People with Dementia and Social Workers' Roles by Eunkyeong Do

The personal care home where I am doing my field placement is a place where diverse groups of people gather and work. Those groups consist of residents, families, staff, volunteers, visitors, and so on. The majority of people are old older adults with dementia who are in closer to the end of life. As I see these people, I feel that I am lucky because I am healthier and younger than them and can help them. Now and then, questions arise in my mind about dementia: what is it, what are the risk factors, what issues make residents or families hard to deal with, and how do staff cope, especially social workers in my field placement. Although I have learned about this disease in a few classes, I do not think I really considered this disease from a client-centered perspective because I thought I already knew about dementia well before I took a few courses. However, I found out that I overlooked very sensitive parts, which can be issues among people when I talked with people that I have known for many years. I feel, at the moment, that all my knowledge pieces about dementia are disorganized in my head. I, therefore, will try to make sense of this issue by utilizing my classnotes, textbook and brochures that guest speakers brought. I will look back on myself and think about this disease again. I hope this time can help me to clearly understand some issues arising with the definition of dementia.

To understand better, it is necessary to describe what dementia is. According to the Alzheimer Society of Manitoba (2010), dementia is defined as a disease of brain cells, which causes memory loss, and cognitive impairment. A currently irreversible and slowly progressive disease, dementia is related to a diversity of dementias, such as Alzheimer’s disease (AD) that Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease, Lewy body Dementia, Parkinson’s disease and Huntington’s disease. All these dementias are different from one another. I do not describe all about these disease here, but further research is needed in order to understand in detail. Dementia is also well-known as a main problem in geriatric care. Of course, as Saxon, Etten, and Perkins (Saxon et al., 2010) note, “…diagnosis of dementia occur[s] in the vast majority of people at the oldest ages…” (p. 189). Often dementia causes disability and morbidity in older people. Degenerative Alzheimer disease, Vascular dementia, B12 deficiency, autoimmune disorders, Parkinsonism, infections, such as HIV/ AIDS, other extra-pyramidal disorders, such as Huntington’s disease, and Trauma can cause dementia (Mackenzie, 2010).

Unfortunately, today’s medical technology cannot help. There is currently no cure for Alzheimer’s disease generates. In terms of caregiving issues, mostly women, especially spouses take responsibility care for their partners of dementia. Sawatzky and Fowler-Kerry (2003) note that “the burden of care often falls disproportionately on mothers, wives and/or daughters, who are unpaid for services. Physical effort, combined with lack of support, medical knowledge and sleep, can often place the health of caregivers at risk” (p. 277). Have you ever thought why women take responsibilities for caregiving more often than men? How should caregivers’ needs be met regarding this issue? In order to meet caregivers’ needs, what policies should be changed? Are there any options to care for people with dementia in the home? Do caregivers in the home should be paid? If caregivers want to care in their home, how can home care social workers assist them? How can social workers help them reduce the sense of burdens?

Making the decision to institutionalize is also an issue in terms of people with dementia. Lundh, Sandberg and Nolan (2000), Nolan and Dellasega (2000) emphasize that “making the decision to institutionalize a loved one is among their most difficult experiences, a time of crisis for the family” (as cited in Caron, Ducharme, and Griffitha, 2006, p. 195). If caregivers choose institutionalization, regardless of the opinion of the cognitively impaired older adults, how should social workers intervene? From caregivers’ perspectives, should social workers respect the caregivers’ decision even if the cognitively impaired older adults do not want to go to an institution? If social workers met family members who were psychologically distressed due to memory loss that caused a bad relationship, how could social workers help them? On the other hand, from clients’ perspectives, if cognitively impaired older family members refuse to go to institutions, should they be at home?

As the Alzheimer society emphasizes, early diagnosis from family is really important to address earlier treatments and to improve the life of people with dementia. Family should look for signs, such as the loss of sense of smell and loss of weight, confusion, decrease of ability to make a decision. Education about Alzheimer’s disease provides behavioural therapeutic strategies, such as activities and music. Such therapeutic techniques can help improve life for both people with dementia and their families. Social workers should think about how they encourage families to be aware of these signs, and how they encourage families to more participate in these therapeutic strategies. If families resisted against participating in these strategies, how could social workers handle this case? Are there any alternative strategies instead of these therapeutic strategies?

According to Saxon et al (2010), “The Alzheimer’s Association reports a prevalence of 5.1 million Americans with Alzheimer’s disease (AD) in 2009 , with a projected increase to 7.7 million in 2030” ( p. 167). The more AD population increases, the more ethical issues maybe increase. Presumably, social workers’ roles are more important than before.


References

Alzheimer Society of Manitoba. (2010). Research: Related dementia-Vascular dementia. Winnipeg, Manitoba: Alzheimer Society of Manitoba.

Caron, C. D., Ducharme, F., & Griffitha, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193-205.

Mackenzie, C. (2010, October 5). Dementia. Presented at a KIN 2610 lecture at the University of Manitoba, Winnipeg, MB.

Sawatzky, J. E. & Fowler-Kerry, S. (2003). Impact of caregiving: Listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing, 10, 277-286.

Saxon, S.V., Etten, M. J., & Perkins, E. A. (2010). Physical change and aging (5th. Ed.). New York: Springer Publishing Company

Inequality affects women’s later lives

A healthy life is crucial for all people. Human beings have to be able to live in a healthy and safe environment with an access to health care system, which provides mentally, emotionally, spiritually and physically supports. As social feminists articulate, I believe that all human beings should have freedom of choice, and their own status in society. This menas that all human beings should live freely from inequalities. As people age, they are likely to experience more health problems. In particular, many older people suffer from mental health problems with aging. Indeed, the majority of sufferers of mental illness in later life are older women. This means that, as some of the main findings point out in the literature, older women suffer more often from depression and dementia than men in their old age. Milne and Williams (2000) note that because women are more vulnerable to discrimination and socio-economic disadvantages based on age, gender, and class in their early years, their later lives are harder. It is obvious that older women are discriminated against under the patriarchal system, so that old women live in an unequal society.
Indeed, our society has some concerns about older women. First, older women's groups which include visible minority populations are more vulnerable. Anather problem is that older women's issues, such as poverty, housing, and older-women-centered- care needs are still largely ignored by health policy makers and psychiatric professionals. There is no service to respond to their care needs. In addition, according to the authors, the previous literature does not have much information about the effects of inequalities on older people who have mental illness problems.
Milne and williams (2000) identified that mental health problem as older women face today stems from inequalities: poverty, housing and living situation, marriage and home life, trauma and abuse, and health and disability. As might be expected, poverty is the biggest considerable risk factor for mental health problems. Older women who lived in low-income in their earlier lives experiecnce the highest levels of poverty in their later years. Low-income women may be disadvantaged in terms of fundamental necessities for a living. As socialist feminists argue, such disadvantages for women are based on the capitalist society, which does not recognize women's domestic work as a valuable component of productivity. Domestic house work is not paid, and does not include pension. The biggest problem is poor women often experience lifelong poverty. Moreover, social isolation, loneliness, and living alone are great risk factors for developing depression or anxiety.
Secondly, according to the authors, marriage and home life factors make older women more vulnerable to mental illness. Older women, who had married and worked at home, compared to women who had worked outside of the home are more likely to experience depressive illness. Presumably, women had low-self-esteem due to their very little earnings with no benefits. In this case, they saw themselves helpless.
Further, trauma in terms of sexual experience in childhood or younger adulthood may also lead to depression. This means that a high prevalence of trauma affects older women suffer from menatl illness than men. The cause of this trauma originates from an ideology contructed by men. Radical feminists argue that, in partriarchy, women's bodies are viewed as sexual objects. This means that male power in patriarchy controls society's members to look at women as sexual slaves. As some radical feminists argue, patriarchal society tolerates male violence against women as acceptable behaviour. This tolerance may have to develop that men control of women's bodies and to the use of women's bodies for pornography and prostitution.
All these risk factors based on low-income, low-self-esteem, and victimization affect many women's later lives, so that women have more mental illness problems. These cumulated inequalities may continue in the future because our society stll treats women unequally although many women's group argue poverty for a long time. For example, women still work in low-waged workplaces, which have no benefit. Domestic house work is still not calculated as productive work in the Canadian tax system. In addition, our society's members oftern see only one type of woman who is skinny and "sexy", which is constructed by patriarchy.
In order to change such a fixed standard of society's members, firstly, the previous failed policies should be shifted. In terms of older women with mental health problems, the society should consider whether women's income is adequate, and if they live suitably. In doing so, the society's members should accept the idea that social inqualities considerably affect the mental health of older women, and should take older women's issues seriously. To do so, community and society's members should be interested in women's voices or issues by listening to older women without ageism. Although eliminating ageism is rally challenging, a step towards hearing older women's voices is necessary. This is possible when health providers and professionals are trained, and policy is focused on older women with mental health problems. For example, professionals in academic fields should help students recognize older women's issues. Particularly, it is important to encourage older women who have trauma to attend a woman's group so that they can share their experiences.
Today, older women especially women of visible minority and Aboriginal are still poor. Unfortunately, many of them who have mental health problems had hard time for a living in their early years. They were poor, and suffered from low-income and hardship of life. For this reason, older women are sufferer from mental health problems, such as depression and anxiety than men in their later years. Canada nationally faces this issue as a big concern today.