Case study on needs of the older person
This report will focus on the needs of an older person using the ideas of developmental theorists. The subject of the case study will be a 70 year old female called Y and the key theories discussed will be Eriksons life cycle model and Maslows Hierarchy of Needs.
I have based this study on a lady who I will refer to as Y. She is a neighbour who I have known for several years and is 70 years old. She had a fall recently which left her hospitalised for a short period with a broken shoulder. Her mobility is also waning due to arthritis and her shoulder injury has left her unable to drive and requiring physiotherapy. She also need short term help with aspects of personal care such as washing and dressing. She is a widow and I know her (adult) children fairly well. She and the family know that I am studying social work and one of the children had actually asked me for some advice recently about her mothers situation and how they might access support services. I have had some discussions with the family and told them about this assignment during the course of these discussions; they have given me consent to discuss Ys case. Y still has capacity to give consent this type of issue and she is also happy for me to use her details on the understanding that she will remain anonymous.
Once I had obtained consent for Y and her family and provided assurances that her information would be kept confidential, I met with her on three occasions to discuss her needs, her feelings about her situation and how her situation might be improved. I had access to her medical records; I also met with her son and daughter on one occasion to discuss their mothers situation. The interviews lasted around thirty minutes and were relatively informal.
Developmental stage and psychological models
The development model that I am applying to this case study is Eriksons theory of psychological development. It is a model that believes personality development is something that continues through the course of a persons life and Erikson breaks this down into eight different stages of development. The early stages cover the first stages of a persons life. Moving through adolescence into young adulthood and middle age. At each stage Eriksons model explains some of the thoughts and feelings that are likely to occupy a persons mind, and discusses how success or failure in work or relationships can impact on a persons psychological well-being (Newman and Newman, 2012).
It is the latter stage of Eriksons model that are most relevant to Y. She has passed through stage 7 which Erikson sees as a period often pre-occupied by careers and parenting to the final stage of the model which is labelled Integrity vs Despair. At this point people are often examining their lives and considering whether they have a feeling of contentment about what they have achieved in life or feelings of disappointment. They are often worried about the future and there is a gradual realisation that the end of life is imminent (Ryan and Coughlan, 2013).
Erikson wrote about the concept of ego integrity and that people analyse that opportunities they have taken or lost in life. If people feel that they have not made the most of lifes opportunities there can be a feeling of despair that they no longer have time to put it right (Ryan and Coughlan, 2013).
When I applied this theory to Y I found that she was a person who was on the whole happy with what she had achieved in life. She had enjoyed a career working in local government; she had been happily married and raised two children who seemed to be going on to live fulfilling lives. I did not feel that Y had regrets about the past but she was starting to worry increasingly about the future.
Any view of Y of course should take into account her wishes, feelings and needs as an individual rather than simply looking at her age and pigeon-holing her according to a theoretical model, Social work as a profession should avoid stereotyping (Zastrow, 2014) and this is something by social work codes and standards
Attitudes and belief systems
My discussions with Y have me an insight into her attitudes and belief systems. Returning to Eriksons model, I found that she had a positive view of her life to date but was increasingly concerned that the period of her life where she is an active citizen is coming towards an end. This is a view that can be held by other in society about older people. Ageist views that older people are a burden to society rather than making a contribution exist (Thompson, 2003) and I felt that Y herself was buying into this outlook.
I also felt that Y was worried that her lack of mobility would prevent from achieving her goals of playing an active part in the lives of her young grandchildren. Again, Eriksons model suggests that dissatisfaction in the later stages of life can lead to despair and this was a concern about Y.
I have given consideration to Maslows hierarchy of needs in looking at what psychological needs Y might have. Maslow argued that people are motivated to satisfy a certain level of need before being motivate to move on and meet the next (Mcleod, 2007).
Y has safety needs at this point. Her fall and her limited mobility are making her more vulnerable at home. My discussions with her established that she was concerned about having more falls or her mobility continuing to wane. She needs to be reassured in some way that her current condition is hopefully temporary, that she will recover from her shoulder injury and soon be as active and independent as she had been prior to her fall.
The next of Ys needs from Maslows hierarchy that should be prioritised are her love and belonginess needs (McLeod, 2007). She clearly receives love from her family but her current lack of mobility, particularly the fact that she cannot drive until her should has healed, means that she is having less contact with family and friends; she is also reliant on people coming to her rather than being proactively able to go and make contact with friends and loved ones.
Maslows theory touches on the importance of self-esteem and this may well be a particular need of Y at the moment. She is feeling vulnerable due to a combination of age, declining mobility and a feeling that she is less able to look after herself than previously. She needs to get her confidence back and getting out and doing the social activities she has done prior to her fall will be central to her recovery both physically and psychologically.
I think that one of Ys greatest needs over the next few months will be to remain engaged with the community around her. There is a concern that social isolation could lead her into depression; she will begin to overly dwell on the negatives of her situation and consequently move into a downward spiral both psychologically and physically.
Recommendations for holistic care needs
In the short-term, Y needs a carer to visit her once a day to help her get washed and dressed. She can make basic meals but a temporary frozen meals service might also be useful for her.
She will require ongoing physiotherapy for her shoulder. Monthly sessions at the local hospital should be a minimum but she also needs to take responsibility for doing her exercises each day.
A holistic assessment should also focus on her mental health; Y may be prone to some level of depression and this is something that professionals and family need to monitor. Counselling sessions should be commissioned if required.
Y should also be in touch with Age Action so she can use their information service, in particular in relation to social activities and travel whilst she cannot drive
There are a number of practical steps that can be taken immediately to make the home environment safer for Y and hopefully improve her overall well-being. One thing that she can do is identify current hazards in the home that increase her risk of falling and remove them. This might simply be furniture or ornaments in places that cause a problem. She can also invest in making the bathroom safer with rubbers mats and by installing hand rails around the bath and shower.