Supporting Self Care Network
Newsletter
February 20, 2002, #3

Self Care and the Elderly...

Contents

Welcome
Editorial
Highlights
Member Profiles
In Practice
Sharing Resources

Welcome

by Lynnette Leeseberg Stamler
Associate Professor and Director
Collaborative BscN Program
Nipissing University

It is a pleasure to welcome you to the third issue of the Supporting Self-Care Network newsletter. As a member of the Network Development Committee, it has been exciting and rewarding to watch these newsletters come together, thanks to the contributions of a variety of members.

This issue focuses on a timely theme-- supporting self-care in an aging population. Hector Balthazar's editorial starts us off with an articulate and lively point of view expressed by a senior who is himself involved in supporting selfcare and care giving. The other articles compliment his call for a renewed emphasis on self-care as an integral part of successful aging.

This theme is of interest to all of us both professionally and personally. As we grow older, concerns about quality of life become more important than those about quantity. And, as the proportion of old Canadians (80 plus) continues to increase, this group will become less of an anomaly and more of a force to be reckoned with. It will serve us well to ask these older Canadians about their goals for self-care and how health professionals can best support them in their pursuit of those objectives.

I invite you to join in the discussion about this important topic by sending a message to discussionmailing list [address was here].

Editorial

by Hector Balthazar

In the western world, especially in North America, old age is viewed as a stage in life to be delayed, avoided and even denied. More than the slow deterioration and break down of the body, seniors mourn their loss of social roles, which had previously provided them with emotional sustenance and had given meaning to their lives.

Society needs to explore what is unique to old age and promote ways of supporting that uniqueness instead of promoting false ways of regaining youth.

In the end, it only succeeds in older people - the unwary that is - ape youth without ever regaining it. Cosmetic surgery, multi-vitamins with lutein, prozac, square dancing, bingo and Viagra are scarcely a prescription for a purposeful old age.

Aging baby boomers may produce - by reason of their numbers - a shift in society's view of older people. Hopefully, they will press for a role in society while proving at the same time that every stage in life is as creative as any other, a fact long noted in the annals of wisdom, but hardly acknowledged.

Openness, individual freedom and independence are prized in our society. For their maintenance they need to be tempered with a spirit of mutual cooperation. What we are witnessing in the health field is reflective of this and self-care is an example par excellence. The empowerment potential inherent in its practice carries with it other important benefits for an individual's health, both physically and psychologically. Self-care is an important method of enhancing the quality of one's health. This is not something simply cooked up by policy makers faced with deficits in the health sector.

Supporting self-care as a concept has been an emergent factor in the thinking and practice of professionals in the health field. It's been recognized that by treating patients holistically, results are far more impressive than one finds in cases where traditional paternalistic ways of relating has been the way of operating. Part of this new approach is to teach patients how to assume more and more responsibility in the management of their health. This involves judgment calls on the part of professionals for the range of 'independence capacity' among patients is broad. The extra effort all this may put on professionals, especially at first, carries with it returns far greater than the original investment of time and heart. For best results, seniors must shed their unnecessary dependencies and professionals must surrender professional forms of power and status to meet patients on a human level, free of the contaminants of class and rank.

My wife and I are fortunate to have a family doctor who easily stands as a model to other professionals in this respect. She is a healer, friend and confidante in the best sense of these words. Her approach is such as to inspire confidence to engage in a health-related relationship that is not only beneficial to us but to her as well.

Hector Balthazar is a caregiving retiree who lives in Ottawa. Prior to his retirement, he laboured to advance the development of the self-help movement at Health Canada and the Canadian Council on Social Development.

Highlights

Self-Care- what it can mean to the senior population
by Gerri Hewitt, Executive Director, Manitoba Society of Seniors

In the summer of 2000, the Manitoba Society Of Seniors (MSOS) was invited to become a part of a research project into self-care and seniors. The project would be funded by four organizations and by Health Canada and directed by Dr. Malcolm Doupe. Over 40 members of MSOS participated in the project.

Despite the wonderful advances in science, technology and medical discovery, self-care remains a relatively simple yet very powerful and too infrequently discussed method of care.

The two most frequently asked questions posed by the participant seniors were: "Just what is self-care?" and "Why should I be interested?" The very simple answer to both questions was "Self -care involves you taking the steps to improve your health in any way that you want and involving whomever you want in the process." This was a new concept of health for many of the older adults. Not that they, in reality, had not been doing many of the recommended steps all along -- such as staying active and being involved in the community - but rather, it was the "self-care" part of a good personal health plan that needed some work. For the more frail, older adult, this concept was somewhat frightening because they had always been trained to accept the direction for their care from professionals. Now they would be given the opportunity to take responsibility for that care themselves.

The research project used written surveys and focus groups, to identify five domains of health as being important within self-care; these are Functional Health, Cognitive Health, Social Health, Personal Health and Emotional Health. Strategies were identified by the participants to optimize the total person. As a result of this project, a manual has been developed to assist adults of all ages, especially those seniors who wish to stay in their homes and communities.

This is only a start on the road to the promotion of self-care in the seniors community. The Manitoba Society of Seniors is looking forward to continuing the development of this exciting project.

Member Profiles

Rodney Crutcher, MD

Rodney Crutcher is an active clinician and an Associate Professor in the Department of Family Medicine at the University of Calgary. Rod stresses the importance of bringing clarity to the meaning of self-care and how physicians can support individuals and families in their health care journeys.

"The idea of supporting self-care allows us to acknowledge that patients are sometimes the real experts when it comes to knowledge, resources and experience with a health problem. Sometimes health professionals do more than is appropriate. It helps us frame the roles and responsibilities of the health professional, the patient, his or her family and the wider community."

With no formal curricula and few operationalized learning strategies or evaluations, Dr. Crutcher acknowledges that supporting self-care is sometimes difficult to teach medical students and residents. "I believe that nurses and other health professions are further ahead in this," says Rod "and that physician educators need to learn from other disciplines."

Rod believes strongly in an interdisciplinary approach that includes patients as teachers. "It is easy to learn the medical facts about diabetes," says Rod. "But it is far more powerful and enlightening to hear an individual who has diabetes describe what it is like to live with the condition 24-hours a day."

The aging of Canada's population presents a number of challenges to medical care. "As the number of people with chronic health problems increases, physicians will need to become more comfortable with caring and supporting, rather than curing. Our colleagues in nursing, pharmacology and other health professions are important partners in this change, but patients and families will be essential to designing appropriate care."

Dr. Crutcher points out that a physician's role with older patients is both complex and changing. "It is not easy to get comfortable with role ambiguity and to know when to switch from an active diagnostic and treatment role (such as when a patient has an injured joint) to a supportive role (such as when a patient has chronic arthritis)."

Dr. Crutcher believes that another challenge will be to acknowledge the spiritual needs of older patients and to make appropriate referrals to people that can help in this regard. "Unfortunately, the current fee system supports patch work, high-tech medicine when what is needed is high quality, high-touch care that acknowledges all aspects of health--the emotional, mental, social and spiritual aspects as well as the physical."

"We can no longer learn and practice in silos." says Rod. "Supporting self-care provides a window that allows us to come together and be innovative in our approaches."

In Practice

Supporting Self-Care for the Older Adult: Building Upon a Self-Care Framework
by Malcolm Doupe and the Manitoba Team

In the late 1990's physicians and nurses of the Supporting Self-Care project of Health Canada developed a framework which could be used as a guide to help health care consumers practice self-care. Components of the framework included: supporting the person, sharing knowledge, facilitating learning and personal development, helping to build support networks, and providing a supportive environment. Our team wanted to build upon this framework by examining how health care professionals and older adult consumers viewed this concept with the goal of finding the best ways of promoting and assisting in the practice of self-care.

To do this we held focus groups for three separate groups of participants: key decision makers from community organizations such as the Manitoba Society of Seniors, older adults living in the community, and a variety of health care professionals (physicians, nurses, pharmacists, social workers, occupational therapists, dentists). Participants were asked to identify and discuss the important features of self-care, appropriate strategies to support self-care, and the barriers to practicing and supporting self-care. Themes, identified from this information, were then taken to three workshops where they were presented for small group discussion and a consensus of opinion. A total of 24 older adults and 39 health care professionals participated in one or both of the focus groups and workshops.

All agreed that the most important features of self-care included functional, social and cognitive health. Also considered as key were safety, having an environment appropriate to the level of need, and education. Less common themes were knowing available community resources and informal support between two older adults.

Strategies included educating the consumer about self-care, providing individuals with the opportunity to make decisions about their own care, comprehensive assessments that treat health in a holistic manner, and collaboration, which includes communication with other professionals and community resources when providing care. Barriers to practicing and supporting self-care varied according to participants. Older adults listed lack of motivation, non-compliance and health care system dependency as important barriers to their self-care. Health care professionals identified insufficient time and collaboration, and lack of awareness of community life as important barriers to supporting self-care.

As a research team we think that the information from the focus groups and workshops builds upon the original supporting self-care framework and that it provides further understanding of and insights into self-care. We hope our findings will help health care professionals develop appropriate and effective self-care strategies with and for their older adult clients. If you wish to obtain more information about this project, you may contact Malcolm Doupe at Malcolm_Doupe@sbrc.umanitoba.ca

Sharing Resources

Book Review
by Krystyna B. Kouri
Sherbrooke Geriatric University Institute
Self-Care in Later Life: Research, Programs and Policy Issues
by Marcia G. Ory and Gordon H. DeFriese
Springer Publishing Company (1998)
ISBN: 0-8261-1186-6
Hard Cover, 267 pages

For any one interested in the role of self-care in regard to health and older persons this book is an invaluable resource. Organized around eight themes, the strength of this volume lies in the diverse perspectives submitted by experts from the field. Thomas Konrad begins the book with an epidemiological approach and looks at the role of self-care in maintaining independent functioning among elderly populations. Current knowledge regarding factors that tend to either encourage or discourage the practice of self-care skills by older adults is presented by Eleanor Palo Stoller. Research and theoretical dimensions are examined through subjects such as the underlying research bases of programs designed to foster self-care (submitted by Thomas Prohaska); self-care intervention research perspectives (outlined by William Rakowski); and theory-based research versus descriptive research (addressed by Leventhal, Leventhal and Robitaille).

The role of assistance technology in self-care is examined by Laura Gitlin; and sociocultural perspectives are presented by several authors; namely Kathryn Dean who looks at the international dimension, and Davis and Wyckle, who explore cultural origins and beliefs about self-care in older minority and ethnic populations. A lengthy list of references completes this well-conceived overview of self-care issues as they relate to the elderly population.

Website Review
by Peggy Edwards
Principal, The Alder Group
www.hc-sc.gc.ca/seniors-aines

This bilingual website-sponsored by the Division of Aging and Seniors at Health Canada-provides a feast of reliable information designed to enhance understanding and mutual support across generations. The site is well-designed and easy to negotiate. It contains lists of publications by category (ranging from Alzheimer disease to palliative care), sections on selected issues such as injury prevention and medication use by seniors, a calendar of events, statistical profiles and web links. The website also supports the National Advisory Council on Aging which has its own section and copies of Expression, a thematic quarterly newsletter on topics such as "self-help groups," dealing with depression" and "our take on technology."

Two particularly impressive aspects about this site are its timeliness and tone. Upon entry, you immediately see the What's New section and access to statistical profiles that are updated weekly. The tone is thoughtful, respectful and straightforward. It offers the perspective of older Canadians and validates seniors' life experiences in issues related to health, family, tradition and history.

This site is a "must" bookmark favourite for both professionals and consumers who are interested in supporting self-care in an aging population.