Dependency in Old Age: Problems, Benefits, and Functional Capacity

Geropsychology and Dependency in Old Age

Ue Universidad Europea Unit 6. Dependency in Old Age Geropsychology Allyah Hassell 2024-2025 allyahmayney.hassell@universidadeuropea.es Ve más alláUe

Prevalent Problems in Old Age

Three Most Prevalent Problems In Old-age DEMENTIA DEPRESSION DEPENDENCY

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Defining Dependency

What is Dependency? "The permanent state in which people who, for reasons derived from age, illness or disability, and linked to the lack or loss of physical, mental, intellectual or sensory autonomy, need the attention of another or other persons or important aids to carry out basic activities of daily living or, in the case of people with intellectual disabilities or mental illness, other support for their personal autonomy." - Dependency law (Spain)

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Characteristics of a Dependent Person

What Is A Dependent Person? Someone limited in their ability to function independently on a daily basis over an extended period of time due to mental and/or physical disability

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Dependency Statistics and Functional Ability

Dependency in Numbers · The probability of disability increases with age · Approx. 80% of people > 85 years suffer from some kind of disability in daily life · Women: prevalence rates higher than those of men · Higher rate for mobility-related disabilities Functional Ability ADLs IADLS bathing dressing toileting transferring continence feeding using phones shopping food preparation housekeeping laundry transportation taking medication handling finances

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Degrees of Dependency

Grade I: Moderate Dependency

GRADE I. Moderate · Help for several ADLs · At least once a day · Needs of intermittent or limited support for personal autonomy

Grade II: Severe Dependency

GRADE II. Severe · Help for several ADLs . Two or three times a day . Does NOT require the permanent presence of a caregiver · Need for EXTENSIVE SUPPORT for personal autonomy

Grade III: Great Dependency

GRADE III. Great · Help for several ADLs · Several times a day · Indispensable and continuous support from another person due to: · Loss of physical, mental, intellectual or sensorial autonomy · Need of generalized support for personal autonomy

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Case Study: Maria's Dependency

Degree Of Dependency? . Maria is 78 years old and she suffered a stroke 2 years ago that caused some serious consequences. . She struggles to access the bathtub and when she gets in, she cannot clean all of her body. · When getting dressed she can put on her trousers but cannot put on jackets or coats due to a paralysis of an upper body limb. . She has difficulty sitting down and standing up from the toilet or any other furniture

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Dependency Benefits: Requirements

Dependency Benefits: Requirements Be a Spanish citizen and reside in Spain. Moreover, residents should have lived in the country for at least five years, of which the last two should be immediately prior to the application for support; or be a Spanish returnee. Have one of the following degrees of dependency: Grade I: Moderate dependency. Need support of someone else at least once a day to carry out their daily basic activities, or who need intermittent or limited support Grade II: Severe dependency. Need support several times a day to carry out their daily basic activities Grade III: Great dependency. Need continuous support from another person

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Types of Dependency Benefits

Service Benefits

Service Includes different ways of assisting dependent people in their own house or in a residential home, depending on their needs. They can be assisted by both professional carers and their own family. Beneficiaries must pay part of the costs, depending on their financial circumstances and the service available

Financial Benefits

Financial Financial benefits vary according to the person's degree of dependency, but these are only available if the beneficiary does not receive other similar benefits, and it is impossible to offer support through specific services EURO 50 50 BC-69 CHE EZB EKP EKT EKB BCE EBC 2015

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Functional Capacity vs. Independence in ADL

Difference Between Functional Capacity And Independence In ADL? · Functional capacity -> Reflects the ability to execute a task in a test situation related to a daily physical activity · Degree of dependency -> A measure of disability based on the assistance a person receives with these activities and may be more influenced by factors such as cognition, environmental demands, use of assistive devices, and the caregiver's estimation of the need for assistance

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Factors Determining Dependency

Factors That Determine Dependency Physical Psychological Contextual

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Physical Conditions and Dependency

Factors That Determine Dependency Physical conditions · Limited health and physical dependence · Reduced mobility and decreased muscle strength -> falls and accidents · Presence of chronic diseases: arthritis, osteoporosis, cardiovascular diseases -> mobility restrictions and chronic pain · Sensory limitations

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Psychological and Contextual Conditions

Factors That Determine Dependency Psychological conditions e.g. Dementia and depression; self-esteem and self-efficacy • Contextual conditions · Dependence can be the result of model of interaction and social attention • Excessive protection -> stereotypes or prejudiced attitudes towards the elderly > premature loss of independence, higher rates of early mortality and depression (the "self-fulfilling prophecy")

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Summary of Dependency Factors

Factors That Determine Dependency - Physical fragility, mobility difficulties, diseases/illnesses Physical - Sensorial limitations - Drug consumption - Psychological disorders Psychological - Personality factors Contextual - Physical environment - Social environment

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Little's Model (1988) of Caregiver Interaction

Little's Model (1988) Caregiver Person receiving care Negative expectations Overprotective behaviour Decrease opportunities Expectations met Decrease capacities

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Interactive Process in Little's Model

Little's Model (1988) The interactive process between the elderly and their caregivers 1. Negative expectations of the caregiver In relation to the ability of the elderly person to perform an independent behaviour 2. Overprotective behaviours > Deprives the elderly person of opportunities to carry out the behaviour 3. Lack of practice and loss of habits with an associated perception of feeling useless > Decreased capacity and increased dependence > Initial negative expectations are met

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Assessing Dependency

Assessing Dependence

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Methods for Assessing Dependence

Assessing Dependence · Information given by others: · Direct and retrospective · Immediate observation by family or professionals · Katz Index (Katz et al., 1970): · Observations on the best performance of the elderly in BADL . IADL scale of the Philadelphia Geriatric Centre (Lawton and Brody scale) · Dependent/independent · 8 areas · FAQ (Pfeffer et al., 1982) · IADL

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Importance of Reliable Assessment

Assessing Dependence · Importance of a detailed and reliable assessment of the skills of the elderly and the presence of possible dependent behaviours > Differentiate between real limitations and limitations due to overprotection offered by the medium in which it is immersed

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Intervention in Dependency

Intervention in Dependency

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Approaches to Intervention

Intervention in Dependency • Elderly people: behavioural plasticity > optimise their behaviour in daily life through learning strategies and/or environmental manipulations . In the past: focus on BADL · Today: ➢ Including more IADL (people living alone in their own home or community) ➢ Interventions focused on physical aids and environmental reorganisation rather than on the acquisition of skills

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Behavioral Training for Geriatric Personnel

Intervention in Dependency Behavioral Training Program For Geriatric Personnel (Sperbeck & Withbourne, 1981): › Increase professional knowledge about aging ➢ Training in the principles of behaviour modification ➢ Training in techniques that enhance the autonomy of the elderly

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Program of Skills of Daily Living

Intervention in Dependency Program Of Skills Of Daily Living (Executioner, 2000) · Personal hygiene, cleaning, prevention of accidents at home, purchase and conservation of food, preparation of meals and use of kitchen utensils, etc. GENERALES ESPECÍFICOS Y OPERATIVOS 1. La persona mayor desarrolla los hábitos necesarios para lavarse, asearse y presen- tar una apariencia externa aceptable. 2. La persona mayor adquiere independen- cia para vestirse y desnudarse, así como para comprar y cuidar la ropa. 3. La persona mayor desarrolla las conduc- tas necesarias para comer y beber correc- tamente, así como independencia para planear, comprar, conservar y preparar alimentos. 4. La persona mayor adquiere independen- cia para limpiar. ordenar y mantener su habitación o piso donde vive. 1.1. Desarrolla los hábitos necesarios para asearse o presentar una apariencia externa aceptable. 2.1. Adquiere autonomía personal para vestir- se y desnudarse. 2.2. Compra y cuida la ropa. 3.1. Desarrolla hábitos necesarios para comer y beber independientemente. 3.2. Compra y conserva alimentos. 3.3. Planea y prepara alimentos y comidas. 4.1. Limpia y ordena su habilitación. 4.2. Compra y repara los utensilios que necesi- ta para la limpieza y el mantenimiento de la casa. 4.3. La persona mayor, ante situaciones de peli- gro en el lugar donde vive, reacciona ade- cuadamente. P. V.D. Programa de Habilidades de la Vida Diaria PROGRAMAS CONDUCTUALES ALTERNATIVOS Miguel Ángel Verdugo OPsi Egia

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