Question

Ethico-Legal Considerations in the Care of Older Adults

1. What is the republic act of senior citizen in the Philippines? Explain in detailed.

2. What are the rights of senior citizen in the Philippines set-up?

3. How can you help the older adult to alleviate depression?

4. What are the signs that death is near?

Answer 1

QUESTIONS:

Ethico-Legal Considerations in the Care of Older Adults

1. What is the republic act of senior citizen in the Philippines? Explain in detailed.

2. What are the rights of senior citizen in the Philippines set-up?

3. How can you help the older adult to alleviate depression?

4. What are the signs that death is near?

ANSWERS:

1. What is the republic act of senior citizen in the Philippines? Explain in detailed.

• Laws that provide benefits and privileges to senior citizens have long been passed and implemented yet there are still some elderlies who do not know about the scope of discounts on certain items and services.
• This cropped up during the consultation dialogue by the Regional Inter-agency Committee of Senior Citizens (RIASC), Regional Coordinating and Monitoring Board (RCMB) and the Regional Federation of Senior Citizens Association of the Philippines (RFSCAP), together with the Regional Federation of Senior Citizens Association of the Philippines (RFSCAP).
• As defined under Republic Act No. 7432, as amended by RA No. 9257(“Expanded Senior Citizens Act of 2003”) , and further amended by RA 9994, known as the “Expanded Senior Citizens Act of 2010, ” defines senior citizen or elderly as any resident citizen of the Philippines at least 60 years old.
• Senior citizens are entitled to 20% discount and exemption from the value -added tax (VAT) on certain goods and services for their exclusive use. Among these are the purchase of medicines and essential medical supplies, accessories and equipment; professional fees of attending physicians and licensed health workers as well as on medical and dental services, diagnostic and laboratory fees in private hospitals, medical facilities, outpatient clinics and home health care services.
• They are also entitled to 20% discount on fare for land (jeepneys, buses, taxis, shuttle services, MRT, LRT, PNR,) sea shipping vessel and domestic transport services. Many elderly do not know that the 20% discount also applies to taxis.
• This also applies to restaurants, hotels and similar lodging establishments, and recreation centers. Seniors should be reminded though that the discount only applies to them.
• Also subject to the 20% discount are admission fees charged by theaters, cinema houses and concert halls, circuses, leisure and amusement. In some local government units like Baguio City, SM Cinema Baguio is offering free movies to senior citizens who are residents of the city once a day from Monday to Friday.
• When they die, there is discount for their funeral and burial services.
• The law also provides grant of a minimum of 5% discount on water and electric bills registered in the name of the senior citizen residing therein, and provided that the monthly consumption does not exceed 100 kilowatt hours of electricity and 30 cubic meters of water:
• Seniors can also get a 5% discount without VAT exemption on certain on groceries granted by the Department of Trade and Industry and the Department of Agriculture.
• For groceries worth up to PHP 1,300 per week, they can enjoy 5% off the retail prices of at least four kinds of the following basic necessities and prime commodities: Rice, bread, and corn; Chicken, beef, and pork ;Fresh eggs; Coffee, creamer, and sugar;Fresh fruits and vegetables;Garlic and onions;cooking oil and salt;Noodles, canned sardines, and canned tuna;Fresh milk and other dairy products;detergents; Electrical supplies, light bulbs, and batteries and geriatric diapers.
• Senior citizens though cannot avail of this special discount in sari-sari stores, cooperative stores, and wet markets.   
• As the government cares for the health of senior citizens, they have mandatory PhilHealth coverage as stipulated in RA 9994. When they are confined in private hospitals, they can avail of PhilHealth benefits in addition to the 20% discount and VAT exemption. In government hospitals, the No Balance Billing Policy applies.
• To augment their daily subsistence and other medical needs, the government also provides monthly social pension amounting to P500 to indigent senior citizens.
• Another privilege of senior citizens is the provision of express lanes for them in all commercial and government establishments.
• For the 60 and above citizens to enjoy these benefits and privileges, they must present their senior citizen ID issued by the Office of the Senior Citizen Affairs (OSCA). They may present their government-issued ID that shows their age in the absence of senior citizen ID but not all establishments honor this. That is why it is very important to apply for their senior citizens ID at the OSCA or the Department of Social Welfare and Development(DSWD) in their respective city or municipality.   
• An elderly should get a senior citizen identification card and present it whenever needed to avail of the benefits and discounts, Amelyn Cabrera of DSWD Cordillera reiterated.
• Weak or bedridden senior citizens can still avail of the discount especially in the purchase of their medicines and groceries. They only have to make and sign authorization letter for their duly authorized representatives, who will present   it along with the ssenior citizens’ ID, OSCA purchase booklet and their own government –issued ID when paying for the purchases.
• Senior citizens discounts are not only for the benefit of the elderly but they also provide big reprieve for families and breadwinners.

2. What are the rights of senior citizen in the Philippines set-up?

In the Philippines, the rights of older persons and persons with disabilities in general are recognized and guaranteed under the 1987 Constitution under the Articles on the Bill of Rightsand the Social Justice and Human Rights,among others. Aside from these, there are constitutional provisions which guarantee the prioritization of the rights of both sectors. These provisions focus on the following:

• Right to suffrage - The Congress shall also design a procedure for the disabled and the illiterates to vote without the assistance of other persons. Until then, they shall be allowed to vote under existing laws and such rules as the Commission on Elections may promulgate to protect the secrecy of the ballot.”
• Right to health - The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged sick, elderly, disabled, women, and children.
• Right to participate in the society - The State shall establish a special agency for disabled persons for rehabilitation, self-development and self-reliance, and their integration into the mainstream of society.
• Right to education - The State shall: Provide adult citizens, the disabled, and out-of-school youth with training in civics, vocational efficiency, and other skills.
• Right to an adequate standard of living - The family has the duty to care for its elderly members but the State may also do so through just programs of social security.

3. How can you help the older adult to alleviate depression?

Clinical depression in the elderly is common. That doesn't mean it's normal. Late-life depression affects about millions ages 65 and older. But only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.There are several treatment options available for depression. They include medicine, psychotherapy or counseling, or electroconvulsive therapy or other newer forms of brain stimulation (such as repetitive transcranial magnetic stimulation (rTMS)). Sometimes, a combination of these treatments may be used. The option a doctor might recommend depends on the type and severity of depression symptoms, past treatments, and other medical conditions a person might have, among other factors.

Problems affect treatment of depression in the elderly

The stigma attached to mental illness and psychiatric treatment is even more powerful among the elderly than among younger people. This stigma can keep elderly people from acknowledging that they are depressed, even to themselves. Elderly people and their families sometimes also may wrongly misidentify depression symptoms as "normal" reactions to life stresses, losses, or the aging process.

Tips for elserly to reduce depression in the elderly

Reach out and stay connected

• Get out in to the world. Try not to stay cooped up at home all day. Go to the park, take a trip to the hairdresser, have lunch with a friend, visit a museum, or go to a concert or a play.
• Volunteer the time. Helping others is one of the best ways to feel better .
• Join a depression support group. Being with others facing the same problems can help reduce sense of isolation. It can also be inspiring to hear how others cope with depression.
• Take care of a pet. A pet can keep company, and walking a dog, for example, can be good exercise and a great way to meet people. Dog owners love to chat while their pets play together.
• Take a class or join a club to meet like-minded people. Try joining a senior center, a book club, or another group of people with similar interests.
• Create opportunities to laugh. Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.

Find meaning and purpose in life

• Focus on what you can still do, not what you used to be able to do.
• Learn a new skill. Pick something that is always wanted to learn, or that sparks imagination and creativity—a musical instrument, a foreign language, or a new game or sport, for example. Learning new activities not only adds meaning and joy to life, but can also help to maintain brain health and prevent mental decline.
• Get involved in your community. Try attending a local event, tutoring kids, or volunteering for a cause that’s important to you. Community work can be a great way of utilizing and passing on the skills honed in career—without the commitment or stress of regular employment.
• Take pride in appearance. good appearance increase self-esteem and confidence.
• Travel. Travel doesn’t have to be extravagant or expensive to boost the mood. Enjoy time in nature by taking a scenic walk or hike, going fishing or camping, or spending a day at the beach.
• Write memoirs, learn to paint, or take up a new craft.

Adopt healthy habits

• Exercise is a powerful depression treatment. In fact, research suggests it can be just as effective as antidepressants.
• Eat to support your mood
• Support quality sleep
• Spend time in sunlight

Know when to seek professional help

• Antidepressants TO Relieve Depression In the Elderly
  • Studies have found that while antidepressants can be helpful in older adults, they may not always be as effective as in younger patients. Also, the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older antidepressants such as amitriptyline and imipramine can be sedating, may cause confusion, or cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures.
  • Antidepressants may take longer to start working in older people than they do in younger people. Since elderly people are more sensitive to medicines, doctors may prescribe lower doses at first. In general, the length of treatment for depression in the elderly is longer than it is in younger patients.
• Psychotherapy TO Relieve Depression In the Elderly
  • Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are helpful. Psychotherapy is especially beneficial for those who have endured major life stresses (such as loss of friends and family, home relocations, and health problems) or who prefer not to take medicine and have only mild to moderate symptoms. It also is helpful for people who cannot take drugs because of side effects, interactions with other medicines, or other medical illnesses.
  • Psychotherapy in older adults can address a broad range of functional and social consequences of depression. Many doctors recommend the use of psychotherapy in combination with antidepressant medicines.
• Electroconvulsive therapy (ECT) TO Relieve Depression In the Elderly
  • ECT can play an important role in the treatment of depression in older adults. When older patients are unable to take traditional antidepressant medicines because of side effects or interactions with other medications, when depression is very severe and interferes with basic daily functioning (such as eating, bathing and grooming), or when risk for suicide is especially high, ECT is often a safe and effective treatment option.
• Counselling and therapy
  • Therapy works well on depression because it addresses the underlying causes of the depression, rather than just the symptoms.
  • Supportive counseling includes religious and peer counseling. It can ease loneliness and the hopelessness of depression, and help you find new meaning and purpose.
  • Therapy helps you work through stressful life changes, heal from losses, and process difficult emotions. It can also help you change negative thinking patterns and develop better coping skills.
  • Support groups for depression, illness, or bereavement connect you with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.

Other tips for helping a depressed elderly one

• Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the movies—anything that provides mental or physical stimulation.
• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.
• Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some healthy protein at every meal.
• Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with their treatment plan. If it isn’t helping, look into other medications and therapies.
• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

4. What are the signs that death is near?

• Physical symptoms
• Coolness. Hands, arms, feet, and legs may be increasingly cool to the touch. The color of the skin may change and become mottled.

How you can help: Keep the person warm with comfortable, soft blankets.

• Confusion. The patient may not know time or place and may not be able to identify people around them.

How you can help: If this end-of-life sign is occurring, Identify yourself by name before you speak. Speak normally, clearly, and truthfully. Explain things such as, “It’s time to take your medicine now.” Explain the reason for things, such as, “So you won’t start to hurt.”

• Sleeping. An increasing amount of time may be spent sleeping. The person may become unresponsive, uncommunicative, and difficult to arouse.

How you can help: Sleeping more frequently is normal. You can sit quietly with them. Speak in a normal voice. Hold their hand. Assume they can hear everything you say. They probably can.

• Incontinence. They may lose control of urinary/bowel functions. This is a common end-of-life change that can occur during the process of passing on.

How you can help: Keep your loved one clean and comfortable. Ask your hospice nurse for advice.

• Restlessness. The person may make repetitive motions such as pulling at the bed linen or clothing. This is due in part to A decrease in oxygen.

How you can help: Do not interfere with these movements or try to restrain them. Speak in a quiet, natural way. Lightly massage their forehead. Read to them. Play soothing music.

• Congestion. There may be gurgling sounds inside the chest. This is also sometimes referred to as a "Death Rattle." These may be loud. This end-of-life symptom does not indicate the onset of severe pain.

How you can help: Gently turn their head to the side to drain secretions. Gently wipe their mouth with a moist cloth.

• Urine decrease. Output may decrease and become tea colored.

How you can help: Consult your hospice nurse.

• Fluid and food decrease. Your loved one may want little or no food or fluid. The body will naturally conserve energy required for the task ahead. Food is no longer needed.

How you can help: If this end-of-life symptom is present, do not force them to eat or drink if they don’t want to. It only makes them more uncomfortable. Small chips of ice or frozen juice chips might be refreshing. A cool, moist cloth on their forehead might help.

• Change in breathing. The person may take shallow breaths with periods of no breathing for a few seconds to a minute. They may experience periods of rapid, shallow panting. These patterns are common and indicate decrease in circulation.

How you can help: Elevating their head or turning them on their side may bring comfort. Hold their hand. Speak gently.

• Fever. Increase in temperature is common.

How you can help: Consult your hospice nurse. A cool, moist cloth on their forehead may bring comfort.

• Emotional and spiritual end-of-life signs.
• Giving away belongings and making funeral plans. Some people want to maintain control over their life, so they want to participate in making final decisions about their belongings or their person.

How you can help: Although it is emotionally hard for families to talk about final arrangements, it is important to let your loved one do this if they want. Everyone, especially the dying, appreciate having their choices honored.

• Withdrawal. The person may seem unresponsive, withdrawn, in a comatose-like state. They are detaching. It is a typical end-of-life symptom.

How you can help: Know that hearing remains. Speak in a normal voice. Identify yourself. Hold their hand. Say what you need to say. This helps them let go.

• Vision-like experiences. The person may say they have spoken to people who are already deceased. They may say they have been places or seen things not visible to you. This is not a hallucination or a drug reaction. It is a common symptom of the end-of-life process.

How you can help: Do not contradict, explain away, or discount this experience. Affirm them. If the experience frightens your loved one, reassure them it is common and natural: “Yes, these things happen.”

• Restlessness. Repetitive and restless tasks may indicate something unsolved or unfinished is preventing them from letting go.

How you can help: Talk with your hospice chaplain. Help the person recall a favorite place or good experience. Read to them. Play soothing music. Give reassurance that it is okay to let go.

• Communication and permission. Your loved one may make statements or requests that seem out of character. They may be testing you to see if you are ready to let go. They may want to be with a few select people. Maybe they only want one person. If you are not included, it does not mean you are not important or not loved. It means your task with the person is fulfilled. If you are selected, it may mean the person needs your affirmation, support, and permission to let go.

How you can help: Let your loved one know you will be alright. Say whatever words of love and support you need to say. Give them permission.

• Saying goodbye. This is their final gift. How you can help: Listen. Hold them. Say whatever you need to say. It may be just, “I love you,” or recounting favorite memories you have shared. It may be an apology, or saying, “Thank you.” There is no need to hide your tears. Tears express your love and help you let go.

Timeline for end-of-life changes:

• One to Three Months
  •      Decreased desire for food
  •      Increased desire for sleep
  •      Withdrawal from people and the environment
• One to Two Weeks
  •    Even more sleep
  •    Confusion
  •    Restlessness
  •    Vision-like experiences
  •    Change in temperature, respiration, pulse, and blood pressure
  •    Congestion
  •    Not eating
• Days or Hours
  •    Surge of energy
  •    Decreased blood pressure
  •    Glassy, teary eyes
  •     Half-opened eyes
  •    Irregular breathing
  •    Increased restlessness
  •    Cold, purple, blotchy feet and hands
  •    Weak pulse
  •    Decreased urine output
• Minutes
  •    Gasping breathing
  •    No awakening