Identifying learning needs of the institutionalized elderly
University of Lethbridge. Faculty of Education
Lethbridge, Alta. : University of Lethbridge, Faculty of Education, 1993
Global populations are aging and by the turn of the century elderly populations will have increased significantly. The United Nations predicts that by the year 2025 the elderly will constitute 25 percent of the global population (UN Chronicle, 1988). Specifically, the global population of people over 60 years of age was 380 million in 1980, is expected to rise to 610 million in the year 2000 and will reach an alarming billion plus by 2025 (UN chronicle, 1988). The UN Chronicle anticipates faster increases in the 80 plus age group with 34 million in 1980, 58 million in 2000 and 114 million in the year 2025. The Canadian population is not excluded in the United Nations predictions. Canadians are also growing older and grayer. The "graying of Canada" is a phrase frequently coined by the media, in the latter years of the past decade. It is predicted that by the year 2025 approximately one in five Canadians will be over the age of 65 (Cooper, 1989). Senior citizens, in Canada, are now being subcategorized into the "young-old", the "old-old", the "well-ederly" and the "frail-elderly" (Cooper, 1989, p.114). The new era of Canadian seniors boasts a philosophy of living longer and dying younger (at heart). The UN Chronicle suggest that the trend towards aging could significanlty affect a society's development potential, particularly if dependency rates among the elderly are high. Eight percent of older Canadians reside in long term care institutions compared with five percent of older Americans (Tamarkin, 1988). This may suggest that Canadian dependency rates among the elderly population is higher than the United States of America or it may reflect the availability of programs specific to the elderly in Canada. Provincial governments within Canada are attempting to decrease dependency rates among the elderly by intitiating health care programs which will promote individual independence. Present day long term care facilities encourage independence among the elderly, replacing the once predominant philosophy of promoting individual dependency. This theoretical framework attempts to decrease dependency rates within long term care institutions while promoting personal independence, decision making autonomy and lifestyle flexibility. The promotion of the above named concepts assumes that the institutionalized adult's quality of life is enhanced and maintained. The provincial government of Alberta, specifically the Department of Health or Alberta Health, has in the last decade researched and implemented program changes in long term care facilities. These initiatives have had a significant impact on the delivery of care, services and programs provided to the instiutionalized elderly of Alberta. Policy and program changes introduced at the nursing home level have greatly improved and enhanced the resources and quality of existing health care services provided to the institutionalized elderly. In 1985 the revised Nursing Home Act of Alberta was introduced. This document governs all nursing homes or long term care facilities within the province. Professional staff was increased in these facilities to better meet the demands of an aging instiutionalized elderly population. The previous Nursing Home Act had established minimum standards of care and services to be delivered to the elderly but the revised 1985 Nursing Home Act further developed these standards in an effort to increase or maintain the individual's quality of life within an institution and to further promote independence amont the institutionalized elderly. Alberta Health then introduced, in 1987, a classification system for all nursing homes. The ultimate goal of the classification system is to fund facilities in a more equitable manner taking into account individual facility care requirements. For example, a nursing home with heavy or intense care requirements will be funded at a higher rate compared with facilities which have light or minimal care requirements. The classification system determines staffing patterns for the nursing department within long term care facilities. For facilities with above average care requirements the non-professional nursing staff was increased. The professional nursing staff ratio was increased from 17 percent to 22 percent. Professional and non-professional nursing staff was not decreased in any facility. The provincial Department of Health has made a concerted effort to improve the quality of life for elderly individuals residing within Alberta institutions. Medicine Hat, a southeastern Alberta community, has a total population of 42,290 (Census Summary Part3, 1988). The Census Summary (1988) explains that 14 percent of Medicine Hat's total population consists of adults over the age of 65 years. This is much higher than the provincial percentage of 8.2 percent. The Medicine Hat News (1990) reported that in the early months of 1990, 6,000 of the city's residents were 65 years of age and older but that number will soar to 7,200 by the year 2000 with half of these individuals 75 years of age and older. As the past Director of Nursing in a nursing home in Medicine Hat, I am most concerned with meeting the needs of the institutionalized elderly. The revised Alberta Nursing Home Act of 1985 and classification systme of 1987 have created the resources within a nursing home to realistically meet the complex and varying health care needs of older individuals. According to Maslow's (1970) theory of human motivation a hierarchy of human needs exists. The beginning point or basis for motivation theory is the meeting of human physiological needs such as food, clothing and shelter. Maslow's hierarchy of needs then continues with the human need for safety, love and belonging, esteem and lastly, the need for self-actualization. Individual learning experiences promote and meet one's esteem needs. However, Maslow proposed that esteem needs cannot be met unless those needs below it on the hierarchy scale are initially met and maintained. Nursing homes do meet the basic survival or physiological needs of their residents. These individuals are fed, clother and sheltered. Safety needs of the instiutionalized elderly are met by the institution in terms of 'security, structure, order and protection" (Maslow, 1970, p. 39). The institutional setting may not adequately meet the individual's need for love and belonging. This can be attempted, collectively, on a group basis but individual loneliness may prevail. It is hoped that these needs can be met with the assistance of the individuals' family or friends. If love and belonging needs are adequately fulfilled then Maslow acknowledges that esteem needs may be attained. Esteem needs include the desire "for self-respect or self-esteem and for the esteem of others" (Maslow, 1970, p. 45). The long term care facility may attempt to meet an individuals' esteem needs by providing learning opportunities which will promote "individual recognition, achievement, mastery, competence, confidence, independence, status, importance, appreciation and dignity" (p. 45). The meeting of an individual's esteem needs may or may not lead one to strive for self-actualization which, according to Maslow is the epitome of being. The need for interdependence is perhaps a higher need than self-actualization. The need for interdependence suggest that each individual or groups of individuals must rely on the other for their co-existence. Interdependence is crucial within long term care settings as residents, their familiees and/or significant others and the institution strive for an environment of mutuality. Historically, the physical, social, spiritual and mental well being of the institutionalized elderly was a goal most long term care facilities strived for. This conceptual framework surmises that learning needs are a part of the individual's mental and social needs. Nursing homes contain several departments which address specific needs of the resident. For instance, the nursing, dietary, phsiotherapy and occupational therapy departments ensure that the physical needs of the institutionalized elderly are assessed and addressed by the recreational department within a long term care facility. In Medicine Hat, community senior citizen centers as well as the local college have provided learning opportunities for older adults who reside in a community setting. However, long term care facilities have not truly addressed the issue of providing learning sessions for the lucid institutionalized elderly. Perhaps this is due, to some extent, to certain attitudes espoused by society in general, towards aging and the institutionalized elderly. Nursing homes may be perceived by some members of society as the final resting place for the living. Inhabitants of nursing homes may be perceived as a collective group rather than individuals with uniquely varying personalities, preferences, desire and emotions. The institutionalized elderly are individuals who wish to live their lives as do otje members of society, with definition, purpose and the desire to be recognized. Society has in the past negatively stereotyped aging and has held an infatuation with youth which has contributed to the ideology that aging was not an important process to be studied (Groombridge, 1982). However, with the realization that the elderly population is increasing significantly researchers are becoming more interested in understanding aging as it constitutes a complex process which involves biological, psychological, social, political and economic factors. According to McDaniel (1986) aging is poorly understood at present but is receiving greater attention and an increasing amount of research has rectnely been intiated on the subject. In my opinion, research initiatives concerning the institutionalized elderly are long overdue. Long term care facilities are now placing greater emphasis on the goals of resident individuality, personal autonomy and institutional flexibility with regard to the reidents' lifestyles. Long term care professionals are now motivated to inquire and seek clarification from their clientele in an effort to achieve this new goal. An increasing elderly population has prompted researchers to consider new and unexplored areas of critical thinking concerning elderhood. The identification of learning needs among the lucid institutionalized elderly is an unexplored area of elderhood. Past research on learning needs among the elderly indicates that gaps do exist in the research. Further studies are required in order to understand and plan future learning programs for the lucid instiutionalized individual.
ii, 151 leaves : ill. ; 29 cm.
Dissertations, Academic , Older people -- Education -- Alberta , Adult education -- Alberta