Healing From a Loss of Independence
Managing the changes that come with the new phase of life
Being independent, taking care of our own daily needs and living the way we want to is a vital component of life for most people. Sometimes, however, that independence can fade away with the aging process. Often older adults who have health or memory issues have to face the sobering reality that they can’t do the things they used to do on their own.
Everybody’s reaction to a loss of independence is different. “Their experience is unique to them,” says Dr. Cheryl Phillips, senior vice president, public policy and health services for Leading Age, an association for not-for-profit aging service providers.
The typical response to this type of realization, however, is fear – the fear of “moving into an environment with more help or supervision or having help come into the home,” Phillips says. “It means a loss of autonomy as well as individual and personal control.”
In a typical scenario, the family sweeps in and declares that a parent can’t live alone anymore based on their health, agility or state of mind. Talk of home health care or assisted living heightens the stress of the aging parent. “When we go in most of the time the patient says ‘I don’t need help. I have lived here all my life,’” says Dawn Beninghove, a registered nurse and founder of the home-health-care services firm Companion Extraordinaire.
Seniors who have planned for this moment are completely ready and organized for the next phase of their life. “On the other hand, there are some people that have not taken the initiative to prepare for the next phase,” says Mary Arthur, dementia care coordinator for Rappahannock Westminster-Canterbury, a continuing care retirement community. “There is fear of the unknown, embarrassment, anger, frustration and denial. Depression is also a large part of leaving the home that most people have known their whole life.”
People have varying degrees of frustration about the situation. “A lot of times patients understand that they have lost independence but they don’t want to believe it,” says Allison Fillmore, clinical nurse manager at Bon Secours Home Health Care. “They don’t want to lose that independence but at the same time they have to give up something because they could injure themselves or someone else” due to declining health or mental alertness.
There are a small group of risk factors that signal someone may have trouble accepting a change in their lifestyle. Anyone who has anxiety and/or a negative attitude may have a more difficult time transitioning to home health care or assisted living. “Some people with visual or hearing impairment may find it harder to socialize and meet people,” says gerontologist Jenny Inker, a licensed assisted living facility administrator in Virginia and an instructor in the VCU Department of Gerontology at the VCU School of Allied Health Professions.
Any lifestyle change can be challenging, especially if someone has a negative mindset. Looking at it as an opportunity and not a challenge promotes the positive aspects of the situation. A move to assisted living, for example, means they won’t be responsible for home maintenance or repairs. It also means they have the opportunity to meet new people and take advantage of social activities.
“People who do well tend to be people who feel they were well prepared,” says Inker.
“You want to maintain the social activities they had prior to the move,” says Phillips. “You want to make sure where possible that their prior connection to friends, family and social groups is supported. Try to maintain the connected threads that already exist. Making sure the social portion of care is taken care of is every bit as important as the other physical aspects of care.”
Some older adults, especially those who have lived alone for a long period, consider the move to be a pleasant change because they look forward to being with others their age. Many have ongoing friendships or relationships that continue even after their move to assisted living or are open to making new friendships. “That can help them settle in,” Inker says, adding, “Assisted living staff also need to understand who that [new resident] is as a person and use that information to help the person settle in.”
Holly Carson, marketing director for Heritage Green Assisted Living in Mechanicsville, tries “to match what it is people are looking for care wise and assistance wise,” she says. “We want them to maintain that [independence] as much as they can.”
She likes to pair new residents with a mentor from Heritage Green. “That goes a long way,” Carson says. “We use the mentor to help get them involved.”
Helping new residents meet people who have gone through similar circumstances is another way to make them feel comfortable. “The RWC staff strives to connect residents with similar beliefs and likes,” says Arthur of Rappahannock Westminster-Canterbury. “Our clinical staff looks at each resident as an individual and personalizes their needs and wants.”
Home health-care administrators also encourage their patients to have meaningful relationships and interact with family and friends. “Studies show if you have a meaningful relationship, it’s worth getting up every day,” says Beninghove. “You want to allow a person to have as much independence as possible. You have to make them feel like they are contributing. If they move in with family, they need to feel they have a purpose.”
THE PROBLEM OF PAIN
Many seniors who have home health care or are in assisted living are not only coping with a loss of independence but they also may suffer from chronic medical conditions resulting in chronic pain. “Physical, social, psychological and spiritual pains are all components of chronic pain,” says Dr. Aparna Ranjan, medical director, hospice, Bon Secours Richmond. “It could have started with physical pain but oftentimes when it lasts longer than several weeks, it is considered chronic. Psychological and emotional components are an inherent feature of such pain and can even worsen the perception of physical pain, making it difficult to control or cope with.”
Studies have shown that having some type of relationship with another person can take a person’s mind off of the pain. “Studies have also shown if you redirect thoughts through massage, music, a favorite show, for example, or find a childhood memory, it can bring the pain number down,” says Beninghove. “Then you may not need as much medication intervention. You have to find triggers for patients and use them.”
The most important thing that family and friends can do is to be there for support. “When an individual loses cognitive or physical abilities, conversations change,” says Arthur. “People do not always know how to react but should remember that the person is still there. As a friend, offering a listening ear or a helping hand is a huge support.”