Maintaining independence, social connection, choice and control.
These are a few common words and phrases that we hear a lot when talking about ageing and aged care. There are many more, but the focus of this story in light of mental health week and month is ‘What keeps people well’?
When we talk about ‘healthy and active ageing’ people often think about the physical side of things first. Research has shown that there is a connection between how our emotional and mental state impacts on our physical self as well, and that’s another whole blog in itself!
Depression is a challenge for older people too, especially when becoming more frail and losing independence and control over daily activities of living.
When you do something that a client can still do, you reduce their control and choice.
I’d like to share some personal insights and observations that helped me better understand the challenges of ageing well and the importance of maintaining independence.
Aunty Nellie* has always been a very independent and practical woman, with a dry sense of humour that regales stories of the past with directness and bush wit. Nothing gets past Aunty Nell.
(*Name changed for privacy reasons)
Over the last few years, macular degeneration has all but taken most of her sight and even with medical intervention and assistive technology (fancy word for a giant magnifying glass and a reading machine), she is legally blind and becoming more physically frail as well. This has meant she can no longer drive and has to plan meticulously what she does and how she does it in order to keep safe.
Others might make an observation that her ‘disability’ limits how active and independent she can remain and she should have ‘more help’. Well Aunty Nellie has news for them – after all she spent her (earlier) retirement years working tirelessly as a volunteer for meals on wheels as well as a host of other community activities that kept her involved in the social fabric of her local community. This is what helped keep her ‘well’.
So how has Aunty Nellie tackled this latest challenge of ageing?
She keeps to a routine and everything has a place in her house to reduce trip hazards and risk of falls.
Her garden has always been important to her and she knows every inch. She gets out there every day and keeps doing what she can. Once a fortnight someone comes to mow her lawn or do the bigger jobs she can no longer do.
There is a community bus that goes to the nearest ‘big’ town for shopping. She still walks the 300m to the bus stop, but the driver drops her home to her door and helps her get the shopping off the bus. Aunty Nellie still unpacks her shopping and cooks most meals.
She gets family or a local carer to pick her up and take her to events and activities.
As most of her family live away from her, the telephone is also crucial in keeping her connected. She has an A3 size sheet that someone helped her print and laminate. It has all the key phone numbers written in BIG text – family, local services and emergency numbers.
What helps keeps Aunty Nellie well is:
- Maintaining her independence and control over her daily routine as best she can;
- Minimising risk but not letting her ‘disability’ stop her from keeping an active routine;
- Having a purpose and interests that stimulate her, keeping ‘in touch’daily with people she knows and cares about and linking in with community services that help her maintain her independence.
When reflecting on Aunty Nellie and what I see in remote Indigenous services, the fundamental principles are the same.
Sometimes we as service providers, carers, family and funding bodies – forget that ageing and aged care is all about ‘people’.
- As a person, having a sense of purpose and a connection with others is critical, hence why ‘social support and activities’ are a specifically funded category of care.
- Access to transport as a means of ‘getting out and about’, even if this is just a trip on the aged care meal run around the community – or the next out station or town to see friends and family, is important.
- Domestic assistance – not taking away what a client or carer can still do – but maybe some of the key things that are barriers to getting around, or keeping a ‘safe space’like a monthly yard clean up to keep the long grass down and snakes away. Removing clutter and items that ‘visitors’ have left behind and in the way.
- Access to aids where these are needed in order to help maintain mobility and independence, such as a walking stick, or walker, a magnifying glass, or a reader.
- Care workers and family taking time to actually talk with (not to) and listen to clients.
- Linking old people in to other community activities and giving them purpose, such as story telling at schools, sharing and passing down skills such as how to find bush tucker and medicine – this gives people ‘purpose and meaning’.
Think about how having purpose, choice and control impacts on ‘self’ and well-being; how people get frustrated when either or both of these are missing from daily life, and it will help us understand the importance of these fundamental elements of ‘living well’.