Welcome

• Facilitator greets participants as they arrive and presents them with place card and Participants' Folder.

Introduction of Facilitator -

• Facilitator introduces herself/himself and provides a brief description about her/his background. Caregiving experience may be briefly shared if relevant. The facilitator does not usually refer to personal experience in future sessions.

Overview of Program- 10 minutes

A. Information about Facility

• 2 A. Share information about facility:
  location of washrooms, parking instructions, smoking policy and telephone number.

B. Contents of Folders

• B. Review contents of Participants' Folders. Each folder contains the Agenda for Workshop 1, an outline of the themes, an evaluation form for Workshop I, resource lists, as well as paper, pen and name tag. The name and telephone number of the facilitator(s) are included.

• Review the Outline of the Themes (Appendix 1). The topic for Workshop 1 is Reflections on Aging and Caregiving: Myths and Realities. The material presented offers some factual information and encourages participants to examine perceptions and beliefs. Briefly discuss each theme.

• There is a table set up with some literature from several community resources. Participants are invited to browse through this and take materials that could be useful (unless indicated otherwise i.e., For Display Only). This table will be here for all six sessions so the material will be available each night.

• Facilitators will find it useful to refer to Appendix 1 to explain the intent of each workshop to the participants. Each week, the Objectives for the Workshop will be displayed on the flip chart.

• Additional material will be given to participants each week to be included in their folders.

C. Overview of Purpose

• C. Brief explanation of the purpose of the six-week program.

• Purpose: To bring caregivers together to discuss their experiences and to gain information that is applicable to their situation. The sessions focus on caregiving to older adults.

• The topic for each session was chosen because of its relevance to the caregiving experience. Each module builds on the others to increase our awareness about the aging process and caregiving experiences, ways we can better relate to others and ways to care for ourselves.

Introduction of Participants - 45 minutes

• Participants can introduce themselves and give a brief description of their caregiving situation. The facilitator may choose to do an "ice-breaker" exercise at this point.
• Participants are encouraged to express what they expect from the six-week program. Some group "rules" can be developed.

Nutrition Break - 10 minutes

• Participants can partake of refreshments and browse through the Community Resource material.

Presentation - 50 minutes
(see #6 after presentation)

• Refer to content for Workshop 1 - Reflections on Aging and Caregiving: Myths and Realities

Brief discussion about caregiving.

• Discuss participants' perceptions of "caregiving".
• Discuss the formation of our "image" of aging: it is shaped by observations, media portrayals, personal knowledge, memories and cultural influences.

Presentation

Workshop One - Reflections on Aging and Caregiving: Myths and Realities

Introduction

Reflections on Caregiving

"Informal care" describes the unpaid care and support provided by family members and friends to another family member or friend who requires assistance because of a condition(s) that limits their ability to carry out necessary activities. This care is based on a personal relationship with that person as compared to someone who is hired to provide a service. Some people may prefer to use the term "family care".

Family caregivers provide a wide range of support and care: emotional support, companionship, personal care, transportation, financial advice and/or support, household management, and organizational activities (such as arranging for services or working with different departments or organizations when issues arise).

The role of caregiver is usually an "add-on" role and seldom are people prepared for the tasks involved.

There are 2.8 million informal caregivers in Canada: of these, 2.1 million provide care to an older adult.

While caregiving is not a new phenomenon - family members have always looked after each other since the beginning of time - the context in which caregiving occurs has changed.

More people are living longer than ever before and so many experience age-related limitations in the later stages of life.

More women are in the paid labor force and at home since they have traditionally been the primary caregivers, there are fewer of them available to provide care. People are remaining at home for much longer with complex chronic conditions. Families are spread out all over the world so there may be fewer people available to share the caregiving tasks.

Facilitator's Note: Discuss Perceptions of Caregiving.

Reflections on Aging - Myths

Many myths abound about aging. This session will explore the most common myths and confront the realities by using factual information.

Myth # 1: We have a clear understanding of old age

• Our concept of old age is not clear cut.

• In order to understand what old age is, we need to examine all aspects of our lives: physical, psychological, social and spiritual.

• Age-related changes occur throughout the life course; they do not magically begin at the age of 65.

• There is no clear definition of when old age begins. Chronological age (our age in years) is not a reliable indicator of a person's ability to function in our world.

• Our perception of what is "old" is often based on what a person can do, their functional ability. This assessment has little to do with actual age in years.

• We all age at different rates: Heredity, lifestyle, disease and environment are major influences on the rate of aging.

• Every system in our body ages at different rates, as well.

• Many times, the symptoms of "old age" are actually the effects of disease.

Myth # 2: Old Age and Disease are one and the same

• Old age is not a disease - it is a normal phase which occurs in the life cycle.

• It is true that the incidence of disease increases as we age.

• More than 80% of people over the age of 65 have some type of chronic disease. The fact is, however, that with a few lifestyle adjustments the vast majority are able to cope very well. An example is arthritis which is prevalent but varies significantly in severity.

• The most common chronic diseases among Canadian seniors are arthritis and rheumatism, hypertension, heart trouble, and respiratory problems.

• Disease can be harder to detect in older people than in younger people. Sometimes the signs and symptoms may be diminished, absent or not characteristic of the condition. Therefore, changes in functioning may be attributed to "age" rather than an insidious disease process. If the disease is overlooked, it will go untreated, sometimes until a crisis results. Hypothyroidism is one example of a disease often missed in the elderly.

• As many older people take multiple medications, the potential for adverse drug-induced problems becomes greater. Many symptoms can be caused by drug interactions and reactions.

• Most chronic diseases do not begin in later life; the seeds for these are sown much earlier, as with cardiovascular disease. It is the cumulative effect of damage that we observe in later life.

• One clue to determine whether problems are the effect of true aging or of disease is whether the onset is acute or insidious. An acute onset, such as sudden shortness of breath, would suggest an illness.

• Most people remain very active well into old age; the key is to challenge ourselves. "Use it or lose it" has become a popular maxim. The quickest way to decline is to be totally inactive.

Myth # 3: The changes that occur with age make independent living impossible.

• The majority of older adults do live independently.

• The loss of independence is a major threat to everyone.

• Apprehension about losing one's independence causes considerable anxiety, particularly among older people.

• The reality is that only 7% of people over the age of 65 live in institutions (nursing homes).

• It is true that the likelihood of institutionalization does increase with advanced age. One factor is that there may not be anyone available to assist the older person as those around them are aging as well.

• Even with considerable functional impairment, most people can remain at home with some assistance from family and/or formal home care agencies.

• The normal changes that occur with age do not preclude living independently. Some adaptations in living arrangements may be required, as they are at many stages in life.

• The influence of disease is a significant factor affecting a person's ability to live independently. It is most often a health crisis or deterioration that precipitates a change in living arrangements.

• Maintaining independence may require some innovative arrangements; modifications to housing may be required.

• In the caregiving situation, the threat to or loss of independence may challenge relationships. Some behaviours may emerge which are hard to understand.

• Being active participants in decision-making processes affecting their lives may help some people to maintain some independence even when physically challenged.

Facilitator's Note: Encourage the Caregivers to Discuss the Idea of Independent Living and What it Means to Them.

"Independence is not the quantity of tasks we can perform without assistance but the quality of life we can live with help." G. De Jong, 1979 (original source unknown)

Myth # 4: We have little control over our own aging process.

• Through our attitudes and our choices, we can exert a major influence over our own aging process.

• We can make positive decisions about our lifestyle.

• Many of the changes we once assumed were inevitable results of aging are now understood to be the effects of factors such as heredity (which we can't influence), lifestyle, disease and environment.

• For example, excessive exposure to sun exacerbates drying and wrinkling of the skin, not to mention increased risk of cancer. Another example is limited mobility, once thought to be inevitable with aging. Research and observation have shown that regular, appropriate exercise allows people of any age to maintain flexibility and range of motion and to remain mobile.

• Regular exercise, good nutrition, good relationships, adequate sleep and limitation of harmful habits such as smoking enhance our sense of well-being and thus exert a positive influence on every facet of our lives.

• We do experience specific age-related changes in each system in our body. In the absence of disease, these changes do not prevent us from enjoying life to the fullest.

• Generally, the effect of the changes is that we have fewer reserves to draw on and slower response times.

• The opportunity to make our lives the best that we can remains with us for life - speed is not an important factor in experiencing life to the fullest.

Myth # 5: Old people are a homogeneous group.

• The differences among the elderly are more pronounced than for any other age group.

• There are marked differences in health status, age, physical abilities, marital status, housing, religion, income, sex and ethnicity. People age at different rates.

• It is very important not to generalize about characteristics of elderly people. A characteristic you observe may be a "cohort" effect; that is, the effect of a group of people in a particular age group sharing a similar experience. An example of this is the frugal nature of many people who experienced hardship in the Depression era.

• People become "more" individual as they age; that is, personality tends to remain intact throughout a lifetime, but personality traits may become exaggerated.

• Needs of older adults vary significantly from decade to decade: for example, from the young-old (65-75) to the old-old (85+). This is important to remember because the age range of "older adults" can span 50 years!

Myth # 6: Old age brings significant mental decline.

• Significant mental decline is not a normal part of aging.

• Significant mental decline is the effect of disease.

• With conditions such as Alzheimer Disease, mental deterioration can be irreversible.

• Sometimes, mental deterioration can be reversible. Some causes of reversible mental decline are:

  • Infections
  • Untreated disease
  • Drug Interactions
  • Malnutrition
  • Dehydration
  • Grief

  • Sensory deprivation

• When an elderly person exhibits confusion, it is crucial to have a proper diagnosis by medical personnel.

• Abrupt changes in mental status often signal physical illness.

• It is recognized that intellectual stimulation is necessary to keep the mind healthy, just as physical activity is necessary for the optimal functioning of the body.

• Memory loss is often a major concern of older adults. Most times, this is selective memory. People of every age "forget" things, but rarely do younger people attribute this to their age!

• Older people who do experience some mild short-term memory loss can use aids such as notes, lists etc. to jog their memories.

Myth # 7: Old age does not allow for human growth and development.

• Growth cannot be measured solely in physical terms. Our physical growth is actually complete by the late teens.

• Our psychological, emotional and spiritual growth continues for our lifetime.

• An individual's personality, life experience, coping mechanisms and attitudes are major influences on the potential for human growth until the end of our days.

• The ability to contribute to society and to grow personally is not age related. Aging may actually enhance the opportunity for personal growth as one interprets life events; a new perspective can develop in later years.

Wrap-Up Discussion

• Caregivers are an important part of the health and community care system.
• The work of caregiving needs to be recognized and supported within all systems in our society.
• The myths and misconceptions that surround aging often create more limitations than the realities do.
• Our society tends to perpetuate myths by defining "productive" life in terms that exclude the elderly: speed, youth, occupation, and income.

Questions and Discussions - 20 minutes

Evaluation of Workshop 1 - 10 minutes

Closing Remarks

• Participants are encouraged to relate information to their personal situations.
• Distribute Evaluation forms. Participants do not need to sign the forms. Completed sheets can be left in a designated spot.
• Facilitator briefly summarizes major points of the session. Caregivers can be informed that the next week's topic is Normal Aging. Date and time can be reiterated.