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PROMOTIVE AND GROUP BASED REHABILITATION OF THE ELDERLY
4TH SEPTEMBER 2014
Ailish Dennehy
Tom Hefferon
Jenna Suhonen
Elina Hyvarinen
Daniela Saringer
Sonja Datlinger Kofler
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https://www.youtube.com/watch?v=4ZnxRJspnfc&feature=youtu.be
https://www.youtube.com/watch?v=TSsfa4nWYsw&feature=youtu.be
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OVERVIEW
Presentation of cases Discussion Our findings Conclusion
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In the future, the elderly will be a more heterogenous group with different needs and hopes. Their life courses will be more diverse and have more adaptable families, careers and also actual information concerning their services and rights in social and health care, rehabilitation and therapies.
Also, part of these generations will have better pensions, socio-economic situations, properties and more international life style.
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OUR TASK
Three case studies will be presented, they have different early state symptoms or demands concerning their mental, physical, psycho-social and environmental independency / autonomy /well-being / successful aging.
In the group:1. Describe different national solutions for three
cases which will be based on your own countries services and possibilities to promote or rehabilitate these person, couples, and families.
2. Compare these different solutions and create the best combination from all of these different national possibilities.
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DEFINITION
Process of evaluation of a person with impairments, and the interventions aiming at that person's social participation
(Adapted from Blouin, Maurice, Dictionnaire de la réadaptation and International Index and Dictionary of Rehabilitation and Social Integration — IIDRIS)
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GROUP-BASED REHABILITATION
Client-centred approach which involves the people themselves being proactive and organising their own activities
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COMMUNITY BASED REHABILITATION
The aim of community-based rehabilitation (CBR) is to help people with disabilities, by establishing community-based programs for social integration, equalization of opportunities, and rehabilitation programs for the disabled. The strength of CBR programs is that they can be made available in rural areas with limited infrastructure, as program leadership is not restricted to professionals in healthcare, education, vocational or social services. Rather, CBR programs involve the people with disabilities themselves, their families and communities, as well as appropriate professionals.
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Watch Carefully!
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CASE ONE Bertha 79 year old woman Problem with locomotive system (lower limb and back
problem), problem with musculo-skeletal system, pain and a little depressed, who has also some sleep disorders and dizziness, some hearing problem
Lives alone in old detached house near by the little city center, large yard around the house, garden with apple trees and goosberries
One daughter and her family - living far away and visiting about once a month, some friends and neigbours who help occasionally
No driving license, uses rollator for outdoor activities, low pension income No regular home-help, but has little problems and also risk
in every day life Many hobbies, which she has given up one by one (choir
singing, handicrafts, reading, gardening) – sitting a lot and watching TV, laying often on her bed, also during day time
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PROBLEMS/ISSUES
Biological/Physiological
Musculoskeletal issues Back pain (?reason for the pain, ?arthritis) Hearing problems Dizziness Reduced mobility High risk of falls Difficulties with ADLs (washing, walking etc..)
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POSSIBLE HELP
Biological/Physiological
household modifications suitable sports and therapy assistive technology home health care for ADLs pain medication good nutrition
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SOLUTIONS BY COUNTRY
BIOLOGICAL/PHYSIOLOGICAL
Austria
GP (+/- referral)physiotherapysocial worker (from the hospital – discharge mgmt)
Finland
GP physiotherapyRehabilitation-Mgmt database for professionals - TOIMIA
Ireland
GP + referralhospital – special pain clinicsmedical social worker (from the hospital – discharge magmt)
Get help from GP and Outpatient teamhttp://www.toimia.fi/
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PROBLEMS/ISSUES
Psychological/ Mental
Depression Sleep disorder Lethargy Hearing problem: ?exclusion from groups Lonliness Financial pressures No sense in life (husband died, children far
away, no hobbies) ?addictions like smoking, alcohol, medication
abuse
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POSSIBLE HELP
Psychological/Mental
friends, retirement groups activities that she likes (singing,
gardening, reading) counselling medication contact with her family
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SOLUTIONS BY COUNTRY
PSYCHOLOGICAL/ MENTAL
Austria
GPpsychiatrist /psychologistself help groups / voluntary groups
Finland
GPpsychiatrist /psychologistself help groups / voluntary groupsdatabase for professionals - TOIMIA
Ireland
GPpsychiatrist /psychologistself help groups / voluntary groups
•Maybe the main problem is that she does not want to do any activity, in this case, we can only encourage her
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PROBLEMS/ISSUES
Social
Lack of interaction/participation Lives alone No driving license Small pension (cannot afford taxis/activities) Reduced mobility (cannot go out without
rollator/ snow) Gave up her hobbies
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POSSIBLE HELPSocial
friends, retirement groups activities in groups (singing, gardening?,
reading-club) counselling & visitors (from home health
care) build up better contact with her family –
social worker day care centre University for seniors- studying
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SOLUTIONS BY COUNTRY
SOCIAL
Austria
social workers (only get involved if someone tells them)home health careself help groups / voluntary groups
Finland
taxi benefits for people who have a loss of function self help groups / voluntary groupsdatabase for professionals - TOIMIA
Ireland
transport pass – free travel … everyone gets it at the age of 65self help groups / voluntary groups
Maybe she wants to be alone? Happy being by herself?
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BEST SOLUTION FOR BERTHA
-- Assessment by Toimia -- Case-Management by Rehabilitation-Councillor
(ReCo) – get multi-professional team together:
physiotherapist (moving + sports activities),Psychiatric team(depression),doctor (medication),nursing staff (help with ADLs)home health care (counselling – visitor-service,
shopping service)voluntary group (socialising, activities, hobbies)
-- Free transportation: pubic transport / taxi is for free for people over 65
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Watch Carefully!
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CASE TWO
Old couple - Lisa (85) and Georg (88) Married over 60 years, living in detached
house Georg is active person, has many friends and
hobbies outside the home, driving car, does no house work, ”everything must be as it has been always”
Lisa, many health and functional problems, difficulties in IADL-tasks, no home help services, not satisfied her role as a wife, as a mother with demending adult children (Sunday lunches, serving mother) – desires own time, own hobbies, own life, but don´t know what to do….
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PROBLEMS/ISSUES
Biological/Physiological
LisaMany health and functional problemsMultimorbidityReduced mobility
GeorgeNo problems
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POSSIBLE HELP
help in the household suitable sports and therapy home health care for ADLs medication for health problems
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SOLUTIONS BY COUNTRY
Austria
GP (+/- referral)physiotherapy
Finland
GP physiotherapy
Ireland
GP + referralphysiotherapy
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PROBLEMS/ISSUES
Psychological/Mental
LisaUnsatisfied with her lifeOverburdened- burned outNo free time – would like to have her own
life?Not confident enough to do her own things
GeorgOld fashionedDoes not like change
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POSSIBLE HELP
Psychological/Mental
counselling from social worker/psychologist/couples therapy
encourage her to speak with George contact her family to reduce
expectations mental training/ life-coaching to
strengthen her confidence to stand up for herself
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SOLUTIONS BY COUNTRY
Austria
GP -Psychologist-social worker – would start conversation with family and Georgelife-coaches/motivation trainer paid privatelyself help groups against burn out
Finland
GPsocial worker – would start conversation with family and George
Ireland
GPpsychologistself help groups / voluntary groupspublic nurse for organising home help
Important to assess their readiness for rehabilitation
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PROBLEMS/ISSUES
Social Lisa
no interacting with people: lack of participation loneliness reduced mobility – can not go socialising? never had own hobbies / activities because of
household/children/husband does not know how to realise her wishes
GeorgeGood social life – no problemAbuses Lisa’s kindness
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POSSIBLE HELP
women’s clubs to find friends and socialise counselling – conversation George/Lisa activities in groups/hobbies clarify the roles in the family and outside the
family
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SOLUTIONS BY COUNTRY
Austria
ask friends and family for advice or services/clubs/groupslocal authorities: social workers get information for group activities to find new hobbies and friendsregister in self help groups / voluntary groups
Finland
get information for group activities to find new hobbies and friendsregister in self help groups / voluntary groups
Ireland
register in women’s clubfree transportation to the clubsRegister with voluntary organisations
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BEST SOLUTION FOR LISA AND GEORG
-- use more private services: life-, mental-, motivation-Coaches; Workshops; self-help-groups
-- get more self-confidence to say “no” and give up some burden and work
-- couple’s therapy -- organize help for the household (get George
to help) -- meals on wheels (even if George does not
like this) -- Free transportation: pubic transport / taxi is
for free for people over 65
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https://www.youtube.com/watch?v=kGt0udeqyxg&feature=youtu.be
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Watch Carefully!
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CASE THREE
Karen (85) and son (62) Widowed two years ago, lived with her son, who
has psychiatric and memory symtoms (old dx mental retardation from 1950´s), detached house far away from city center.
Too tired to take care of home and son and their everyday life – has heart disease, blood pressure, sleeping disorders – son has behavioural disorders (angry, hostility) and his day-night –rhythm is interrupted
They don´t have home-help or other services, because son becomes angry about visitors/strange people. Karen has only contact to her own physician (controls)
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PROBLEMS/ISSUES
Biological/Physiological
KarenHigh blood pressureHeart diseaseSleeping disorder
Son JohnOutdated diagnosis
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POSSIBLE HELP
Biological/Physiological
Karen consult a GP – medical check up for herself give his mother a break – HomeHealthCare,
DayCareCentre
JohnProper medication Psychiatric review
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SOLUTIONS BY COUNTRY
Austria
GP- medical check uphospital
Finland
GPlifestyle change – more activity for herself
Ireland
GP community pharmacist
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PROBLEMS/ISSUES
Psychological/Mental Karen
BurdenedBurnt out
JohnPsychiatric and behaviour disorderDay night rhythm is interruptedAnger and hostility (?injure others and
maybe himself)Memory symptoms
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POSSIBLE HELP
Psychological/Mental
Karen: get her a break from her songive her options for the treatment of her
son
John: consult a psychiatrist get new diagnosissearch for treatment-options
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SOLUTIONS BY COUNTRY
Austria
DayCare/Inpatient CareCrisis Intervention TeamPsychologist
Finland
Rehabilitation Centremental InstitutionCrisis Intervention Team
Ireland
DayCare/ Respite –rest for KarenCrisis Intervention Team
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PROBLEMS/ISSUES
Social
Karen lack of social interaction no transport-possibility lost contact with her friends no visitors because of son’s anger no social life
John no social interaction at all, no friends
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POSSIBLE HELP
Social
Karen: join self help groups/local retirement groupsmake friends and invite people when her son
is awayhome health care to get time to be active
John: make new friends in the psych. ward/Day Care?less aggressive with appropriate medication
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SOLUTIONS BY COUNTRY
Austria
Karen social health servicesget information about groups and activitiesCrisis Intervention team to protect herJohnSupported Living Environment for John
Finland
self help groups / voluntary groupsgroup activities
Ireland
transport pass – free travel … everyone gets it at the age of 65self help groups / voluntary groupslions-club
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BEST SOLUTION FOR KAREN AND SON
-- make both of them happy and give them the possibility to lead a healthy life
A) son moves out: advantage for her, does not have to care for him any more
for him: maybe he makes new friends as well B) son stays at home: need definitely some
help: HomeHealthCare, DayCare, Psychologist & proper medication
C) both move out and get help in a supported living environment
D) she moves in a nursing home and social services will have to help him out then.
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Health promotion of elderly, Liimatainen 2007
PROMOTION PREVENTIONIdentification, evaluation and strenghening of resources
PERSONAL/INDIVIDUAL
SOCIETAL / CONTEXTUAL
Identification and prevention of risks
Primary prevention
Secondary and tertiary prevention
Creatieng possibilities and participation
Self care, voluntary individual
Social policy, culture of societies and services
Environments of everyday life
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CONCLUSION
Need of multidiciplinary approach (one person to coordinate
– Rehab-counsellor) Each case is different
– look at each individually More information about the patient
– good assessment online (Toimia) It is not only about one disease or one problem
– we have to see the whole picture Different types of rehabilitation
– it was easy to find a good solution with all countries and professions
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WHAT WE HAVE LEARNED
Better understanding of what social rehabilitation is
Learnt the importance of good communication between the whole multidisciplinary team
Learnt more about the different national perspectives on issues discussed
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