There are a number of benefits to having adult daughters studying university subjects from home; not only do I get cups of tea and coffee brought to me in my home office, I also learn lots of new and interesting things. This week it was the difference between pathogenesis (the origin or cause of disease) and salutogenesis (the origin or cause of health).
By the way to save you looking it up… Salus is the Latin word for health, and genesis is the Greek word for origin and was first coined by a fellow called Aaron Antonovsky, a professor of medical sociology in the 1970’s.
I have to admit to travelling further down the research rabbit hole than was possibly necessary when I came across the term salutogenesis, but I found it an interesting concept. After the initial “salu-what?”, a few papers and YouTube videos later, I discovered that salutogenesis and pathogenesis could be viewed as the scientific labels of what we in the aged care sector would refer to as wellness and reablement.
Wellness emphasises a person’s needs, aspirations and goals, while reablement focuses on helping people to regain functional capacity and improve independence. The wellness and reablement approach provides a framework which places older people and their strengths at the heart of aged care.
If we think about a person living with Type II diabetes, we might consider what the causal factors were that lead the person to develop diabetes and whether there is there a way that we can work with the person to reverse the disease. This is the pathogenesis pathway and it is more of a reactive approach; something has gone wrong and now we need to fix it. The outcome sought is to no longer have diabetes.
Similarly what about the elderly person who has experienced a fall which resulted in a broken hip? When helping that person to recover, health professionals will be seeking to ensure that everything possible is done to aid both recovery and prevent this from happening again. At this point, an aged care service provider may also be working with and assisting the person in their recovery under a reablement approach, helping the person to return to full health or at least regain some of their independence.
And this is all good – we want to help people to recover, to regain capacity, to be able to do the things they could do previously.
But what if we took a different approach? Rather than waiting for something to go wrong, why don’t we take a proactive approach and help a person to remain healthy, perhaps even gain additional wellbeing in the process? This is salutogenesis.
Salutogenesis recognises the second law of thermodynamics, where there is a natural tendency of a system left to itself to degenerate into chaos. You know what it’s like; imagine what would happen if you just sat down on the couch and watched Netflix over the past 6 months instead of going to the gym, or doing some form of regular exercise… you’re probably not going to have that beach body!
The applied salutogenesis model incorporates the idea that things can and do go wrong. It asks us to consider what we can do now to prevent or minimise an adverse outcome when something comes along that could harm us. We can equate this to our aged care view of ‘wellness’.
An example of this might be a person participating in activities such as yoga or tai chi with the aim of developing their core strength, which in turn minimises the risk of a falls injury should they trip over an uneven surface.
But wellness (and salutogenesis) is more than just considering the physical aspects of health – it’s also about being able to deal with stress effectively, to have good coping mechanisms in place.
I think most of us want to live the best life we possibly can. We want to have fun, be able to get out and about, enjoy relationships and connections. As we age, we don’t want to become ‘trapped’ in a body that can’t keep up with our plans; a complaint I’ve heard from a number of seniors. The COVID-19 pandemic hasn’t helped, with people unable to attend their usual activities. The lack of interaction with their support network and inability to attend regular activities has impacted, and continues to impact, people’s mental and physical wellbeing.
It’s important for organisations and care staff to be alert to issues that relate to the older person’s health and wellbeing and seek to help the person address these before they lead to an adverse outcome.
If the person is missing friends from a regular group activity, see if there is a way that they can use technology to link up via video conferencing platforms such as Zoom, Facetime or Skype.
If the person is unable to attend their regular group exercise program, perhaps they can access a small group or a one-on-one training session until the group exercise program resumes.
If the person is concerned about going to the shops to buy essential grocery items, maybe they can be supported to learn how to use online shopping or perhaps they can access meals on wheels for a short period to ensure their nutritional health is supported.
After a brief hiatus (due to COVID-19 responses taking centre stage) the Royal Commission has resumed and there is increasing discussion around how aged care might look going forward. And the early signs appear to indicate that the concepts of wellness and reablement will remain central to aged care support for many years to come. We should be looking for ways to embed this philosophy of health into our services, into our practices, into the minds of our staff and those we support.
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