Question

Cohen (as cited in Butts & Rich, 2020) said elders often focus all of their energy toward avoiding "the ultimate defeat, which is not death but institutionalization and which is regarded as living death." What effect does institutionalization in long-term care have on a client's self-esteem, feelings of loss, roles and relationships? How can nurses assist clients with these?

Answer 1

ANSWER 1:

Institutionalization is a global phenomenon and its impact on elderly’s quality of life (QoL) is under discussion. Although the importance of active aging and better QoL for the elderly is evident, there is a lack of family care, which increases the elderly’s institutionalization and, by consequence, increase the number of community-dwelling aged people who became residents of nursing homes. Institutionalization has great psychological impact among the elder people:

• Separation is hard at any age for almost anyone. In many cases the institutionalization of the elderly leads to loneliness, isolation, and eventually to depression.
• Loneliness, in many cases, can be considered a disease of old age. Unfortunately, more and more elders are suffering from this scourge of loneliness.
• The risk of depression increases in the case of the elderly institutionalized than those who live in the community or in their own families.
• Also, in many cases, the lack of social support from extended family or community can lead to the elderly person’s loneliness and social isolation
• Many times, the elder person perceives leaving his/her home, where he/she lived a whole life, as a feeling of exasperation and starts to behave like a desperate man/woman who makes irreversible acts such as suicide.
• Leaving behind his/her own life habits and his/her own environment is a traumatic event, because the elder is extremely attached to those things.
• Many of the elderly react adversely to hospitalization, to institutionalization, because they fear that this is the last road from which they will not be able to come back home to their loved ones and to their belongings.
• There are also problem of  nocturnal problems in their decision to institutionalize, often because their own sleep was disrupted. The most frequent disruptive nocturnal events were micturition, pain, and complaints of sleeplessness. Sleep problems of the elderly contribute heavily to the decision to institutionalize an elder and thus to the social and economic cost of institutional care.
• Elderly people will have low self-esteem, feeling of worthlessness, they consider themselves as a burden for family and think better to die than living in hospital and takin high dose medicines.
• Elderly people are more to get Alzheimer disease, dementia who are living in hospital than home
• Social isolation also a bad impact of industrialization among elderly people.

NURSING RESPONSIBILTIES IN ASSISTING WITH THESE CLIENTS:

• An important role in avoiding institutionalization of elders is played by family members who have and advise the elders
• Counselling is an important step in determining the abandonment of institutionalization.
• Constant care, supervision for any suicidal attempts, no judgemental care can help elderly people.
• Elderly families need to be educated to be able to dispel myths about the elderly and especially must be helped to overcome them.
• the lack of social support from the enlarged family or community can lead the elderly to loneliness and social isolation. The elders want in most cases to have relationships with other people, that is why family and community support plays an important role.
• engage the eldery people in activites. Divert their mind in some activites or hobbies of them.
• Encourage to seek community help, social support or support groups.
• encourage family participation in the care of elderly people
• In some cases the lack of family can be substituted by group of friends, support groups, volunteer groups and eventually by seniors clubs and day care centres. An important role in the occurrence of psychosomatic diseases is played by the quality of the family and interpersonal relationships.
• nurse can also help the elderly to enhance their self worth, self respect and self love.