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| Elderly who remain with Families & in community Lonely abused elderly. | Traditional Haredi, Druze, Scientists, Politicians Economic power | ||
| DEHUMANIZATION | HUMANIZATION | ||
| Old age homes. Old are neglected & not respected. | Old communities (Florida) | ||
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Post-Modern Society: In the modern society knowledge and theories were valued. Today there is deconstruction and there is place for interpretation. Knowledge failed to solve problems. People who have experience and their own narratives also have something to say. The patient with his subjective knowledge can assist himself in treatment. We must not underestimate personal experience. These factors advance the status of the elderly. The perception of TIME has changed. In modern society only future was important, while in post-modern society there is place for past and roots and history. The old person can help society to preserve the past. There needs to be continuity between generations. Hierarchy in society. Modern society was characterized by hierarchy. Who contributed and was effective had status. In post-modern society there is diversity and pluralism and difference ethnic groups are tolerated. Social relations: post modernism came to solve problems created by the modern society. There was alienation between people and solidarity. From a family perspective, there are small family units. There is divorce. The old generation has an important role in these families. Young families go out to work and the grandparents take care of children. The grandpa is a surrogate, who escorts the young child. There is focus on link between generations. From a demographic & economic perspective a large population of old people make up the society. They can work, have resources, they are young old people who can contribute to the society. Today we have a consumer society and economy. A society that relies on services and consumers. The old are potential consumers -old age homes, dancing, holidays, theatres. This increases their status in society. There is segregation on one hand, but there is also a need for integration and solidarity. The old in the family plays an important role in solidarity and genealogy. Old give significance to life of the young who is searching for himself. This reduces alienation.
6/11/02
SOCIOLOGY THEORIES OF AGING Theories of Gerontology is part of sociology theories. Comming & Henry: Disengagement Theory -60’s Each theory is connected to its era. In the 60’s action and activity was a central factor. Each person is born with a certain package of energy which decreases with age. A person we ages wants to preserve his energy in order to live longer. Consequently the old voluntarily isolate themselves from the society. Study: 172 - age 50-70 and 107 age 70 plus. They build an index and asked the subject their level of activating in a number of activities: Church service, volunteering etc. They concluded: the older the age the fewer the activities. A correlation between disengagement and life satisfaction - the higher the disengagement the higher more life satisfaction. Also the society encouraged the elderly to isolate themselves. This theory states that all old people are happy when left alone an don’t have much to do. Criticism: The sample was not representative - only whites, over-representation of one gender. Maybe some want to enjoy life in their old age and not to take responsibility. The theory is not coherent and extensive to include the entire population of old people. Because we cannot just say that who doesn’t do anything is satisfied. Other research claimed that Coming & Henry did not distinguish between biological and social death. But these two types of deaths or aging are different. Social death or aging is often forces of the old by the young society who want to shift the old aside. These theorists proposed a new theory - Activity Theory.
Activity Theory - Tubin, Havingharst & Newhearten They also conducted a study to test hypothesis. They did not only rely on self-report, rather old people were also observed and gave psychological test, to determine whether there is connection between social activity to social involvement. Even though a person is not active in society is does not mean that he is uninvolved in other aspects of society. They used a different sample and found that the perception of aging is a personal reaction to pressure on the person which results with retirement. Different people age differently. The type of aging is dependent on his behavior in previous times of his life such as adolescents or late adulthood - age 50 Plus. Besides for biological changes the old are not very different to those in late adulthood. A decrease in activity and involvement is usually due to social forces and does not originate form the old individual. Successful aging is when the old objects to the social pressures and continues to be active in activities that he was involved in during his late adulthood. This theory relates far more to the young old people who are still active. If we work with the old we need to know that each one is a unique individual and we must be familiar with his life and how active he was in his life to determine what he can continue doing during his old age. We need to find alternative activities for the old to do in the day center and the old age home. What activities will we introduce into the day center to provide a rich work of activities for the elderly in a dignified way. Initial Prevention: one must prepare himself emotionally and socially - hobbies, interests etc. During late adulthood so that during old age a person will be able to make a gradual change and will already be familiar with various activities.
Continuity Theory - Atchley Speaks of adaptation. Each person has 2 main impulses. 1) To preserve what we are familiar with (friends, work, activities). But if one had this one force of continuity and continued only one pattern we will not learn to adapt. 2) We need to include changes into our stable life. Only in this way can we learn to adapt to changes in all aspects of life. We interpret the events that we experience and make changes in attitude, behavior etc. Some on the other hand shirt their attitudes constantly. Inductive vs. Deductive. The inductive do not change while the deductive change constantly - there are not stable. Neither of the two polarities are positive. Also Assimilation vs. Accommodation. All people, especially old who deal with change need to keep a balance between the 2 polarities. The old perceives major changes in society. Continuity is advantages and helps the old to function. There is internal continuity - people feel good under these circumstances. They have similar attitudes and that there internal world need to be stable. The old enjoy telling stories. External continuity: the more the old acts in his society and his activities he is less anxious because he does not need to prove himself. Old people need to preserve social networks for their well being. Both types of continuity are necessary for old people who are faced with numerous changes. Some who remember only negative events or who had difficult lives. We need to focus on the positive aspects or according to Frankel to help the elderly search for meaning. Suffering also is a source of meaning and significance and we need to take the suffering and to find positive aspects in it (e.g. I suffered to see my grandchildren).
Exchange Theory - Homins & Blau A person who communicates with others and interacts with them is successful. Theory is taken from economy (profit -debt). Each human interaction is based on give and take and the interaction continues as long as this exists. A person gives and expects to receive in return. There is a problem with quality and quantity. From an economic perspective there is material give and take. This theory may be relevant for economic issues, but cannot be applied to human interaction. In families cannot be based on material exchange, because there are also expressive exchanges and symbolic significant interactions. According to the classical theory the old person is unable to give material so his status decreases. Even though his instrumental giving decreases but his emotional giving can increase. We need to strengthen the emotional aspects. We need to understand the subjective interpretation of the old people. Each message can be interpreted by the other. A child gives to his old mother but does not do it with joy and the old person senses it. When we receive from someone we do not necessary need to get something from the same person, we can get repayed from others. Litvack also spoke of reward that does not need to be rewarded immediately. The old people once contributed to their families and the society and has accumulated assistance towards others. HE expects to be rewarded in the future. Implications of this theory in our work. Listen to subjective interpretation. If we want to improve life we need to focus on what a old person can give. We must not turn him into dependent. We need to give them the opportunity to give. Because giving is very important for the person. Also we must give significance to the old persons knowledge and doing.
13/11/02
PSYCHOLOGICAL THEORIES OF AGING
Erikson: 8th stage of Erikson: Interaction <------> Despair éàåù 1) Interaction: Self security in his life and is organized and significance of his life. He has something to wake up in the morning for. He is satisfied. Vs. His is not in despair and unsatisfied with life. 2) He accepts and is complete with what he accomplished in his life. Vs. being anxious of dying and unhappy with his life. 3)Post-narcissistic: Old people love themselves and have a reason to wake up. A old person contributes to others and loves to help others had reach a stage of interaction and has a purpose in life. If one is in this situation he has aged successfully. Vs. a narcissistic old person who is only focused on himself and his needs. 4) Contribution to the society through volunteering is advantages for the old person.
Carlson expands on Eriksons dimensions: He described functioning of the old in a number of aspects: 1) Personal Dimension: peace of mind; growth and development; open to life. A person who is in despair can regress and deteriorate; avoids life. 2) Family Connections Dimension: has a supportive environment and it he is alone he chooses to be so. The one in despair in dependent and had no supportive network. 3) Mental Functioning Dimension: can learn; has hobbies; can be creative and expressive; volunteering & helping others. Those in despair have regressed/decreases mentally; feels “finished” 4) Physical Dimension: There is awareness of physical changes; realistic appraisal of loss and health; realistic coping with disease. The despaired over deals with disease; suppresses his fears and anxiety; reject other old people 5) Meaning and Significance Dimension: have a sense of being desired; self-esteem; they have commitment towards something and have meaning. The despaired feel they are not loved, valued; bored; busy with their losses.
Clark and Anderson: There are adaptive tasks that the old cope need to cope with to age successful and happily. 1) Perception and Acceptance of Aging: Awareness of their limitations and physical changes and acceptance of the situation and instead there is a focus on other things. 2) Reframing/ Redefining – äâãøä îçãù: Redefining his life and all his activities. Once he was very active and functioned in large areas of the country (economically, work, social networks etc). In old age his living space îøçá îçééä decreases and he needs to accept these changes. Cognitive control - the ability to control his surroundings - buying in a small store instead of a large mall. 3) Redefining of self-appraisal: An old person who appraises himself and has new criteria to appraise himself. He knows he is old and cannot have the same expectations of himself. He needs to redefine his appraisals because this is vital for the elderly and for the surroundings. 4) Finding new sources for gratification of needs: New hobbies and activities. Is the above situations are satisfies then the old can find new activities with new people. 5) Re-crystallization/Interaction (âéáåù îçãù) of goals, values and expectation of Life: These goals differ form that of a young person.
Frankel: Logotherapy - Cognitive Approach A person has significance in life and a reason to wake up, then he has the impulse and motivations, then he has a good aging. It is bad if he has a void and lack of reason to wake. Boredom leads to mental injury. Neodynamic- internal tension is a sign of mental health. This refers to what a person achieves and what he still needs to achieve. There always need to be new goals that provide an incentive for life. Both significance and search for meaning are both important. The old person needs to provide the options for himself and to take responsibility and not to get ideas form others because then the old is unable to identify with them. Meaning comes form interpersonal relations; creating; religion and tradition; work and keeping busy; hedonism; suffering (Frankel research suffering of holocaust - if my suffering gave something to others there was a point in his suffering) we can ask the old what they get out of complaining? If a person had meaning this gives him power to accomplish almost anything.
Self-Psychology: Self-concept: how a person perceives himself? It development and change and is determined through symbolic interaction (i.e. through the responses he gets from others).
Mead: each person has 2 parts: the “I” and the “ME”. The “I” is the subjective part - what I think of myself; and the “ME” is objective - what others think of me. These two create the SELF. What happened to the Self-concept of the elderly. Their ME may change because the society reacts to them. But there are old people who do not consider themselves to be old (i.e. ageless self). The old peoples SELF consists of: Self-Ideal: These are the aspirations, which may be very high (+) Self-Concept: But the old person thinks that these aspirations may not be achieved (-) Self-Esteem: (-) When there is a large gap between self-ideal and self-concept then the self-esteem will decreases. Our goal is to maximize the old person’s self-esteem. The solution is to decrease gap, through lowering the expectations and aspirations. Sometimes people underestimate themselves and consequently have a low self-concept. Preservation of the self. Self-perception changes. The reactions of society lead to decrease of self-concept. He has mechanisms that he uses (read article from Zivoni). A person can focus on his past achievements. He can demand respect from others. What mechanists does he use to preserve the SELF. 1) Continuity is important (sameness, ageless) self-consistency, to preserve the change. They need to focus and strengthen the ME, which in turn will strengthen the I, and ultimately preserves the SELF. Therefore part of treatment with old is making place for memories of the past or who he was and what he did. Through the narrative approach we aid the old in giving a new narrative and interpretation of their life, and to give him encouragement that there is continuity. His part memories create continuity. 2) There are old people who identify with the society’s reaction. This is called “Excess Disability syndrome” - they not only identify with their inability but also exaggerate it. 3) Alienated self- concept -ãéîåé òöîé îðåëø: he behaves differently to what he feels 4) Detachment and Retreat: A reaction of depresssion. 5) A person who lives in a dirty old house: He is saying leave me alone, this is who I am, accept it of lave it - and in this was he preserves his self. He does not want to be taken to an old age home. We must not treat this old individual as a crazy person but must try to communicate with him. 6) Aggression: A person can express his pain.
Refer to handout: Needs of the elderly: 1) Preservation of Autonomy/Coping needs - ùëåðä úåîëú 2) Expressive Needs - art, hand work, drama groups etc. 3) Contributive needs - allow the old to volunteer 4) Need to be influential - also through volunteering; there are committees of old people who can be influential in decision making. Some can run centers or work in the center coffee shop. 5) Transcendental needs - a need for significance in what they do.
Homework: Read the Case of Mazal
20/11/02 The Case of Mazal: Her son helped her continue her life and to rehabilitate herself. She has a reason to wake up in the morning (Frankel). Mazal had a significant activity (sculpting) - this gave her a reason to live. From a physiological aspect the sculpting was a form of exercise. Her self-concept increased. Her expressive need is satisfied. Autonomy of the old can be preserved through ùëåðä úåîëú, which enables him to stay home instead at home and no to be transferred to an old age home.
Maslow’s Hierarchy of Needs: ∆
There are basic needs that need to be satisfied before self-actualization is satisfied.
5 - self-actualization 4 - respect and appreciation 3 - love and belonging 2 - mental and physical security 1 - basic physiological needs
Theoreticians divided the old into a number of categories: 1) Integrated Personality - are balances, rich cultural and spiritual live; open to new stimulus; have social activities; their life satisfaction is high; their moral is high. 2) Focused Personality - are balanced; there activities are selective - not open to all activities in live; derive life satisfaction from their specific activities. 3) Defensive Personality - are anxious and use strong defense mechanisms. They are divided into 2 groups:
- Exaggerate: They do more than they did previously; they are active so as not the leave a moment of time to think of their distress.
- Shrink their activities so as to avoid a situation in which they are unable to act or function.
Loneliness & Theories: There is a difference between loneliness and isolation: Loneliness I sth subjective feeling of the old. Even though they are visits form family and friends they feel lonely. Isolation is an objective situation in with social networks are decreased. In the modern society the issue of loneliness is common. There are factors in the modern society that lead to this phenomena. 1) Life span leads to death of relatives along the way. 2) Social Alienation - the old are rejected 3) Fear to create new social networks and connects. They fear rejection, and maybe loss of his new friend. 4) Reducing of family system - no connecting with grandchildren 5) A tendency to close oneself off.
Their loneliness in emphasized because of other factors:
1) After the spouse dies then the living environment is changed- he may live with his children and then looses his friends in his previous neighborhood. 2) Disability and disease leads to loneliness. 3) Disjunction/Defect in communication, language, thinking leads to loneliness and avoiding new connects. 4) T.V. connects them to world and decreases loneliness. 5) They loose significant others and therefore their loneliness in so extreme.Attachment Theory - Bolby When he was 80 he extended his theory to all stages of life. Theory- to create security in is important to have significant others that are always there to help. He analyzed this situation during all stages of live. In all stages of live relationship with significant others are crucial and are attachment figures. During old age the significant others disappear. They do not have physical contact with others and this adds to their loneliness. What do attachment figures provide? It response to need for available of others when one needs. There is a need to be close to these figures when one is under pressure. There is a sense of well being an decrease of anxiety in the presence of a figure like this. When this figure is lacking the level of anxiety increase. Contact is vital for mental health. Old who are lonely and lack the social conditions of these figures suffer. Physical contact is very important in work with the old.
What is the connection between loneliness and isolation. There is a direct positive correlation between the two. There are people who chose to be isolated and this does not lead to loneliness. Also there can be a indirect correlation.
Hazan conducted a research in the east of London. Jews suffered form objective isolation due to immigration of their children. The state did not get involved nor offered services. Subjective isolation development. This did not lead to loneliness; instead they created social networks with other members of the community. They themselves organization their lives and activities. They chose not to be in contact with outsiders and strangers.
Environmental Theories: When we want to improve the life of others, apart form looking at the individual’s functioning, we need to look at his environment. A persons behavior is a function of the person himself and the environment. There is a dynamic interaction between persona and environment. We need to see how person can improve his functioning, but also need to improve his environment. If he walks with a walking stick he walks slowly but the environment needs to have benches for him to sit and rest. This facilitates autonomy. When environment changes, and when environmental continuity changes (change of residence etc), stress increases. It is called relocation stress. This is most stressful for the old and children. This has emotional implications on the old. Relocation should be accompanied with keeping belongings and familiarity.
Environmental Space (handout: 20/11/02) The more diverse their environment the more significance and interests in life. There is a need for variety. If old people are disabled then need an imaginary environment. They need to hear stories of travels.
Environmental Press
The functioning of the old is a combination of personal competence and environmental press. There needs to be a balanced dose of stimulus.Ecological Theory: An elderly person who is lonely and spends most of his time at home needs to be exposed to diverse environments and stimulus. Also an imaginary environment can be used. It can be historic (their memories) and imaginary (things that they do not know yet). There is interaction between environment and ability (both an oversupply or deficiency of stimulus are negative. A right dose of stimulus is needed). Cognitive control over environment is an important factor. A person, lack of control over his environment, has adverse effects on his self-esteem and even physiological situation (immune system).
Movie: “The home of the Brave”
Changing location to either an old age home, or moving in with children or moving into a smaller house. The movie shows the lack of control that the elderly in the old age home have over their new surroundings. They are in a total institution, in which everything is determined from them on each level of life. This is a closed institute. There is dehumanization and disrespect towards the residents. These changes associated with relocation are difficult and lead to stress and we need to know how we can ease these symptoms.Total Institution: Goffman; Townsend called in Institutional neuroses. Process of de-institutionalization in the late 50’s-60’s. many groups were against institutionalization of any group, young and old, healthy and sick populations. The systems of institutionalization were depression and ultimately death. Instead community care was development in which the society was to take care of those on need. Also this approach is applied to the elderly. There are support neighborhoods and communities that enable the old to remain at home as long as possible. Also when there were institutions there was an attempt to prevent them form functioning as a total institute. The adverse effects of totality - disease, depression, withering.
What makes an institute total: Characteristics of a total institution - (Goffman) 1) Different aspect of life (work, social, leisure) all take place in the same place/ hall. There need to be a numbed of rooms or gardens so to make the environment as diverse as possible. 2) All the activities in old-age-home are organized for the residents and the residents do not have a say. The management determines activities, food that is eaten, time when activities take place. The total control over residents needs to be limited. They need to be heard and need to participate and not to be forces. Democratization is the opposite of totalitarianism. Social work needs to persuade management in how to advance democratization in the old-age-home. This can be accomplished through committees. We must prevent the old to become dependent. 3) Common treatment is given to everyone. There is no personal treatment. And people are referred to as a whole and as just numbers in a group. 4) Goals of the institution is their personal gain, whether financial or prestige. Social work need to defend the interests of the old.
Why do people enter old-age-homes?
1) There is a decision to do so. But who decides? The old or the children. The old need to be partners in the decision because the decision involved them. There are two decisions: to leave the home; and to enter a new place. To leave one’s home is a very difficult decision, because one’s home has symbolic significance. Later, the person needs to know where he is going. It is a process that id often ambivalent. Making the change must not be done during times of crisis. First the crisis must be passed and then the decision can be made. The house must now be sold because the old must have know that he can return if he wants. The decision and change is often accompanied by anger and blame. There is also reason of loneliness. People think that loneliness will be solves through entrance into an old-age-home. Negative attitudes towards old-age homes have changed.Study: Tubin & Liberman (1970) studies and compared 3 groups of old people to determine the implication of transition to old-age-homes. 1) Old people who were already residents of homes. çåñéí 2) Old people who were to enter the home. 3) Old people who lived in the community. They examined personality factors (neuroses, apathy and sense of control). Findings: Groups 3 the personality scores were high because they functioned in society and wanted to live, were active ad motivated. Group 1 had very low psychological scores. Group 2 had middle level scores - they had anxiety. They concluded that entering the home had adverse effect on personality. Tubin & Liberman coined the term Environmental continuity. As environment continuity increase the adaptation will be better and psychological stress will decrease. If it decreases then the opposite occurs. It is therefore important that the old persona brings his personal belongs into his new room in order to increase environmental continuity.
Articles: Barzilai Hada: “Territorial Behavior of the old in the old-age-home”
When old people come to old-age-homes. Territorial behavior is connected to behavior is an area. What happens when a person moves from a personal to public territory. There is a struggles for territory. Each person needs personal territory, which a person feels belongs to them and feels that he controls it. In an institute the old make manipulations to preserve their personal territory. In old-age-homes, because the private territory is limited the old try to take control over the public territory and they fight over their place in the dining room and their half of the table. This is not due to childish behavior; rather it is connected to self-concept of the old and the need to enlarge territory. They also use defensive behavior through body language. They turn their chair and reject others from their territory. There is also increased gossip, which allows person to remove himself from the general group. There is also aggression. Research on old-age-homes teaches that there needs to be diverse environments; privacy (and minimize camera’s in each room) - on one hand there is a need for surveillance while on the other there is a need to provide privacy. The structure of the institute: lobby, lighting, benches, railings so the old can be independent.4/12/02
Assessable surroundings: The corridors needs to be broad; accessibility to toilets, dining room, garden etc.; benches. Sturdy chairs and non-slippery floors.
Relocation stress: 1) To decrease this stress there needs to be preparation before hand (showing a movie of the new location). In the group which was not prepared there was a higher death rate. 2) Partnership in the decision. 3) decrease discontinuity between changes.
Liberman: Characteristics or indicators that portray a positive surrounding/environment. 1) High level of autonomy. 2) Privacy - leave closed spaces; private areas; do not burst into bed rooms. 3) Control (external/initial; internal/secondary; control over time). A person who feels that he has control over his external surroundings, usually has a sense of internal control. A person has a internal locus of control. 4) Social integration -old age homes should be established in the center of the community. The social worker needs to try to integrate the old into the community. There need to be inter-generation connections. Common activities between kindergarten and old age homes. Liberman, in his study, concluded that a good home provides physical and mental securing for the old; accessibility; that they can find themselves easily in the place; privacy; right dose of stimulus.
Social work intervention (refer to handout - 4/12/02)
Continuum of services: Community care. There is a diversity of services from one extreme to the other.
îåñã ìçåìéí ëøåðé - îçì÷ú ñéòåã - áéú àáåú - ãéåø îåâï - îùôçúåï - îøëæ éåí - ùëåðä úåîëú - îùôçä
There needs to be a continuum form one level to another so that the transition is characterized by minimum change. Article: Tova Gamliel: "äìåáé ëæéøä ìòéîåú áéï ÷áìú äæ÷ðä ìáéï äùëçúä" This study was a observation and interview. She asked how people perceive the lobby in the old age home.
| áéú àáåú | ãéåø îåâï |
| Segregation | Segregation |
| De-humanization | Humanism |
| Felt that lobby is the last station before death | They did not have this feeling |
| Aging perception | No perception of aging |
| This was perceived as a hotel for the old | |
| Low socio-economic level | High socio-economic class |
| Exaggerate disability and old age. | Ageless self - the person does not feel old |
| Many sit in the lobby in their wheel chairs. The dynamics differ to those that take place ãéåø îåâï. | The lobby was diverse, and halls are also used by others for lectures or conventions |
| Front door lobby there is more activity, life and diversity while the back door exit is to escort to hospital etc. | |
| Lack of both external and internal control. | Members have control over external surrounding and therefore over internal surroundings. Self-esteem increases. |
| îçì÷ä ñéòåãéú øçå÷ îé äçáøéí äàçøéí | |
àùì (ñåâ ùì ãéåø îåâï) In a new neighborhood the old were placed in the first floors of building and young families with children were placed in the top floors. This was an attempt at inter-generation connection. There were also services provided in the buildings. This is an example of ãéåø îåâï.
îùôçúåï: A service for the old. A family adopts an old person for the day, who comes to spend that day with the family and eats with them etc.
ùëåðä úåîëú: Aids old in a number of ways and provided diverse services and activities. It provided personal aid and advice. Also there are improvements of roads, benches, pavements. Some neighborhoods turn into these times of supportive communities for the old. There is an àá ùëåðä who is the handy man. In case of emergency aid is provided and there is ëôúåø îöå÷ä. Encouraged friendly visits and activities. There is meals-on-wheels. There is a consulting social work and other rights. There are volunteers that escort the old on their errands. This enables the old to remain in the community.
îøëæ éåí: The elderly come to spend that day.
îåòãåï: For the old who are independent.
ðåôùåï: Old person lives with family, but when family goes on vacation then the old are left and taken to the center.
îòøëú úîéëä ìà ôåøîìéú - Social Supportive Network: (Oslander): Family is the first network that the old person is exposed to. Under stress it is easier to cope when there are supportive mechanisms. The network is usually supportive. This protects and supports during times of stress. Those who were alone during Gulf War were in a much worst situation that those who had an informal supportive network. Jerald Caplan coined this term. Supportive networks are a type of defense mechanism which decreases to a minimum the negative symptoms that may develop during stressful situations. There are 2 definitions of Social networks: 1) Oslander: A set of human contacts, through which the individual maintains his social identity and get support on 3 levels: instrumental, emotional and symbols (an attachment figure) 2) Shuval: A collection of points that are connect. The points are the people, while the connections are the interactions. The person has contact with a number of levels of people. First, family member; distant family members; neighbors.
Conclusions: Research shows that the more dense the network the more the person is immune to changing situation and stress. The more the network consists of family members the stronger the network. Social workers aim to development informal networks for the old.
Social Networks:
Litwak: What parameters do we need to consider when dealing with old. 1) Proximity and distance: the person who is closest will come first if the old person fell. 2) Range of Obligation (time and diversity - ä÷ó). 3) Life style: if the old person is religious then part of his network should be religious. 4) Motivation of those in the network: Does a person or child have internal or external motivation - does he do it because he has to or does he do it out of love. Family is obliged to give instrumental support for long term periods and emotional and symbolic support for short-term periods. Friends on the hand, give short term support instrumental and emotional. Neighbors provide primarily short term instrumental support during emergencies. When old were asked what their expectations were from their informal networks, they answered that they mainly wanted emotional and symbolic support from their supportive networks. They expect instrumental support from the formal institutions.
Social workers role: He must consider the community to see who can be part of the old person’s network. The postman can ask the old person how he feels when he delivers the mail.
Pet -Therapy: This is an informal support system. What impact does this have on old people? Anxiety decreases in the old. Old people who have contact with animals had better contact with people. They take dog for a walk and in this way have other interactions with other dog owners. A person has responsibility if he takes care of animal. This therapy also has positive physiological affects (decrease in blood pressure).
Davis: The theory of Touch: Skin hunger is a necessity and is vital to decrease anxiety and increase security. When there are attachment figures a person knows that he has someone to turn to during times of distress. Members of the network are potential attachment figures.
Another way of positive intervention is through group work: Books: Toseland and Burnside Members of groups can become attachment figures if there are good relations.
Goals of groups work: 1) Belonging and Affiliation: The group increases of sense of belonging and attachment. 2) Group provides validity and social approval - àéùåø 3) In the group they can be involved in activities and play roles. They are given significance roles 4) Mutual learning and one can learn from the others experience. 5) Problem solving: similar problems arise and can be solved together. 6) Getting and exchanging information.
Levels of Prevention: Social workers not only treat but work on prevention. Aging is a natural process but has side-effects. 1) First Level of Prevention: Providing information before there is a problem or symptom or aging. This is a preparation stage before the person ages. He needs to know what possible changes will take place once he goes on pension. Also includes educating the young members of society about the truths of aging. Increase health, exercise etc in the elderly. 2) Second Level of Prevention: This is the intervention once there is a minor problem. Social work intervenes in a number of ways (sessions - individual level; day centers - group level; volunteers, increasing networks, strengthening intergeneration relations) 3) Third Level of Prevention: When there is a chronic problem social workers try to aid by coping with the situation that exits. Making the best of the situation and teaching the old to accept and cope with their positions. There is interdisciplinary intervention in all 3 levels.
18/12/02
Movie: “The Shower”
For a son to wash a father is an unnatural thing. It is a humiliating situation for both son and father. The father is dependent on his son and prefers to be washed by his son, who is a family member, that by a nurse. What happened to a son who has to see his father in this weak situation. There is a certain role exchange that leads to humiliation, hopelessness, fear etc. Once the mental energy that goes into washing ones father there is a closeness is formed between the. Marital relations: the healthy spouse needs to treat the sick spouse. This may lead to problems in the relationship. Often the grandson is a mediator between the granny and grandpa. There person feels at home in his shower, with his own soap, his own slippers and his way of washing him. We need to be sensitive to all the little nuances that a person has. To all his needs and desires. These are the things that matter. When the old insisted on showering at home this shows the limited control that he has over his life.When a parent ages this is a par t of the normative processes. The family balance has been shaken and needs to reestablish homeostasis. The boundaries of the family system need to be redefined and flexibly. Children need to invest more time in their parents. Distance vs. closeness; Individualization vs collective; personal vs common responsibility. These are 3 indicators that show how the family changes over the years. (Searts - theoretician). She examines these indicators. During aging the family diminished and centers on the old people. While during adolescence, the family broadens itself. Each member of the family needs to join in the treatment of the old. There is a transition to a collective. Children cannot reject their parent in old age. There is a reversal of role between parents and children. The emotions are different and both parents and children have to cope emotionally. The direction of treatment is negative and pessimistic. The schemas that we formed during childhood of our strong parents are challenged.
What children go through: They fear becoming the head of the genealogy. There is an invisible loyalty to our parents. There is a mutual principal according to the children feel an obligation to take care of parent.
Conflict Acceptance or rejection Dependence vs independence. Each family crisis intensifies the family members relations. There is unfinished business and closing of account, that are once again addressed during aging. There are a few types of conflicts: a continuos conflict; a renewed conflict; a new conflict.
Types of behaviors that children adopt toward their parents: 1) ôòéìåú éöø: There are children who over-invests in their parent due to symbiotic relations or guilty feelings. They have internal reason to over-invest in their parent. This is negative when it is on account of their own personal families. 2) ðîðò áò÷áéåú: This occurs when children are detached of when they prefer to pay for services for their parent instead of being involved themselves. 3) Shifts between the polarities: Child is very actively involved with parent, and stops his assistance because of burnout or because the parents complain. He then shift to the other extreme of ignoring his parents completely, has guilty feeling and the vicious circle begins again. 4) Constructive Assistance: Child takes care of his parents, but does not do this on the account of his own family and work.
Blenther: Speaks of the concept "áâøåú ôéìéàìéú" - A stage in life when the adult child has accepted his relationship with his parents. He is no longer angry or has learned to overcome his anger for his parents. He no longer has the need to settle account with his parents and is prepared to take care of them.
01/01/03 The Old Persons Family: Interaction-generation Solidarity: The old person has family relations. There is a modified extended family (îåøçáú- îéåöáú). Today families live differently. There is intimacy with a distance. Today they do not live in the same house. There is a primary caregiver, usually the daughter, who lives close to the senior. What kind of solidarity is there between the generations? Look at Family Integration Solidarity handout. If there is consensus between parents and children’s attitudes and values there will be less conflict. Refer to the scale: If the senior only receives then his relative position decreases. The family needs to provide an opportunity for the old person to give. How to family members increase solidarity and respect the old and his position as head of genealogy. This form of communication between family members increases solidarity. All the generations benefit from intergeneration solidarity. In the western world the daughter is the primary caregiver, while in the east the son is the primary caregiver. Cassandra Complex: She was perceptive and said that the “Troyan horse” can be a danger. Woman are more sensitive. The daughters are the kin- keepers. Why are there gender differences. Daughters have a different psychological identity, to sons. Women’s PI develops with interaction, while men’s PI develops with separation. In the initial stages of infancy both children are connected to mother, while in the oedipal stage the boy separates from his mother and aims to become similar to his father. During adolescence there are more intense conflicts between mother and daughter, than there are between other members of the family. The connection between mother and daughter continues throughout life, before and after they marry. When a daughter becomes a mother they become friends but the daughter often still wants to be the little girl. The daughter never leaves her mother. When the daughter is 40 and her mother is old, the relationship continues to exists. Women are more intimate than men. They are more attached to other family member than men. Women are inclined to create social networks while men are more competitive. Women widows prefer social interactions with others, while widowers prefer being cared for by one person. The biological theory strengthens these claims. The women cared for the children and nurses them. Men go out to hunt. Jung says that each sex gets in touch with the male/feminine aspects of her and his personality.
Intervention: We never work only with the senior. We work with the entire family on a number of level of prevention and with all 3 the methods. On the 1st level of prevention groups can be formed and relationships strengthened. On the 2nd level of prevention individual treatment can be offered to senior and his family and also group therapy with entire family and all generations. Community work and projects for all the generations. çå÷ ñéòåã (1988) - comes to strengthen the old person and his family. Strengthens the old person; Increases his stay at home; Delay is entrance into the old age home. The law allows children to focus on emotional aspects of relationship with parents. The old person lives in family, and has financial difficulties, and receives no other grants from other sources.
Empowerment: Due to his position the old person can have a low self esteem. The social work needs to empower the senior. The elderly person needs to be able to control situations in his life and to know and take care of his needs. The old person needs to be an active participant in knowing his problems and finding solutions to them. Needs vs. empowerment Needs vs rights. Social work can believe that the needs of the old need to be provided, while others feel that it is the old persons right to be involved in this process.
Psychological needs that expressed in empowerment: 1) Locus of control: if the old is allowed to decide he is in control. 2) Self-efficiency: 3) Strengthening self-concept:
8/01/03
Retirement - ôøéùä: Implications of retirement: This is a stage of transition. There is change in status; shaking of self-concept; leisure time increases; boredom; changes in financial situations; implications on the family system. Is retirement a personal change of does it affect others? Retirement affect not only the individual. We are talking about natural forms of retirement and not forced retirement of retrenchment. 70% of elderly have positive associations with retirement, but this all depends on how they prepare themselves.
Retirement is a social issue. What implications does it have on the state, employers, and retirees? State encourages retirement at age 65. When there is a difficult economic situation state encourages retirement of the older society, to make space for the younger generation who support the meshek. The retirees prefer to continue working and being efficient. Some organizations allow gradual retirement. Form age 60 the person gets ÷éöáú æé÷ðä, which is about 20% of average salary. Others, in addition to this get pension if they were employed. If a person continues working and doesn’t retire he adds 2% to his allowance, for each year that he continues working. Employers prefer that people retire at age 65.
Types of Retirement: Age 65 - âéì äð÷åá; selective; flexible.
Personal Implications of Retirement: Frustration, shaking self-concept, identity, status changes. There are family changes. Influence of couple relationship. It is a stage of transition. There is a change in roles. Redefining roles and relationship with family. How does one use his time? What happens with the marital relationship? The man has entered the women’s territory. Yung: During mid-life the women becomes more autonomic, while the man becomes more intimate. They need to redefine their goals. They spend much more time together. Types of relationships: 1) Good relationship: find a balance between autonomy and intimacy. 2) There are parent-child relationships after retirement of both spouses. The stronger takes care of the weaker. 3) Parallel relationships: there is no intimacy and they lead separate lives.
Retirement is dependent on a number of factors: 1) Demographic factors: education, one who developed hobbies prior to retirement, gender difference (women spend more time at home); income (people who have resources are different to the poor); Age (retirement is a transitional stage that may last 5 years. It differs for one who is 55, who still has many years till retirement and one who is 64, who will retire in one year) Achley: there are 7 stages of retirement: 1) The far stage - 5 years away. There is a will to retire. (age 55 women; age 60- man) 2) The near stage - 2 years before retirement. 3) The honey moon stage - a half a year to one month before a retirement. A happy stage. 4) Disappointment stage. A person does not know what to do with his free time. He decides what to do with his time. 5) Re-orientation: Re-organizing ones life and activities (to volunteer, hobbies etc) 6) Stability: A person has a set agenda, until he gets sick of weak. 7) Death.
In light of these stages, social workers have an important role in stage of retirement and retirees. Social workers aid people to plan their retirement. Planning for retirement can be analyses in the form of an upside-down triangle.
1) Listening to a lecture on retirement, on a rational level. 2) Lecture in smaller groups, which discussion of emotions. 3) Group work 4) Individual treatment. 5) Follow-up after the stage of retirement.
On what aspects do we work in treatment. What do we talk about in groups? Personal issues; economic issues (changes, rights etc); family; leisure; social life; health concerns.
Bernman: Model of retirement: there are 3 stages in retirement. 1) Leaving the old role (mentally a person prepares himself; decision-making and planning). 2) The formal act of retirement (formal ceremony) 3) Adaptation following retirement (plan new agenda)
Social workers role: Aid retiree in stages of transition; we need to be attentive; on group commune level social work must be active. Today there are many retirees, even before age 65. This leads to complications.
Senile Dementia: Dementia begins gradually at 20, when cells reproduce slowly. The older the person is the higher risk of dementia. Families find it difficult to cope with a demented parent. The old feel that they are going through changes and often feel embarrassed. Today there is preventive treatment and nutrition. Age and genes predict dementia. Loneliness and not communication with others leads to higher risk dementia.
Exam 40 questions Social Network, Don’t read “Ronen”