actively take part in a lifestyle of their actively take part in a lifestyle of their choicechoice


• The person’s involvement with these community The person’s involvement with these community activities gives them a positive image and valued activities gives them a positive image and valued social-roles. social-roles.

• Participation promoted new friendships and Participation promoted new friendships and relationships and keeps them in touch with relationships and keeps them in touch with family and friends. family and friends.

• This is very important to the maintenance of a This is very important to the maintenance of a person’s physical and psychosocial well-being.person’s physical and psychosocial well-being.

Strategies that assist the older Strategies that assist the older person to promote a healthy lifestyleperson to promote a healthy lifestyle

• The older person should be able to live a The older person should be able to live a normal and healthy life comfortably in their normal and healthy life comfortably in their own home or in a homely environment own home or in a homely environment within their local community. within their local community.

• The carer should ensure the person’s The carer should ensure the person’s home has been suitably adapted to meet home has been suitably adapted to meet their changing needs.their changing needs.

Strategies that assist the older Strategies that assist the older person to promote a healthy lifestyleperson to promote a healthy lifestyleThis can be achieved by providing the person with This can be achieved by providing the person with

• personal care assistance with their grooming, personal care assistance with their grooming, • health and hygiene, health and hygiene, • medication and with medication and with • domestic home duties. domestic home duties.

This may also include providing care assistance This may also include providing care assistance for any pets the person may have, (if in home for any pets the person may have, (if in home care)care)

Strategies that assist the older Strategies that assist the older person to promote a healthy lifestyleperson to promote a healthy lifestyle• An important role of the carer is to assist the An important role of the carer is to assist the

person to maintain contact with family and person to maintain contact with family and friends. friends.

• This can be done by involving the family with the This can be done by involving the family with the person’s day to day living requirements such as person’s day to day living requirements such as decision making, recreation and social life. decision making, recreation and social life.

• • Only if they want family/friends involved they Only if they want family/friends involved they

have the right to refuse contact.have the right to refuse contact.

• Support should be provided to the person to Support should be provided to the person to have their concerns and or complaints heard have their concerns and or complaints heard and acted upon by sharing their information, and acted upon by sharing their information, with their permissionwith their permission, with an Aged Care , with an Aged Care Advocacy Service. Advocacy Service.

• This service will then provide the person with This service will then provide the person with information and advice and may support or even information and advice and may support or even represent then too ensure their concerns and represent then too ensure their concerns and complaints are heard and dealt with in the most complaints are heard and dealt with in the most appropriate manner.appropriate manner.

Healthy lifestyle habitsHealthy lifestyle habits

Personal CarePersonal Care

• ShoweringShowering

• Elimination and maintaining continenceElimination and maintaining continence

• Preventative health carePreventative health care

• Monitoring and maintenance of current Monitoring and maintenance of current health issueshealth issues


Personal groomingPersonal grooming• Dressing and shavingDressing and shaving• Oral hygieneOral hygiene• Eye careEye care• Nasal careNasal care• Ear careEar care• Hair careHair care• Skin careSkin care


• Physical activity and exercisePhysical activity and exercise• Nutrition and mealtime habitsNutrition and mealtime habits• Personal hygienePersonal hygiene• Leisure and recreational activitiesLeisure and recreational activities• Building and maintaining relationshipsBuilding and maintaining relationships• Continuing meaningful cognitive activitiesContinuing meaningful cognitive activities• Rest and sleepRest and sleep• Community participationCommunity participation• Personal development and educationPersonal development and education

Provide support to the older person Provide support to the older person to maintain social and community to maintain social and community

networksnetworks

• Each older person should be given the Each older person should be given the opportunity to participate as fully as opportunity to participate as fully as possible in making decisions about the possible in making decisions about the events and activities of his or her daily life events and activities of his or her daily life and the services he or she receives.and the services he or she receives.

Participation and Participation and IIntegrationntegration

• Each person should be supported and Each person should be supported and encouraged to participate and be involved in the encouraged to participate and be involved in the life of the communitylife of the community

• It is your role to ensure that the person has the It is your role to ensure that the person has the opportunity to develop and maintain skills and to opportunity to develop and maintain skills and to participate in activities that enable him or her to participate in activities that enable him or her to maintain and protect their valued roles in the maintain and protect their valued roles in the communitycommunity

Participation and Participation and IIntegrationntegration• Without a focused effort, older people will be at risk of Without a focused effort, older people will be at risk of

losing their social network, so then it becomes limited to losing their social network, so then it becomes limited to the people whom they live with, support workers and the people whom they live with, support workers and possibly immediate family. possibly immediate family.

• These relationships may be impersonal, temporary or These relationships may be impersonal, temporary or forced as transient (respite) clients move in and out of forced as transient (respite) clients move in and out of the residence, employees transfer to other worksites or the residence, employees transfer to other worksites or positions and a host of professionals are involved for positions and a host of professionals are involved for short periods. short periods.

• Family involvement varies considerably dependent on Family involvement varies considerably dependent on proximity, the manner in which the family is received and proximity, the manner in which the family is received and the attitude or relationship of individual members the attitude or relationship of individual members towards the person.towards the person.

Participation and Participation and IIntegrationntegration

• As a strategy to increase the level of As a strategy to increase the level of participation, opportunities for contact with a participation, opportunities for contact with a range of people in typical situations should range of people in typical situations should occur. occur.

• Valued activities provide the opportunities and Valued activities provide the opportunities and experiences for people to meet and for a variety experiences for people to meet and for a variety of relationships to develop. of relationships to develop.

• The role of the support worker is to create these The role of the support worker is to create these opportunities, assist in fostering and maintaining opportunities, assist in fostering and maintaining new and existing relationships and to be able to new and existing relationships and to be able to withdraw as support needs decrease.withdraw as support needs decrease.

Integration is Integration is DDependent onependent onPhysical PresencePhysical Presence

(being there and doing it through)(being there and doing it through)

• Living in the communityLiving in the community

• Participating in recreation/clubs and groupsParticipating in recreation/clubs and groups

• Using community facilitiesUsing community facilities • ShopsShops• Financial institutionsFinancial institutions• Adult education centersAdult education centers• Libraries etc.Libraries etc.

Integration is Integration is DDependent onependent on

Positive imagePositive image (behaviour, ability (with or without (behaviour, ability (with or without assistance) and appearanceassistance) and appearance

• Physical appearance of the person in relation to Physical appearance of the person in relation to clothing, hygiene and suitability for activity/venueclothing, hygiene and suitability for activity/venue

• Behaviour is appropriate as to not draw attention Behaviour is appropriate as to not draw attention to the person not being differentto the person not being different

• Level of assistance provided enables optimum Level of assistance provided enables optimum participation and demonstration of abilitiesparticipation and demonstration of abilities

Integration is Integration is DDependent onependent on

• The appearance and conduct of you also The appearance and conduct of you also impacts on the preconceptions of other impacts on the preconceptions of other participants as to their attitude and rapport participants as to their attitude and rapport established with an older person. established with an older person.

• It is imperative that you foster a positive It is imperative that you foster a positive image of both yourself and the person you image of both yourself and the person you are supporting.are supporting.

Social IsolationSocial Isolation

• Social isolation Social isolation has a profound effect has a profound effect on many older people on many older people

• It adversely affects their health both It adversely affects their health both physically and mentally.physically and mentally.

If social isolation is reducedIf social isolation is reduced

• It can contribute to maintaining or improving their overall health.

• Increased social activity tends to improve the persons health thereby reducing the need for medicinal resources.

• Social interaction is necessary to alleviate boredom, loneliness and unhappiness.

Causes of Social IsolationCauses of Social Isolation

• Loss of mobility due to ill healthLoss of mobility due to ill health

• Restricted travelRestricted travel

• Fear for personal safetyFear for personal safety

• Emotional pressure and time if performing Emotional pressure and time if performing the role of a carerthe role of a carer

The individual’s social networks should be The individual’s social networks should be established in consultation with the established in consultation with the individual, their relatives, friends, carers individual, their relatives, friends, carers and others with a vested interest in the and others with a vested interest in the person’s well-beingperson’s well-being

We need to considerWe need to consider

• Tailoring a social program to the individuals needsTailoring a social program to the individuals needs

• Ensuring transport arrangements can be metEnsuring transport arrangements can be met

• The persons personal safetyThe persons personal safety

• Increasing the persons confidence and self esteemIncreasing the persons confidence and self esteem

• Information and referrals to health professionals, the Information and referrals to health professionals, the services and activities they provideservices and activities they provide

There are three groups of support and social There are three groups of support and social classifications classifications

They are They are

• support networks, support networks,

• community networks and community networks and

• appropriate people or agencies.appropriate people or agencies.

Support NetworksSupport Networks

• AdvocatesAdvocates

• FamilyFamily

• Carers Carers

• FriendsFriends

• Clergy and other pastoral providersClergy and other pastoral providers

Community NetworksCommunity Networks

• Ethnic organisationsEthnic organisations

• Clubs Clubs

• Community centresCommunity centres

• Support groupsSupport groups

• Recreational groupsRecreational groups

• Voluntary organisationsVoluntary organisations

• Veterans and war widow organisationsVeterans and war widow organisations

Appropriate people and/or Appropriate people and/or organizationsorganizations

• SupervisorsSupervisors

• Health care professionalsHealth care professionals

• Clergy or pastoral providersClergy or pastoral providers

• National associations National associations (Palliative Care Ass., Grief and Loss (Palliative Care Ass., Grief and Loss Ass., Stroke Ass., etc)Ass., Stroke Ass., etc)

• Support groupsSupport groups

• Veterans and War Widow OrganisationsVeterans and War Widow Organisations

• Advocate OfficeAdvocate Office

• Helping a person who is older to gather Helping a person who is older to gather information about what is available in the information about what is available in the community is a good starting point to community is a good starting point to increase their involvement. increase their involvement.

• Having information which makes sense gives Having information which makes sense gives confidence to do things and move around the confidence to do things and move around the community. community.

• It is also important if people are to have It is also important if people are to have choices and make decisions. choices and make decisions.

• For example making a map of the local area is a good For example making a map of the local area is a good way to help a person discover what is available in their way to help a person discover what is available in their community. community.

• Start by helping the person to draw their home and then Start by helping the person to draw their home and then plot out all the other things the person uses and the plot out all the other things the person uses and the things of interest in the local area. things of interest in the local area.

• Starting up a scrapbook of places they might want to go Starting up a scrapbook of places they might want to go or things they wish to be involved in is also helpful for or things they wish to be involved in is also helpful for encouraging choice and decision-making. encouraging choice and decision-making.

• Collecting advertisements, menus, business cards and Collecting advertisements, menus, business cards and timetables can aid memory, recall and decision-making.timetables can aid memory, recall and decision-making.

• Being part of the community also means getting to know Being part of the community also means getting to know other people and joining in local community events. other people and joining in local community events.

• As members of the community we rely on others to help As members of the community we rely on others to help meet our needs. meet our needs.

• Because we are also human beings we often need to Because we are also human beings we often need to spend times with other people and to have friends and spend times with other people and to have friends and acquaintances. acquaintances.

• This process of becoming involved is often called This process of becoming involved is often called networking. networking.

Why are Social Networks Why are Social Networks Important?Important?

• Regular social contact with others who are significant in Regular social contact with others who are significant in our lives and whom we value cannot be underestimated. our lives and whom we value cannot be underestimated.

• Human beings have an in-built desire for relationships Human beings have an in-built desire for relationships with other human beings. with other human beings.

• These provide us with the foundations upon which we These provide us with the foundations upon which we establish the quality of our lifestyle. establish the quality of our lifestyle.

• Our relationships and networks with others have both a Our relationships and networks with others have both a direct and indirect influence on how we see the world direct and indirect influence on how we see the world and ourselves. and ourselves.

• This in turn prejudices how we meet a life time of needs, This in turn prejudices how we meet a life time of needs, both for ourselves and for those with whom we have both for ourselves and for those with whom we have contact. contact.

Why are Social Networks Why are Social Networks Important?Important?

• Networks and relationships give rise to ties with the Networks and relationships give rise to ties with the community and feelings of being included. community and feelings of being included.

• In your role as a Personal Care Worker you have a In your role as a Personal Care Worker you have a responsibility to support people to be included in their responsibility to support people to be included in their communities. communities.

• Being a member of a community is much more than Being a member of a community is much more than living in the community and using community facilities. living in the community and using community facilities.

• It is also about belonging. It is also about belonging.

Networking is based on the understanding Networking is based on the understanding that all people have capabilities, strengths that all people have capabilities, strengths and talents and these are used to assist and talents and these are used to assist and support others as needed.and support others as needed.

Basic needs for survivalBasic needs for survival

• SafetySafety

• Food Food

• ShelterShelter

To improve the quality of our life we To improve the quality of our life we must also have needs in other areas must also have needs in other areas

of our lives met.of our lives met.

• IndividualityIndividuality

• ChoiceChoice

• Physical and Emotional Well-beingPhysical and Emotional Well-being

• ChallengesChallenges

• Risk takingRisk taking

• Most peoples’ networks are interrelated and do Most peoples’ networks are interrelated and do not exist alone. not exist alone.

• They encompass all aspects of a person’s life They encompass all aspects of a person’s life and interweave through all of our life domains to and interweave through all of our life domains to provide us with a comprehensive support system provide us with a comprehensive support system that adds to the quality of life. that adds to the quality of life.

•

• So it can be said that our networks are related to So it can be said that our networks are related to our employment, education, friendships, our employment, education, friendships, recreation, health, family and just about every recreation, health, family and just about every other aspect of our lives.other aspect of our lives.

Ask yourselfAsk yourself

• How many social networks do you have?How many social networks do you have?

• What are they like?What are they like?

Social & Recreational ActivitiesSocial & Recreational Activities

• We need to We need to recognize the need to recognize the need to modify or adapt social and recreational modify or adapt social and recreational activities to meet specific needs of the activities to meet specific needs of the older person and report and report it to older person and report and report it to the appropriate person.the appropriate person.

Social & Recreational ActivitiesSocial & Recreational Activities

• Due to physical and mental deterioration that Due to physical and mental deterioration that occurs during the aging process it may not be occurs during the aging process it may not be possible for a person to fully participate in some possible for a person to fully participate in some social or recreational activities without adapting social or recreational activities without adapting them to suit their particular needs. them to suit their particular needs.

• This may not be evident at first but in time This may not be evident at first but in time should become apparent to the support worker should become apparent to the support worker who must get it addressed.who must get it addressed.

Suitable ActivitiesSuitable Activities

• Memory and concentration skillsMemory and concentration skills

• RelaxationRelaxation

• Pleasant events Pleasant events (Social drinks or outings)(Social drinks or outings)

• Special events Special events (Birthdays, Weddings, Parties)(Birthdays, Weddings, Parties)

Activities to Stimulate Activities to Stimulate Cognitive AbilitiesCognitive Abilities

• Crossword puzzlesCrossword puzzles

• Shopping tripsShopping trips

• CookingCooking

• Playing musical instrumentsPlaying musical instruments

• ReadingReading

• Board, card and computer gamesBoard, card and computer games

• If a person is having difficulty with an If a person is having difficulty with an activity do not just stop them participating.activity do not just stop them participating.

• There are usually many ways in which the There are usually many ways in which the activity can still be pursued using some activity can still be pursued using some piece of adaptive equipment.piece of adaptive equipment.

• Where you believe a person is not Where you believe a person is not participating in an activity try to find the participating in an activity try to find the true reason. true reason.

• If it is a physical thing report your findings If it is a physical thing report your findings to the appropriate authority and try to get it to the appropriate authority and try to get it corrected. corrected.

It could be a simple as It could be a simple as

• getting a hearing aid, getting a hearing aid,

• a new pair of glasses, a new pair of glasses,

• having a handrail fitted because the having a handrail fitted because the person is frightened of falling, person is frightened of falling,

• getting special shoes made or getting special shoes made or

• giving one on one support.giving one on one support.

Impact of aging on the individual’s Impact of aging on the individual’s emotional and psychological well-emotional and psychological well-

beingbeing• There seems to be a strong link between a There seems to be a strong link between a

person’s social and mental activity and their person’s social and mental activity and their physical well-beingphysical well-being

• With aging some people seem to loose their With aging some people seem to loose their identity and must be given the opportunity to identity and must be given the opportunity to reminisce and review their life. reminisce and review their life.

• Motivation declines due to the lack of stimulation Motivation declines due to the lack of stimulation and possibly the perceived value of the task.and possibly the perceived value of the task.

• There is a need to practice, maintain and There is a need to practice, maintain and learn new skills and areas of interest.learn new skills and areas of interest.

• We need to ensure that the older person is We need to ensure that the older person is involved in the decisions that affect them, involved in the decisions that affect them, know the full range of options available know the full range of options available and have input into their implementationand have input into their implementation

Common Emotional Disorders that Common Emotional Disorders that may affect an older person includesmay affect an older person includes

• Anxiety:Anxiety: a feeling of apprehension, dread a feeling of apprehension, dread or unexplained discomfort, associated with or unexplained discomfort, associated with a sense of helplessness arising form a sense of helplessness arising form internal conflict.internal conflict.

• Depression:Depression: a term which can be used to a term which can be used to denote a serious disorder of mood. denote a serious disorder of mood. Feelings of sadness dominate which are Feelings of sadness dominate which are accompanied by psychosomatic features.accompanied by psychosomatic features.

Common Emotional Disorders that Common Emotional Disorders that may affect an older person includesmay affect an older person includes

• Bi Polar / Manic depressive disorder:Bi Polar / Manic depressive disorder: a group a group of reactions whose main characteristics is mood of reactions whose main characteristics is mood swings ranging from profound depression to swings ranging from profound depression to acute mania, interspersed with periods of acute mania, interspersed with periods of normality normality

• Phobia:Phobia: an intense fear of some situation, an intense fear of some situation, person or object so that the danger is magnified person or object so that the danger is magnified out of proportion and may result in panic attack.out of proportion and may result in panic attack.

• People who develop a mental illness face People who develop a mental illness face isolation and discrimination, in addition to isolation and discrimination, in addition to the unfortunate negative stereotypes of the unfortunate negative stereotypes of being an older citizen. being an older citizen.

• These attitudes can force people to hide These attitudes can force people to hide their illness or feel ashamed. their illness or feel ashamed.

• They may find difficulties in They may find difficulties in communicating and keeping relationshipscommunicating and keeping relationships

Emotions on Admission to Emotions on Admission to Residential CareResidential Care

• For most people, admission to residential care is For most people, admission to residential care is unplanned and often unexpected, occurring because of a unplanned and often unexpected, occurring because of a major event in their life. major event in their life.

• stroke,stroke,• a fall, a fall, • the death of a partner, or the death of a partner, or • the inability of a relative to continue caring for the inability of a relative to continue caring for

them.them.

• This means that a resident will probably experience a This means that a resident will probably experience a range of emotions on admissionrange of emotions on admission

Positive Emotions on entering Positive Emotions on entering Residential CareResidential Care

• Relief:Relief: – that he/she is no longer a burden on carers or that he/she is no longer a burden on carers or

relativesrelatives

• Security:Security: – with the provision of accommodation, care and dailywith the provision of accommodation, care and daily

activitiesactivities

• Freedom:Freedom: – from stress of running his/her own homefrom stress of running his/her own home

Positive Emotions on entering Positive Emotions on entering Residential CareResidential Care

• Company:Company: – if he/she has lost a partner or is living aloneif he/she has lost a partner or is living alone

• Challenge:Challenge: – entering a new phase of life, new challenges entering a new phase of life, new challenges

to meet and masterto meet and master

Negative Emotions on entering Negative Emotions on entering Residential CareResidential Care

• Anger:Anger: – at having to enter residential care, at their at having to enter residential care, at their

own physical frailty, at their family and carersown physical frailty, at their family and carers

• Grief and Loss:Grief and Loss: – of a partner, home, independence, health, of a partner, home, independence, health,

pets, possessions, of making all his/her day to pets, possessions, of making all his/her day to day decisionsday decisions

Negative Emotions on entering Negative Emotions on entering Residential CareResidential Care

• Fear:Fear: – of the quality of life ahead, regimentation and of the quality of life ahead, regimentation and

deathdeath

• Loneliness:Loneliness: – at having left their old environmentat having left their old environment

• Despair:Despair: – life will never be the same again, unwanted, life will never be the same again, unwanted,

forgotten or no longer useful.forgotten or no longer useful.

Encourage and support the older Encourage and support the older person’s self esteem and confidenceperson’s self esteem and confidence

• One of the most overpowering emotions One of the most overpowering emotions an older person has is the thought of being an older person has is the thought of being a burden to their children and a burden to their children and grandchildren. grandchildren.

• As their physical strength fades the things As their physical strength fades the things they used to do become difficult and they they used to do become difficult and they have a feeling of being of little use to have a feeling of being of little use to society.society.

Encourage and support the older Encourage and support the older person’s self esteem and confidenceperson’s self esteem and confidence

• This is the time when support form the This is the time when support form the family is most needed. family is most needed.

• The traditional role once held in society of The traditional role once held in society of passing on knowledge and wisdom has passing on knowledge and wisdom has largely diminished with the advent of the largely diminished with the advent of the information age. information age.

• Computers are the main source for Computers are the main source for information retrieval by the young.information retrieval by the young.

Encourage and support the older Encourage and support the older person’s self esteem and confidenceperson’s self esteem and confidence• Some older people tend to believe that the Some older people tend to believe that the

younger person cannot understand what they younger person cannot understand what they are feeling because they are not old. are feeling because they are not old.

• Sometimes there is a feeling of inferiority as the Sometimes there is a feeling of inferiority as the young are generally better educated than their young are generally better educated than their elders.elders.

• Speaking out and voicing their opinions could Speaking out and voicing their opinions could alienate them from the small attention they do alienate them from the small attention they do receive.receive.

Encourage and support the older Encourage and support the older person’s self esteem and confidenceperson’s self esteem and confidence• Quite often there is a fear of being left alone and Quite often there is a fear of being left alone and

pride does not allow them to communicate how pride does not allow them to communicate how they are feeling.they are feeling.

• Extending family values into the lives of elderly Extending family values into the lives of elderly people allows them to feel wanted. people allows them to feel wanted.

• Being involved in everyday workings of the Being involved in everyday workings of the family unit builds confidence that is synonymous family unit builds confidence that is synonymous with self-esteem.with self-esteem.

• The family does not have to be from their own The family does not have to be from their own bloodline, it can be old friends or new ones. bloodline, it can be old friends or new ones.

• They should be encouraged to look after one They should be encouraged to look after one another, give each other support and the carer another, give each other support and the carer should encourage and steer them towards this should encourage and steer them towards this goal. goal.

• They may feel reluctant at first but the They may feel reluctant at first but the environment in which one lives can be very environment in which one lives can be very persuasive.persuasive.

• If professional staff work at creating this as If professional staff work at creating this as normal those living with in the system will take normal those living with in the system will take up the challenge and retake some control over up the challenge and retake some control over their lives. their lives.

• Care must be taken to allow for setbacks and Care must be taken to allow for setbacks and mistakes will all communications being positive. mistakes will all communications being positive.

• Try to ensure every outcome is successful by Try to ensure every outcome is successful by letting the person adapt at their own paceletting the person adapt at their own pace

Three things determine how Three things determine how others react around usothers react around us

• ThoughtsThoughts

• FeelingsFeelings

• ActionsActions

• People mirror others. People mirror others.

• If they are surrounded by positive expectations If they are surrounded by positive expectations and attitudes they will respond in the same way. and attitudes they will respond in the same way.

• The positive outlook boosts a person’s self The positive outlook boosts a person’s self esteem and confidence strengthening their esteem and confidence strengthening their sense of identity and of feeling valued. sense of identity and of feeling valued.

• This in turn helps maintain or even improve skill This in turn helps maintain or even improve skill levels and abilities. levels and abilities.

• Receiving only neutral or negative messages, Receiving only neutral or negative messages, the reverse is possible and can lead to the reverse is possible and can lead to disastrous consequences.disastrous consequences.

• Older people must be supported or cared for in Older people must be supported or cared for in an environment that ensures their emotional an environment that ensures their emotional well-being. well-being.

• There is a legal and moral duty for all care There is a legal and moral duty for all care providers to project a feeling of security to those providers to project a feeling of security to those they are providing a service to. they are providing a service to.

• Activities and social gatherings alleviate the Activities and social gatherings alleviate the sense of loneliness. sense of loneliness.

• They should not feel threatened or vulnerable. They should not feel threatened or vulnerable.

• They should feel secure, contented and at ease to They should feel secure, contented and at ease to discuss any issues that are of concern. discuss any issues that are of concern.

• Any feelings of anger, frustration or anxiety must be Any feelings of anger, frustration or anxiety must be reported and addressed in the appropriate manner. reported and addressed in the appropriate manner.

• They must be supported through difficult times such as They must be supported through difficult times such as the grieving process to accept the loss and move on. the grieving process to accept the loss and move on.

• Where necessary, professional intervention may be Where necessary, professional intervention may be requiredrequired

• Normal displays of love and affection must Normal displays of love and affection must not be stifled. not be stifled.

• Allowing people a degree of control over Allowing people a degree of control over what happens to them, encouraging self-what happens to them, encouraging self-determination makes one feel good. determination makes one feel good.

• There is a strong link between emotional There is a strong link between emotional fitness and physical well-being.fitness and physical well-being.

• Ensure empathy is shown to an older Ensure empathy is shown to an older person who is emotionally distressedperson who is emotionally distressed

• Emotional distress is something we all fell Emotional distress is something we all fell at some time and it affects us all at some time and it affects us all differently. differently.

• The most commonly talked about The most commonly talked about emotional distress is probably external emotional distress is probably external pressures rather than internal ones.pressures rather than internal ones.

• Most types of emotional stress results in some form Most types of emotional stress results in some form of physical symptom such as sweaty palms, of physical symptom such as sweaty palms, shortness of breath, tensing of muscles and chest shortness of breath, tensing of muscles and chest pain. pain.

• As the episode passes a person usually trembles as As the episode passes a person usually trembles as they relax. they relax.

• Other forms of emotional distress comes for within, Other forms of emotional distress comes for within, such assuch as

• FearFear

• AnxietyAnxiety

• GuiltGuilt

• LonelinessLoneliness

• These affect the person’s personality in These affect the person’s personality in different ways that vary from being different ways that vary from being withdrawn to outbursts of anger. withdrawn to outbursts of anger.

• If allowed to perpetuate, the person is If allowed to perpetuate, the person is invariably powerless to initiate change and invariably powerless to initiate change and will eventually give up or become will eventually give up or become embittered, resulting in poor quality of life.embittered, resulting in poor quality of life.

• As a worker in close contact with clients on a As a worker in close contact with clients on a daily basis it will be up to you to observe the daily basis it will be up to you to observe the signs and symptoms of the emotional distress. signs and symptoms of the emotional distress.

• Respond with empathy, not sympathy. Respond with empathy, not sympathy.

• You will also need to report this to your You will also need to report this to your supervisor and anyone else who works with the supervisor and anyone else who works with the clientclient

• Personal Care Workers need to ensure Personal Care Workers need to ensure that they meet the emotional and that they meet the emotional and psychosocial needs of the older person. psychosocial needs of the older person.

• If your attempts at providing support are If your attempts at providing support are clearly not meeting the person’s needs clearly not meeting the person’s needs then you need to seek assistance from an then you need to seek assistance from an appropriate person at your workplace.appropriate person at your workplace.

• The strategies for addressing the situation The strategies for addressing the situation are formulated within local protocols by are formulated within local protocols by consultation with appropriately qualified consultation with appropriately qualified staff. staff.

• The support team implements and The support team implements and monitors results. monitors results.

• Changes are made if the person improves Changes are made if the person improves or worsens.or worsens.

ActivityActivity

Left Hand / Right HandLeft Hand / Right Hand

Loss and GriefLoss and Grief • Most people have experienced some Most people have experienced some

sort of loss. sort of loss.

• Its important we provide a framework Its important we provide a framework however for looking at losshowever for looking at loss

LOSS has been grouped LOSS has been grouped into four major categoriesinto four major categories

1) 1) The loss of a significant The loss of a significant person:person:

• Death of a loved one is probably the Death of a loved one is probably the ultimate loss, its final and complete; also ultimate loss, its final and complete; also desertion, separation, divorce, abortion desertion, separation, divorce, abortion and stillbirths fall into this category. and stillbirths fall into this category.

• Older people will have faced a lifetime Older people will have faced a lifetime often of loss of significant people.often of loss of significant people.

2) 2) The loss of a part of the self:The loss of a part of the self:

Physical Physical • Structural lossStructural loss: :

– loss of a limb, loss of an organ, disfigurement, loss of a limb, loss of an organ, disfigurement, loss of hair, loss of teeth, any outward loss of hair, loss of teeth, any outward change, loss of body image (through surgery change, loss of body image (through surgery or burns or accidents)or burns or accidents)

• Functional loss:Functional loss: – loss through stroke, paralysis, blindness, loss through stroke, paralysis, blindness,

arthritis, infertility.arthritis, infertility.

3) 3) The loss of external objectsThe loss of external objects

• Loss of possessions Loss of possessions

– money, jewels, property and symbols of money, jewels, property and symbols of identity such as photo’s artifacts etc, identity such as photo’s artifacts etc, through burglary, robbery and natural through burglary, robbery and natural disasters such as fire and floodsdisasters such as fire and floods

4) 4) Developmental lossDevelopmental loss

• Birth trauma, Birth trauma, • Weaning, Weaning, • Growing up, Growing up, • School, exam failures, School, exam failures, • School-to-work transition, School-to-work transition, • Leaving home, Leaving home, • New relationships, New relationships, • Marriage, Marriage, • Old age and multiple cumulative lossesOld age and multiple cumulative losses

combined units

Business

integration

war widow

participation

common emotional

introduction

entering residential

healthy lifestyle

older person