Psychosocial Care and Support of Elderly

1. Addis Ababa UniversityCollege of Education and Behavioral StudiesSchool of Psychology Psychosocial Care and Support of Elderly By: KonjitKebede January,2020

2. Outline • Background • People who in need of Psychosocial support • Existing Situations of Elderly people in Ethiopia • Steps in Providing psychosocial care and support • Ways to Deliver Psychosocial Care and Support • PSC Strategies to Address the Needs of Elderly • Psychosocial support and Community development • Guiding Principles for Community Based Psychosocial Support • Importance's of psychosocial care and support

3. Background • The term psychosocial is often used in the field of humanitarian response which • refers to the close connection between psychological aspects of human experience and the wider social contexts inclusive of human capacity, social ecology, culture and values . • Psychosocial support refers to any local or outside action that enhances the aspects of an individual or situation to best allow for recovering from the effects of any issues affecting the wellbeing. • Psychosocial support involves a scale of care and support which influences both the individual and the social environment I n which people live and ranges from care and support offered by caregivers, family members, friends, neighbors, teachers, health workers, and community members on a daily basis

4. Cont’d • PCS is also provided through interactions that occur in caring relationships in everyday life, at home, in the Institution and in the community. • PCS is also a continuum of care and support that is an ongoing nurturing relationships that communicate understanding, unconditional love, tolerance and acceptance, and extends to care and support offered by specialized psychological and social services. • Psychosocial care is aimed at improved physical, social, and emotional well-being. Well-being is understood to include physical safety, mental resilience, ability to maintain social relations, and a continuing capacity to learn. • Psycho-social well-being is based on an inseparable combination of biological, emotional, spiritual, cultural, social, mental, and material aspects of experience • Psycho-social programs emphasize on the totality of people’s experience and underline the need to view these issues within the context of the wider family and community networks in which they occur.

5. Cont’d • PCS addresses the dynamic relationship between psychological and social effects of experiences, each continually influencing the other. • PSYCHOLOGY • Minds • Thoughts • Emotions • Feelings • Behaviors • SOCIAL • Interaction and relationships with other • Environment • Culture and Tradition • Roles and Tasks

6. Who needs psychosocial care and support? • Everyone needs psychosocial support because human beings have different social, emotional, andpsychological needs. • However, extra attention need to be given to people who haveexperienced grief, the death of a loved one, physical and sexual violence, displacement, or any of the other difficult situations. • Anyone who experiences the psychological, social, and physical reactions mentioned above will need psychosocial care and support. • Based on different empirical evidences and personal observation, elderly and women, children and unemployed disadvantageous young people, mentally ill, the disabled and handicapped and those who are leading destitute lives are groups which strongly require psychosocial care and support services in our country

7. Empirical Literatures on the Existing Situations of Elderly people in Ethiopia • According to WHO (2010) definition, ageing refers to the process of physiological, psychological and social change that are progressive, detrimental and irreversible, of structural and functional body organ. • The other concept that can be defined in relation with aging is elderly which refers to a category of adults who have attained advanced ages, 60 or 65 years. Ethiopia uses 60 years and above to refer to the elderly (United Nation, 2010). • According to Ethiopia Demographics Profile (2019), states the age structure of the population 3.92% (male 2,059,129 /female 2,185,814) belongs to the population age between 55-64 years while 65 years and over count 2.97% (male 1,445,547 /female 1,770,262) of the total population. • It is anticipated that by 2050 Ethiopia's elderly population will increase by 55% and will outnumber the population of children for the first time in Ethiopia's history. • Old age has been divided into different groups, Chronological age, which refers to the individual’s age in years. Biological (Physiological)aging is concerned with changes occurring in the structure and functions of the human body; which is concerned with individual and behavioral changes; emotional aging describes changes in one’s attitude and lifestyle dependent on one’s self-perception of being old; and finally functional aging is the comparison of individuals of the same age group in terms of those within the group being unable to maintain their functions in society.

8. Empirical Literatures on the Existing Situations of Elderly people in Ethiopia • The experience of Ageing is highly affected by cultural factors. The societal perception of aging in Ethiopia has both positive and negative reflection and presumptions attached towards aging and old age peoples. • On the positive, older people are most commonly seen as wise, worthy of carrying responsibility, resolvers of conflicts (peace makers), community advisers, persons with great experience and authority (seasoned in specific expertise), and a lot more positive traits. • What comes to mind when we hear the Amharic word shimagile (literally, old man) is often a person who would resolve conflicts and make peace. • Accordingly, the process of resolving conflicts other than through arbitration has come to be called shimgilina. • On the contrary, alike in other parts of the world, ageing and older people are also perceived negatively. The Amharic word shimagile (old man) or Arogit (old woman) may imply physically fragile persons, easily susceptible to diseases, persons who could have little or no involvement in certain kinds of work, especially menial work, persons who need and deserve to be supported, etc. In extreme cases, there are also sayings that portray older people as no longer useful, as expressed in the Amharic saying “karejuaybeju”

9. Empirical Literatures on the Existing Situations of Elderly people in Ethiopia • In Ethiopia, older people have traditionally been viewed in a positive light and valued as repositories of information, wisdom and assets to their family and communities, both in rural and urban areas. But this is now changing as development and modernization are closely connected with social and economic changes that are weakening traditional social values and networks that provide care and support in later life. • Existing literatures indicate that people over the age of 60 are one of the most marginalized and poorest groups in the country. • A qualitative study done by Help Age International (2011) indicates that Older persons living in Ethiopia are challenged in achieving household security as a result of unreliable sources of income, instability in their livelihoods, lack of diversified livelihoods opportunities, and limited access to social and health services. Majority of them were depending on the bagging. • The other anthropological study conducted within the regional state of Amhara found out the needs of the elderly living in that area are, food insecurity caused by shortage of land and unfair distribution of agricultural land, absence of appropriate shelter in association with poverty, unavailability of sanitary facilities like toilets, health complications and absence of health centers in the area, the burden of caring grand children, abuse and neglect were some among others. Older adults were also vulnerable to elder abuse, Including physical, verbal, psychological and financial abuse, abandonment, neglect and serious losses of dignity and respect. (Kifle, 2002).

10. Empirical Literatures on the Existing Situations of Elderly people in Ethiopia • Furthermore, the other study conducted in SNNPR identified the following to the needs of the elderly in the area, poverty in association with food insecurity, poor health-care system, lack of housing and decent living environment, nonexistent or limited family support driven by gradual erosion of the culture of extended family and mutual support are mentioned. While most neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss. (Medhin Ethiopia, 2009). • From the above empirical findings one can conclude that, older persons constitute one of the most vulnerable sections of the society. They are not only physically weak but, also lack economic resources, self esteem and social status. • Problems of elderly people include economic dependency; mental illness, approximately 15% of adults aged 60 and over suffers from a mental disorder. dementia and depression among older people as public health issues. • Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities.), lack of meaningful social relationships, choice and control issues as Older people prefer to live with dignity and independence. • Hence enhancing the promotion, integration and provision of psychosocial care and support in family, community level and specialized services are important to this segment of the population.

11. Relationship between Psychosocial support and Community development • United nation currently frames a number of activities and approaches that fall within the psychosocial realm as “community-based approaches” or “community development approaches. • Hence psychosocial support is based on community based approach building on the knowledge, skills and capacities of people of concern and their communities. • A community-based approach is a way of working in partnership with Persons of Concern. It recognizes the resilience, capacities, skills and resources of Persons of Concern, builds on these to deliver protection and solutions, and supports the community’s own goals. • Community based psychosocial support (CBPS) is an approach in which humanitarian relief integrates psychosocial aspects into the response. • The foundation of all community-based psychosocial work is the recognition of the affected community’s capacity for recovery, resilience and future rebuilding and development. Psychosocial support is important to foster capacity building towards self-governance and collective decision making for ongoing community development. • The main objective of implementing community based psychosocial program is to build and enhance the capacity of the community to be able to provide care and response to elderly psychosocial needs.

12. The IASC psychosocial support pyramid model

13. Steps in Providing psychosocial care and support • In general, Psycho-Social care and Support is the means to guide and direct people to find their best skill, potential, Knowledge for a better life. • To provide psychosocial care and support services steps may include • assessing the existing situation, Identifying the specific target people, treating and rehabilitating those who are affected and prevention of the occurrence of the issue and community integration both in the prevention and rehabilitation are the steps in providing psychosocial care and services.

14. Ways to Deliver Psychosocial Care and Support • Various literatures state that different means in which psychosocial care and support can be delivered thorough. • Among these, community centered self help groups such as in Ethiopian context Idir, IkubMehaber can be mentioned, through empowerment and capacity building activities in partnership with the target group and community members, through strengthening social welfare programs, through awareness and advocacy and in promoting positive thinking psychosocial care and support can be delivered to the target groups within the community.

15. Psychosocial Support and Care strategies to Address the Needs of Elderly • Enhancement of physical and mental health: Good health is one of the most important factors in the elderly sense of well-being. • Provision of adequate financial support: Aged needs steady and adequate income to guarantee security and eliminate fear. They require money not only for feeding and housing but also for health care services. • Ensuring suitable housing: The major problem of the aged generally is housing. Some elderly cannot afford safe, comfortable housing while those who can afford good housing do not keep the regulations for safety requirement. • Restorative services for those who require institutional care: Institutional care of the aged e.g. care for the elderly in nursing homes is not encouraged except in such situations as in serious health and mental health problems. • Knowledge about laws guiding geriatric care: The aged need to be independent to choose the kinds of activities they pursue. They need to make decisions concerning their lives. Provide age-appropriate information about rights and entitlements, including knowledge of laws that provide protection, such as government funds, pensions and child–care grants.

16. Psychosocial Support and Care strategies to Address the Needs of Elderly • Improving the quality of life and Meeting the autonomy need: The elderly need autonomy, supportive relationships and meaningful activity. as the aged are sometimes not respected by the people because of ageism, that is, the notion that old people are no longer useful as they think, it should be one of the strategy enhancing the quality of life and promote the independence and respect for the rights and dignity of the aged and working very closely with the family of the aged since the family is the primary provider of the care for their aged. Need to Challenge social conditions that contribute to social exclusion, stigmatization or subjugation and to work towards an inclusive society • Reducing psychological instability and Ensuring adequate social support: There is usually lack of support for most of the aged. This lack may be financial, material, medical, peers and family ( Staehelin, 2005). Moreover depressed individual, especially an aged has many issues to deal with such as: bereavement, especially the loss of a spouse; increased awareness of one’s own physical vulnerability i.e. that one’s own life is limited; and prospect of dependency on others to have one’s basic needs met. • In General, training for health professionals in providing care for older people, preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders, designing sustainable policies on long-term and palliative care, providing security and freedom; adequate housing through supportive housing policy, social support for older people and their caregivers, programs to prevent and deal with elder abuse, Developing clinically appropriate, culturally and linguistically competent, age-friendly services and settings are some of the major strategies in providing psychosocial care and support for elderly people.

17. Guiding Principles for Community Based Psychosocial Support 1. Promotion of Rights: All activities related to elderly (any groups who are involved in) should pay Attention to their rights and dignity, without discrimination, avoiding unnecessary distress, fear, and pain e.g. physical, emotional and spiritual 2. Do No Harm: any activities that are carried out do not cause any further distress or even re- traumatize. Address elderly people’s spiritual needs to maintain good mental health and a feeling of belonging or connectedness to the community. 3. Empowerment and Participation: Family and community are the natural caregivers That will remain after psychosocial activities are over. Psychosocial activities should involve local resources and community participation. Build on community self help strategies, promoting community ownership and control over resources using participatory processes of engagement and decision-making. 4. Best Interest: Psychosocial activities should not be conducted to further political, economic, or personal Interests, or for the benefit of media interest, rather based on the specific need and ensuring the psychological wellbeing. 5. Cultural Sensitivity: Knowledge about local culture is necessary to ensure the program is suitable to local needs, and are not in conflict with local rules and customs. Recognize and encourage the community’s belief in its own capacity to make change and to protect their overall wellbeing by building on their own resources.

18. Principles of psychosocial care and support for Elderly • Access to rights: Strive to support the protection of older people and their access to their rights and entitlements. • Respect and kindness: Psychosocial support may be provided simply by changing the way we behave towards older people.This is about showing respect and kindness at all times in a way that builds the dignity of all people. • Participation: Use a participatory approach where older people are involved in identifying their needs, planning, facilitating and evaluating interventions. • Family-based care: use a family approach which supports the people within the context of his or her family environment. • Strengthen Existing Resources: Start from strengths, by acknowledging the existing knowledge, skills and expertise that the older person brings to each situation. • Build on locally appropriate practices: Research and strengthen locally appropriate ways of supporting older people so that one is not encountering resistance to practices which are considered foreign. Older people in particular may appreciate traditional approaches rather than unfamiliar ways of receiving support. • Consideration of gender: Be gender sensitive, understanding that the needs of older women may be different from those of older men. • Strategic leverage: Think about ideas of how you might more broadly influence the lives of older people both in the local community, or more or widely, maybe even at a national level. This principle includes consideration of the “do no harm” principles for every intervention with older people.Facilitate community education and awareness on the needs of the older,

19. Importance of psychosocial care and support • A large body of research has found that people who are socially integrated have better health and greater longevity than similarly placed individuals who are socially isolated (Pillemer, Moen, Wethington, & Glasgow, 2000). • Psychosocial support is important in order to maintain a continuum of family and Community based care and support. • It is about helping children, elderly, families and communities to improve their psychosocial wellbeing. • It encourages better connections between people, and building a better sense of self and community is expressed through caring and respectful relationships that communicate understanding, tolerance and acceptance is about promoting everyday consistent care and support in the family and community. • In general, psychosocial support services helps people to feeling safe, connected to others, calm and hopeful; having access to social, physical and emotional support; and feeling able to help themselves, as individuals and communities.