Mental Health in Later Life - Essay Example

Reading Header: MENTAL HEALTH IN LATER LIFE Topic: CRITICAL REFLECTION ON THE IMPLICATION OF THE CONCEPT “QUALITY OF LIFE” AND WELL BEING OF AGED PEOPLE October 21, 2009 Introduction The quality of life has been an issue of discussion for a long period of time as famous philosophers have come up with different theories of trying to define the real meaning of well being or generally a quality life. Actually its definitions and indicators which can be used to measure this quality of life of a person hence his well-being, shows a very high variation ranging from the socio-economic status of the respondents, the levels of contentment to needs and also functional ability, to meaning in life, life satisfaction, to the basic wellbeing and happiness (Ferrans & Powers 1985, Holmes 1989, Zahn 1992, Peplau 1994, Farquhar 1995). Regardless of the fact that the quality of life issues are relevant to comprehensive aspects of nursing and in general home care services, their implications are greatly pertinent in the care of aged people who experiences loss of functional capacity and struggle with chronic mental disorders. This therefore brings has to the effect that most of the old aged people usually requires a specialized kind of home care and nursing services especially as the group risks the development of mental disorders due to the dissatisfaction of the lives they have accomplished. The current National policies in most of developed countries are addressing the issues dignity in old age. The tools that are used to evaluate the current subjective Quality of life in both health and clinically diagnosed mentally sick populations, is based in the person’s level of contentment with the diverse domains of life(Woolhead, 2004). In the Woolhead report the way of living for these people was defined by specific objective indicators and biased fundamentals such as recent pleasant or sad events that, any urge for preferred future changes, uncertainties and concerns and projects. The old people raised complain in the treatment they received in hospitals and old age homes. Their issues of concern included being inappropriately dressed and lack of privacy in these institutions. They also sited a case where life is prolonged by machines instead of living nature to take its course as a form lack of dignity. The old people have also had challenges in living a satisfying life because of lack of financing from government (Woolhead, 2004). Comparisons with the general healthy population, studies of quality of life (QOL) in a population of mental health problems has demonstrated to come up with similar type of issues manifested in the general population. This was clearly explained in the study of Subjective quality of life, an assessment which studied a group of 95 men and 70 women using the Satisfaction with Life Domains Scale (SLDS) and five open-ended questions. Even if statistical analyses showed no momentous difference among men and women on quality of life, age of the individuals was systematically associated to levels of satisfaction with older participants showing a high degree of satisfaction with their lives than the respondents of the younger ages. The collected responses obtained in the study sample to the open-ended questions showed that smaller number of the more satisfied older respondents expressed future worries for their lives, wish for change of the living ways and plans for the future as compared to the unsatisfied young respondents (C Âeline, Normand, and Raymond 1998). Since the from the research done respondents are the ones who are delegated to give their life satisfaction, indicating that quality of life in question is subjective to the specific person depending on how he understands a satisfied life. This has led to the development of some common factors which may have been used to conventionally analyze the measure of mental well being and the quality of life of the elderly people. Generally the quality of life of a given individual is determined by factors such as Functional capacity, perceived health, good housing conditions, an active life style, and good social relationships were some of the factors that explained life satisfaction and subjective quality of life (Nilsson et al. 1998). Furthermore as well being aspects differs within a population, quality of life may also include the personality displayed by an individual and this portrays how comfortable the person is with living conditions and general well being. The definition of quality of life in the recent past has gained a lot of interest in the medical, health care and the nursing areas. This has been due to the fact that as the living standards of people is highly upgraded in conjunction with improved health care programs and increased access to health care, the number of elderly people is growing in our community. People of high ages usually are subjected to a number of health problems along with decreased levels of physical and physiological functional capacity. As a result of this the growing aged population who usually develops and lives with chronic disease conditions, body health problems and lowered performance, there has been a rising need to help these patients to actively and happily live a good life in spite of their chronic illness and lowered functional capacities (Lawton 1991, and SarvimaÈki 1999). Quality of life and mental well-being of people in their old age A great variation has been registered on the well being of aged people and parameters used for this includes the following health, functional capacity, and adaptation mechanisms as intra-individual circumstances for quality of life, at the same time as factors in the biophysical and socio-cultural milieu are expressed as external conditions as they influence living standards of these old men indirectly. Or instance in the study sample consisted of 300 subjects, aged 75 or older and living in Melbourne, Finland. The data obtained from the study was very contradicting with thee general implications of aging in the community, as the information obtained from the research showed that the elderly participants’ quality of life was generally fairly good. This was virtually indicated from the precise correlations among the research variables related to quality of life, which were significantly correct despite the fact that the results for the regression analyses portrayed un-identical explanatory models from individual aspects of quality of life (SarvimaÈki and Bettina, 2000). From the Australian research, it has been seen that by considering the satisfactions with particular domains of life. Old people show a greater satisfaction level to free time, leisure activities, organizational involvements and helping the needy. Secondly they are contented with their current housing, suburb and their interactions with the local community and the society at large is highly satisfactory. The other area in which these aged people find a high degree of satisfaction as compared to the younger counterparts is in the area of general expression of the individual morale which tackles aspects of kindness, generosity, honesty, sincerity including the relativity in the development of good moral qualities to the society. Lastly elderly people have decreased worries and usually shows reduced stress related pressures and daily strains. These findings can not be technically correlated to its causal mechanisms, as it’s not clear to identify whether it is due to the effects of maturation/old age or are peculiar to this group of people. On the other hand, in our view it is logical to understand that the involved consequences as mainly due to the effects of ageing or maturation process that occurs on these respondents plus the experiences that be an adjunct to it. It has been shown that the old people entirely portray conceivable trends on the satisfaction with the way they deal with life matters, as most have retired; feel satisfied with the amount of free time which they are entitled to in their daily activities, as well as their leisure time and communal based activities. The other thing which makes the elderly people appreciate their way of life also touches on the issue that being able to accomplish paying for the mortgage and now that the children have left, the households become large thus creating a spacious environment as well as being conversant with the suburb in which they live and have many old friends and acquaintances. On further considerations the satisfaction of these elder people is subjected on many factors but one of the major factors is decreased on lack of active participation on activities carried out on our community. This inability to involve mostly to positive events may lead to domination of negative effects into the personality of an individual, as it leads to lack of motivation and thus poor motivation for life. Both favourable and adverse events that are encountered by individuals in the daily activities may either lead to encouragement to life or a cause of mental deterioration. Adverse events and daily hassles are the main source of negative affect, while favourable events and daily uplifts (enjoyable encounters and activities) are a source of positive affect. In surveys it is consistently found that older people report fewer major events than younger people. They are less likely to change marital or job status, less likely to have wonderful or distressing interactions with their children (C Âeline, Normand, and Raymond 1998). Of course the probability of some events increases - widowhood, retirement and ill-health to name the three most obvious - but on balance life becomes less eventful( Lack, 2005).A consequence of this relative lack of events is not only low levels of positive and negative affect but also relatively small changes in levels of well-being and psychological distress. The average amount of change recorded by older people in the Australian panel study from one wave of interviews to the next was considerably lower than among younger people. Actually the information showed that the affiliation between age and satisfaction with quality of life measuring domains at the same time as keeping the gender of the respondent constant was quite consistent. All sixteen correlations were positive, ranging from .06 to .26 with a median value of .14, suggesting that older people were more satisfied with all aspects of their lives. The strongest relationship was found in satisfaction with daily activities, with young people being less satisfied (r 4 .26) than their older counterparts. The other area where the aged and mentally ill people were shown to have a relatively higher satisfaction than the younger ones was in the domains their health status (r 4.18) and their friends trustworthy (r 4 .18) as compared to the older people. Satisfaction with clothing, external communal activities and financial circumstances were also seen to have a similar correlation to age of the respondents. In their, research C Âeline Mercier, and Normand P Âeladeau, and Raymond Tempier, they have shown that the first step in the analysis of quality of life is to validate the occurrence of associations between gender and age of the population sample studied that could bring an effect further analysis of simpler domains. The research analyzed by about 16 subscales of the SLDS showed no clear outline of real global interaction. For instance they came up with a partial correlation between the terms with which those scores ranged from 116 to .11 with a median correlation of 10.1. The peak interaction was detected in contentment with clothing and the reaction with fashion (that is a value of r 4 116); at the same time young women are likely to be more dissatisfied with their clothing than the older women are according to this report, but this is not true with men as there is no relationship between level of satisfaction and fashion or clothing. On the other hand there has been weak interaction in the satisfaction with financial situation (r 4 1.13), with the relationship among age and satisfaction being stronger for women as compared to their male counterparts. An additional slight interaction was demonstrated in the level of satisfaction with external activities (r 4 .11), where age showed a much influence for men than in women. Even though younger men demonstrated a high tendency of less satisfaction than women of the same age, their satisfaction is projected to be augmented with age, and this eventually reaches a satisfaction level ahead of that expressed by the women later on. The subjective health issues have been an important aspect in the study of the lives of old people. In one of the studies there was indication of the old suffering from different diseases. There are indications that at the same age the prevalence of certain diseases vary with gender. The diseases which were recorded in most of the aged included palpitation of the heart, psychosomatic symptoms and muscle pain. The occurrence of these diseases has shown no variation with regards of ones marital status. The occurrence of the diseases in the participants was used to classify them as independent, partially dependants or totally dependants. The oldest people are more dependants compared to those in the relatively young age groups (SarvimaÈki and Bettina, 2000). The external condition the old people live under is also a subject of analysis that fall under subjective issues. Under this analysis the facilities provided in the houses the old people occupy are brought into the limelight. This include whether there is running tap water both cold and hot, the heating of the houses, the presence of toilets in the houses, bathrooms and refrigerators. A survey done on the houses occupied by the old indicated 94% had modern facilities they needed. The other aspects look into the issues of the social surrounding of the old. A survey indicated that the 62% of the old leave alone. Those who lived with any person was probably their spouse. (SarvimaÈki and Bettina, 2000). For instance the study results obtained from the SLDS alongside with the five open-ended questions; there has been a revelation that the significant variation among the participants in the subjective quality of life study is highly biased in the domain of age than gender. These observations have been confirmed both in the general population as initially seen in the mentally sick old patients (Dasberg, 2001). It is a fact that people with schizophrenia are liable to show a elevated level of satisfaction with their lives as they matures and ages and it has produced consistent results with the data reported by Kearns et al. (1987) and Lehman et al. (1992). Despite the facts that gender has insignificant correlations to the domains under study as a measure of life appreciation, it has been seen that females have shown to have increased events (that is both positive and negative) and also expresses more worries, therefore subsequent desire for change of lifestyles and very diversified plans for the near coming future. And in this group (women respondents) the information trends has shown that the older ones are relatively more satisfied, as they tends to express relatively fewer worries, less aspiration for change and fewer personal new plans for the future. Since on the other hand the younger respondents expressed not only higher levels of frustration with more worries, but also aspects of elevated desire for future transformation and plans, this shows that the variations in the levels of satisfaction are in a high conformation with these other factors or parameters used to measure the subjective quality of life the aged subjected to these people, that is the expression of more worries, desire for change and personal projects. From the above observations we can be able to clearly see that the most influential factor that plays a major role of aspirations in the subjective perception of quality of life and generally the mental well being of the old people in the nursing homes and the rehabilitation institutions (Banyard, 2001). On the long run the achievement of individual satisfaction of the quality of life that is significantly demonstrated in the aged and chronically mentally patients is verified from the long time adaptation of themselves to both the positive and the negative events they encounter in their lives, followed by subsequent realignment of their lifestyles to fit the external conditions and personal realities. This has been seen to be followed by a consequent lowering of their life expectations and aspirations, leading to an attainment of much satisfaction with the actual life achievements and thus developing less frustration and anxiety more especially after undergoing the a process of learned helplessness (Bar-Tur L,2000). People with chronic mental disorders and in their older ages have shown to express, after a very long time adaptation attainable prospects which fit the apparent limits of their illness, and therefore from this studies one of the goals of rehabilitation is actually to facilitate encouragement of the patients as well as the aged people to counter effect with higher expectations. This is very contradicting tom the results that can be obtained from the young people who usually develops very high unrealistic and unattainable aspirations which are overwhelmed by their actual possibilities. Due to the fact that most of the strategies laid down by the young people in the achievements of their goals are not actually obtained, they tend to lay down a lot of future projects and plans which sometimes are just futile and frustrating. It follows that there is development of unrelenting dissatisfaction as they do not achieve what they actually want to realize in the limited period of time creating a sense of failure (Adelson, 2000). As compared to the aged people who seem to be static in their way of lifestyles, it is very important to incur a lower level of dissatisfaction. This is because it can influence the motivation of a desire to formulate mechanisms which can enhance transformation and development of personal projects and plan for the future; since can be applied as an incentive for creativity and active participation in projects adapted to each participant’s potential. Conclusion The research studies which have been done on the quality of life or well being and its relationship with age have shown contradicting results from the normal way in which the old people are perceived. This is because older individuals, who are seen in the society to be suffering from harsh mental sickness, actually are subjectively more contented with their lifestyles in their milieu and relatively more satisfied with their general living circumstances than the younger people do. This has disapproved the traditional theory from the longitudinal studies, which has for a long period of time reported that the aging process tends to facilitate social integration and thus influencing the attenuation of symptomatology (Jean, 2006) This is not so as younger people with conditions such as schizophrenia, are more probable to feel discontented with their lifestyles bearing the mind that they are legible to encounter with difficulties in social incorporation and not ready to accept the reality of a relatively early onset of such a disease. They are also less likely to admit the fact of being mentally ill at that particular early age, and this causes the tendency of trying to share the same aspiration hopes and dreams as their peer group in the general healthy population. Since the achievement of these targeted results usually is not attainable they develop an intersection of the clinical and sociological fields, calling a consideration to the subjective awareness of quality of life as well as its significance for both clinical and rehabilitation interventions (Chesson,2008). This also has been suggested by the fact that people with long-term mental health problems in most cases tend to undergo an adaptation to their state, hence facilitating the ability to lower their outlook for ease satisfaction with less. This does not apply to the younger psychotic adults, because of lack of acceptance of reality and thus they persist to share the same aspirations as their peer group who are healthy, and this propagates a sense of high levels of dissatisfaction experiences for this group of people usually when they are incapable of meeting their own expectations. However in reality the gap between set goals and accomplishment that causes a level of dissatisfaction on the other hand has generated more desire for change of lifestyles and formulation of future plans and personal projects and this may be a source of economical development (Bar-Tur, 2000). Therefore since the major issue in the perception of subjective quality of life and well being of aged people is life aspirations, this hypothesis can be positively used in a given nursing institution or rehabilitation center to stimulate the motivation of patients especially the mentally ill people and elderly to live a satisfied life. This will change the perception of people that the psychological and emotional old age is a phase at which individuals pass through a period of sociological declination, dissatisfaction, depression and loneliness (Bruce Headey, 1999). References Anneli S. (2000).Quality of life in old age described as a sense of well-being, meaning and value: Methodological issues in nursing research – Adelson N. (2000). Re-imaging aboriginality: An indigenous people's response to social suffering. Transcultural Psychiatry, 37,11-34 Banyard V. (2001). Understanding links among childhood trauma, dissociation, and women's mental health. American Journal of Orthopsychiatry, 71,311-321. Journal of Advanced Nursing, 32(4), 1025±1033 Bar-Tur L.( 2000). Coping with losses and past trauma in old age: The separation individuation perspective. Journal of Personal and Interpersonal Loss, 5,263-282. Bruce Headey, (1999), Old Age is Not Downhill: the Satisfactions and Well-Being of Australasian Journal on Ageing, Vol18 No 3 1999, Supplement C Âeline Mercier, Normand P Âeladeau, and Raymond Tempier, (1998), Age, Gender and Quality of Life: Community Mental Health Journal, Vol. 34, No. 5 Das, V. (2000). Violence and subjectivity. Berkeley, CA: University of California Press. Das, V.(2001). Remaking a world: Violence, social suffering and recovery. Berkeley, CA: University of California Press. Dasberg H. (2001). Adult child survivor syndrome on deprived childhoods of aging Holocaust survivors. Israel Journal of Psychiatry and Related Sciences, 38,13-26. Chesson A (2008). Practice parameters for the evaluation of chronic insomnia- American academy of sleep medicine report. Standards of practice committee of the American academy of sleep medicine. Farquhar M. (1995), Definitions of quality of life: A taxonomic Journal of Advanced Nursing 22, 502±508 Ferrans C. & Powers M. (1985), Quality of life index: development and psychometric properties, Advances in Nursing Sciences 8(1), 15±24 Lack L (2005). The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep of early morning awakening insomniacs. Lawton M. (1991), A multidimensional view of quality of life in frail elders: In The Concept And Measurement of Quality of Life in the Frail Elderly (Birren J., Lubben J., Rowe J. & Detchman D. eds), Academic Press, San Diego, pp. 3±27 Jean L ( 2006) Sleep duration, illumination, and activity patterns in a population sample: effects of gender Lawton, M. P. 2000. Annual review of gerontology and geriatrics: End of life issues. New York: Springer. Morgan, D.( 2001). The problem of suffering and the sociological task of theodicy. European Journal of Social Theory, 4,199- Naylor E (2009) Daily social and physical activity increases slow wave sleep and daytime neuropsychological performance in the elderly. Sleep 2000; 23: 87–95. Nilsson M., Ekman S.-L & SarvimaÈki A. (1998), Ageing with joy or resigning to old age: Health Care in Later Life 3, 94±110 SarvimaÈki A. (1999), what do we mean by `quality of life' in our care of people with dementia? Journal of Dementia Care 7(1), 35±37 Veenhoven R. (1996), Happy life expectancy: a comprehensive measure of quality-of-life in nations. Social lndicators Research 1996; 39: l-58 WHOQOL Group (1993), the development of the WHO quality of life assessment instrument (The WHOQOL). In J. Orley & W. Kuyken (Eds.), Quality of life assessment: International perspectives. London: Springer-Verlag Zahn L. (1992), Quality of life: conceptual and measurement, issues. Journal of Advanced Nursing 17, 795±900 Uehara. ( 2001). Somatic complaints and social suffering among survivors of the Cambodian killing fields. Journal of Human Behavior in the Social Environment, 3,243-262. Ross, C.(1998). Women's work, men's work and the sense of control. Work and Occupations, 25,333-355. Williams B. (2001). Perceptions of illness causation among new referrals to a community mental health team: "Explanatory model" or "exploratory map"? Social Science and Medicine, 53,465-476. Youngstedt S.(2006) Circadian phase delaying effects of bright light alone and combined with exercise in humans. Am J Physiol Regulatory Integrative Comp Physiol. Dignity village - Old age home(2009). Retirement home, Senior citizens care, Senior citizens Retrieved on 28/10/09 from http://www.prlog.org/10280536-dignity-village-old-age-home-retirement-home-senior-citizens-care-senior-citizens.pdf Read More

Since the from the research done respondents are the ones who are delegated to give their life satisfaction, indicating that quality of life in question is subjective to the specific person depending on how he understands a satisfied life. This has led to the development of some common factors which may have been used to conventionally analyze the measure of mental well being and the quality of life of the elderly people. Generally the quality of life of a given individual is determined by factors such as Functional capacity, perceived health, good housing conditions, an active life style, and good social relationships were some of the factors that explained life satisfaction and subjective quality of life (Nilsson et al. 1998). Furthermore as well being aspects differs within a population, quality of life may also include the personality displayed by an individual and this portrays how comfortable the person is with living conditions and general well being.

The definition of quality of life in the recent past has gained a lot of interest in the medical, health care and the nursing areas. This has been due to the fact that as the living standards of people is highly upgraded in conjunction with improved health care programs and increased access to health care, the number of elderly people is growing in our community. People of high ages usually are subjected to a number of health problems along with decreased levels of physical and physiological functional capacity.

As a result of this the growing aged population who usually develops and lives with chronic disease conditions, body health problems and lowered performance, there has been a rising need to help these patients to actively and happily live a good life in spite of their chronic illness and lowered functional capacities (Lawton 1991, and SarvimaÈki 1999). Quality of life and mental well-being of people in their old age A great variation has been registered on the well being of aged people and parameters used for this includes the following health, functional capacity, and adaptation mechanisms as intra-individual circumstances for quality of life, at the same time as factors in the biophysical and socio-cultural milieu are expressed as external conditions as they influence living standards of these old men indirectly.

Or instance in the study sample consisted of 300 subjects, aged 75 or older and living in Melbourne, Finland. The data obtained from the study was very contradicting with thee general implications of aging in the community, as the information obtained from the research showed that the elderly participants’ quality of life was generally fairly good. This was virtually indicated from the precise correlations among the research variables related to quality of life, which were significantly correct despite the fact that the results for the regression analyses portrayed un-identical explanatory models from individual aspects of quality of life (SarvimaÈki and Bettina, 2000).

From the Australian research, it has been seen that by considering the satisfactions with particular domains of life. Old people show a greater satisfaction level to free time, leisure activities, organizational involvements and helping the needy. Secondly they are contented with their current housing, suburb and their interactions with the local community and the society at large is highly satisfactory. The other area in which these aged people find a high degree of satisfaction as compared to the younger counterparts is in the area of general expression of the individual morale which tackles aspects of kindness, generosity, honesty, sincerity including the relativity in the development of good moral qualities to the society.

Lastly elderly people have decreased worries and usually shows reduced stress related pressures and daily strains. These findings can not be technically correlated to its causal mechanisms, as it’s not clear to identify whether it is due to the effects of maturation/old age or are peculiar to this group of people.

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