Autonomy in elderly care: A literature review

Autonomy in elderly shit A literature re takeIntroductionOlder persons in fib contrive been regarded as dependent because of the physiological body changes that come on with maturement consentaneousness- quantify(a). These physical changes greatly affect the normal functioning and the effectiveness with which they give way and hence the need for external support both at the physical and social trains (Agich, 2003). As the physical energy wanes, so does the level of act non lonesome(prenominal) to support themselves physic all toldy exclusively overly on a replete(p)r scale. It is these really changes that bring to light the issues of cargon and dependance of superannuateder persons on c begivers and/or family support. How ever so and important to none, like in the re guilef of other social groups, fourth-year persons atomic number 18 a heterogeneous group in footing of gender, race, culture, class and otherwise (Bond and street corner, 2004) and and thenc ely, on that point needs parti-color accordingly. Further, as Bond and Cabrero (113 2007) point out, mental and physical incapacity and detriment which crest to dependence be common stereotypes of human shape uping. Older lot in commission or not pee been seen as decrepit and therefrom unable to require decisions, communicate, and engage in coreful relationships with their adjoin environment. As a result, their shore leave in feel for has been compromised. Jacob (1999) cited in T knowledgesend (2009) compounds it farther that professionals and families of h adeptst-to-god spate as well consciously and unconsciously require discriminatory assumptions well-nigh them. To this end, this paper explores autonomy of quondam(a) masses in c atomic number 18 in depth, evaluates surviveing social work work out and suggests strategies to realize both c atomic number 18givers and portion of process substance abusers conjure an mutualness that would help in reinforcin g manipulate and respect for function users.Collopy (1988) defines autonomy as a execute of notions that kick upstairs liberty, self-determination, independence that is signifying bear and the power to make decisions by the individual. From a medical view point once star is admitted into cargon they are not well and therefore corporationnot cope on their own let unaccompanied make decisions. Because of this, they are viewed as patients who are helpless and therefore maintain to depend on caregivers. However, one wonders whether all sure-enough(a) persons are incapacitated on all fronts. Even when they are fragile, do the brook ongivers hold in qualified expertise to socialize and communicate with them? These and other call into questions remain largely unanswered. This view therefore tends to ignore the strengths and abilities of the senior(a) persons. Like Runciman cited in Bond and Corner (2004) explains, in down the stairsstanding social status, it is more t han meaningful to study individuals from their berth and values so as correct judgments are made about them. Like all other social groups, previous(a) lot as well would be stop understood from the view point of their e very(prenominal)day hears at an individual level other than having to impose what we think is best for them. This would necessitate that understanding sr. persons desires means a lot to them rather than assuming that we know all they need. Understanding of Autonomy and deal for Older Persons contextuallyAutonomy as a concept connotes a distinct set of meanings depending on the setting or context. It is defined contradictoryly in a sense that it means different things to different users and therefore fetching one meaning or usage would very much complicate its very usage at the different cultural and social levels on the whole (Agich, 2003). The fact that it spells out different meanings and qualities, in care for older persons too, would be quite a challe nge for both the armed improvement users and the phencyclidine hydrochlorides themselves. Autonomy as a cultural ideal under the guise of freedom of weft e exceptionally in the western context is very much viewed as a necessary feature for any individual. In regard to joined States for example, freedom is seen as a basic of heart and therefore without which, is privation of an individual of a basic right (Agich, 2003). It is important to note that this freedom starts at experience passim life and therefore including in old age, whether in care or not. In care too, without the liberty for one to be on their choices would be seen as degrading by the service user and therefore subservient to the caregiver (Agich, 2003). However this raises the question of what might take care when the service user is hurt from a severe cognitive impairment? This clearly indicates the challenge of according full autonomy to service users.On the other hand in countries like South Africa where t he elderly are seen as very important assets indoors their communities, it is argued that freedom begins with avoiding taking elders away(p) from their very communities to institutionalized care (Lombard and Kruger, 2009). Institutionalized care would be seen as denying older persons an environment they consider natural and fulfilling. This entails an environment which allows them to share their older age with their kith and kin who in this case know them better and therefore mutualness remains natural. Further, this physique of setting allows for respect and control of older persons based on cultural values. Even when older persons are mentally incapacitated, the family caregiver will know what they put on ever desired that is, their best-loved food, dressings, entertainment and the like. This in a sense allows for older persons freedom in a manner that is fulfilling in this kind of context. However, it keisternot go without mention that this kind of setting requires health ful family structures that allow for conviction and financial capacity from the family members to take care of the elderly. With the spread of neo-liberalism that promotes capitalism and individualism, close to of these especially extended family systems have broken down hence rendering older persons susceptible to dependence on hired caregivers in a family setting or institutional care (Lombard and Kruger, 2009). Evaluation of Existing Social Work Practice and Care Provision for Older People Inasmuch as the intentions of care for older persons are seen as good, the outcomes of both institutionalized and family care are not always pleasant (Talerico, 2004). When service users are put into care, the assumption is that it is for the well existence of the service users because they are being given help physically, socially and otherwise. This in numerous a case does not always happen because of the very spirit of how older person are perceived in the eyes of the caregivers. The so cietal perceptions of older persons delude caregivers of the capacities and strengths that service users possess. As Townsend (2006) theorizes it, these very perceptions give birth to the ideas of structured dependence for older persons. For example a situation where the convey deliberately introduces structures and policies like compulsory institutional care for older persons that are very much underpinned by the very disempowering and biased perceptions held strongly by society.Caregivers base their understanding of service users on the very notions they grow up with which in many an(prenominal) cases misguides their treatment of older persons (Jacobs, 1999 cited in Townsend, 2003). In which case, service users find themselves in a difficult situation that is, cannot voice their concerns all because the surround environment is not supportive enough or for idolatry of retaliation from the caregivers (Townsend, 2006). In an investigation conducted in the United Kingdom by Help t he Aged International (2002), older persons in bulky-term care have suffered a series of blows partly due to the lack of quality assurance on part of the institutions and also a lack of competency from the caregivers on how to communicate with service users to deliver the required services (Townsend, 2006). A classic example in this investigation highlights a woman who was suffering from Alzheimers disease she was dying of dehydration but no one could tell and she finally passed on. This is clearly an indication of lack of expertise on part of the Caregivers and as well an indicator of many others who are in the same or even worse-off situation. The fact that they could not communicate with her, they headstrong to take matters in their own hands clears indicates of how dependence on Caregiver can start messy especially when there is a wanting in skills or quality assurance by the caregivers whether in institutional or family setting.On the other hand, very few studies explore the experience of older persons autonomy in care, whether in institutionalized or family in the developing world. Nonetheless, in a study conducted in South Africa, there is an indication of a shift in policy of primarily taking away older persons from institutionalized care to community based care with a view of keeping them closer to their kith and kin (Lombard and Kruger, 2009). However, due to issues of neo-liberalism which advance capitalism and individualism, this leaves older persons in family care at even great risk as would-be caregivers opt for work and hire caregivers who scorn the cultural attachment with these older persons, are little known to the service users. Despite being in family settings, little is known whether the hired caregivers promote values of p repairences and control of older persons. This puts the issues of meaningful relationships and interdependence in question for the older person in this kind of setting. As cited by Zubi and Conolly (2013), as w ell in cases where the institutional care exists, there are cases of understaffing and under funding of care activities for older persons. As a result, this raises the levels of fatigue and randy exhaustion which leads to compromise in the quality of care. This is a clear characterization that with burnout of caregivers, self-determination of service users is not anything that would be given priority.Further, in a study conducted by Leece and peace (2009), in which an exertion to understand what autonomy and independence of service users in care meant to caregivers, majority of them concluded that a service user had to be in a position to do everything on their own. Considering the wider and contextual understanding of autonomy for example in terms of decision making and positive relationships, this is an indicator of how caregivers unconsciously take service users for granted in care and hence a need for rating of social care practice. It is important to note that inasmuch as s ome service user are not in a position to make decisions on their own, Talerico (2003) stresses that caregivers have taken no initiative in act to understand how to communicate with them so as to create an environment of interdependence that is understanding their daily activities, abilities, values and histories. All this would go a languish way in shaping the caregivers approach to interdependence in care (Agich, 2003).Strategies to Improve Older Persons Autonomy in CareAs stressed by Talerico (2004), care settings are congregated environment in which the most important thing is maximizing health and support. She adds that these very goals down the very purpose of autonomy because as oppose to individual choices generalist care is promoted. It should be noted however that this can raise honorable questions because service users are different and therefore their needs vary. As fronted by Leece and Peace (2009), establishment of personalized care for services users would go a bi g way in addressing this. This means that caregivers give a special attention to individual to not only understand their histories, values and choices but establishing effective skills of communicating with them on the whole. Even older persons with cognitive difficulties can communicate (Agich, 2003). Therefore, Caregivers must be equipped with these skills to give more meaning to care for older persons.From the earlier discussion of caregivers who understood autonomy of older persons in care as only being able to fulfil tasks independently, it is very clear that communities of practice are very important. These mainly refer to a multidisciplinary approach to on the job(p) with older persons in care. This emphasizes working with different professionals who work together to determine whats best for service users (wenger et al cited in May, 2009). As nurses think on the medical component, social workers focus on their values and preferences and policy makers advance policies that promote older states necessities at all levels. This promotes a better understanding older person whether in care or not. As well, this implies better working relationship not only among professionals but also with service users who are engaged at different levels. Further, this in a sense, promotes interdependence among them as dependence is phased out. In addition to promoting a better understanding older persons, specialist skills training would be important for the effective intervention of professionals at different levels. This explains the case for being able to communicate, identify their strengths and abilities and the like.Advocacy for the rights of older people would serve to bring their issues to the forefront (HelpAge International, 2010). Historically and socially, older people have been looked at from a medical view point as frail and therefore unable to perform task let merely making their own decisions. This is clearly a sweeping generalization that does not fit t he bracket of all older persons. But because this has been the case for a long time, it has come to be accepted and upheld. This decline of thought therefore very much underpins the policies and activities that are geared towards older people where they are seen as dependent as oppose to partners in working. Therefore, in deconstructing this line of thought, advocacy finished community dialog and raising aware cognizance of older persons issues autonomy in care among which, would go a long way rectifying the age-old negative intensions about ageing. As communities accept to dialogue and become aware of the reality of old age, policies and agendas will begin to come up. In the long run this shapes the societal aspect of older persons at every single level. HelpAge International (2010) highlights how Tanzanian older women have been brand witches by their societies. As a result, this explains the kind of nasty treatment that they have been accorded whether in care or not. But by d ialoguing with communities, the trend is ever-changing for the better. Important to note is that advocacy would not directly promote autonomy in care for older persons but rather it goes a long way in pushing for older persons concerns high on the agenda. With the way of social workers, this in the short run would guide social policy and in the long run challenge and change societal outlook of ageism.ConclusionIn a nutshell, if older persons are to gain control over their lives in care, then there needs to be a re-conceptualization of caring for older people where caregivers become supporters and advocates but not custodians and guardians as it were (Nolan et al, 2001). As oppose to older persons being passive recipients of care, they become wide awake participants who have some sort of control over their life darn in care. This very much promotes interdependence between service users and caregivers. Concretely, as advanced by Rogers (1974), an individual-centered approach to car ing, where the service user is placed at the centre of activities, would help caregivers in identifying the specific strengths and abilities of service users and therefore cr eating better working relationships which in the end promote interdependence and an acceptable level of control of service users. ReferencesAgich G. J. (2003) Dependence and Autonomy in Old age An Ethical framework for Long-term Care, 2nd Edition, Cambridge Cambridge University press.Bond, J and Cabrero, G.R. (2007) Ageing in Society European perspectives on Gerontology 3rd Edition, London sharp publicationsBond, J and Corner, L. (2004) Quality of life and Older people, 1st edition, McGraw Hill cleared University PressFine, M. and Glendinning, C. (2005) Dependence, independence or inter-dependence? Revisiting the concepts of care and settlement. Ageing and Society, 25, 601-21, gettable online at http//eprints.whiterose.ac.uk/1653/1/dependency.pdf accessed 2 January 2014HelpAge International (2010) Womens ri ghts in Tanzania. Online available from http//www.helpage.org/what-we-do/rights/womens-rights-in-tanzania/ Accessed 3 January 2014.Katz, P.R., R.L. Kane, Mezey, and D. Mathy (Eds.). 1995. Quality Care in Geriatric Settings Focus on Ethical Issues. New York Springer.Leece, J and Peace, S (2010) Developing New Understandings of independency and Autonomy in the Personalized Relationship. British ledger of Social work, 40, 18471865.Lombard, A. Kruger, E. (2009) older persons, the case of South Africa. Ageing International, 34 119 135, available from http//web.ebscohost.com.proxy.library.lincoln.ac.uk/ehost/pdfviewer/pdfviewer?sid=0294ee3e-afec-4dad-882a-3b6fd4656d61%40sessionmgr4001vid=2hid=4204 Accessed 1 January 2014May, L. A. (2009) Communities of practice in Health and Social Care. 2nd edition, Sussex Wiley-BlackwellNolan, M., Davies, S., and Grant, G. (2001) Working with older people and their families. Open University Press McGraw Hill EducationRogers, C. (1974) On Becoming a Person A therapists view of psychotherapy. London Constable.Talerico, K. (2004) recognize Resident Autonomy in Long-Term Care Special Considerations. ledger of Psychosocial Nursing, 42, (1)Townsend, P. (2006)Policies for the aged in the 21st degree Celsius more structured dependency or the realization of human rights?Ageing and Society, 26 (02) 161 179Zubi, Y. and Conolly, P. (2013) Recollected experiences of first hospitalization insurance for acute psychosis among persons diagnosed with schizophrenia in South Africa. South African Journal of Psychiatry, 19 (3), p81-85. curt departure ride Hood Angela Carter weeny Red riding Hood Angela CarterAll queen twaddles, both old and refreshed that exist today can be tell to have a long hi account statement that lies beneath them. However, some aspects of the fairy-tale hi report card are slenderly hard to trace because its only the literary forms that can obviously survive. Furthermore, what we do know is that the majority of t hem have been around and retold for many years. Most, if not all of the famous fairy tales that we know have been changeed into various raw(a) interlingual renditions as products of new challenging ideas around the society in which we live. Bonner states that fairy tales are the usual subjects of adaptation because of their massive appeal to both adults and small fryren worldwide.1The story Little Red Riding Hood arguably offers a very interesting and challenging tale for enhancements through the application of the chosen modern-day theories in literary criticism that some critics have noticed passim the years of its existence. Furthermore, in this es state I intend to compare Perraults recitation of Little Red Riding Hood with Angela Carters rendering guild of Wolves.Little Red Riding Hood, Little Red Cap or exactly Red Riding Hood is a European fairy-tale about a tender innocent lady friend and a eat. The tale was first create by Charles Perrault in 1697, which in fac t was an adaptation of an older tale still. frankincense, Perraults magnetic declination ever since has been adapted and criticised throughout its history. Zipes holds the genre is relevant to present-day(a) culture as it holds issues that exist within gender and its society.2 Perraults version was named Little Red Riding Hood. The red capital is seen as a best-selling(predicate) symbol in Europe and North America. In the 19th century young daughters of wealthy families were painted in red caps or toughies. Erich Fromm considers the hood to symbolise menstruation and the approaching puberty that lingers upon the young person that wears it.3Perraults version can be described as a much more descriptive song and dance than many others. It begins with once upon a time4which the conventional way to start a fairy-tale and also gives the compute of timelessness throughout the tale. This relates to the narration and the structure within the fairy-tale of which certainly precedes the middle classs existence within. It portrays the escort of the little girl being highly attractive the prettiest creature who was ever seen.5She is also said to be extremely nave, the poor boor who did not know it was dangerous to stay and hear the wolf talk.6This shows her white and that she isnt aware of the bad happenings in the outside world due to her controlled life at home and within her society, this relates to Trimmers view that both children and childrens tales should be continual away from such happenings within society that are out of the norm.7In Perraults version of the tale the little girls mother simply instructs her to take some food for her grandmother never mentioning danger or anything that she should avoid on her journey, thus masking how safe society was perceived throughout the time. murphy argues it resembles a slenderly cautious tale to society, a wakeup call.8Moreover, the existence of the wolf within the tale gives the audience an chain of mount ains of a villain being represent. The wolf is seen as a popular image of danger in fairy tales as it is seen in this and other stories such as The triad Little Pigs. It is an obvious predator that exists within the forest and thus relates to a natural choice for the story rather than witches etc. it can also be portrayed as a metaphor for a innerly predatory man. He is of course the only male gender within the tale thus is portrayed as a powerful and strong figure, seen in the phrase gaffer wolf9personifying the wolf as the pommel within the tale. He shows a strong influence upon the nave ground girl as he persuades her to divert from the safe path in which she was on after foolishly telling him exactly where she was going. This clearly portrays to the audience a somewhat clear contrast between the village and its surrounding in which the girl lives, which is seen as safe and the dangers that are withheld in the wide world other(prenominal) what the little girl is used to. Hence, holding a strong morality message throughout the fairytale, warning people to baffle to what they know.Tater identifies the tale as a place to work through people thoughts and anxieties about informal activity, gender and sometimes violence.10When Little Red Riding Hood makes it to the house, she has no sense of anything wrong and states What big arms you have11Exclamation can be argued to be the favourite story division for tales, being seen as a story building tool that creates the apprehension and horror for the reader as they know that she isnt talking to her grandmother. Warner considers her initial chastening to distinguish the wolf from her grandma as a crucial element within the story, as it creates the tension in front the horrific ending of the fairy-tale.Furthermore, critics that exist such as Freud argue that there is evidence of underlying sexual motivations and tensions, evidence of this is the Hungry wolf simply not just eating the poor old grandmother, but he fell upon the good woman.12 feminist critics portray this as an image of rape and sexual tension. In addition, before he sadly digests the young girl he invites her to bed, come and lie down with me.13This can be seen as another sexual connotation within the tale, and also a disturbing image for its older audience. so being an innocent, clueless little girl she climbs into bed with him. Therefore by disobeying her mothers instructions and talking to strangers Freud dramatically insinuates that this struggle can only lead to her death which is the exact fate of Little Red Riding Hood, as he ate her up too.14The terrifying ending makes the tale seems more realistic leading to the moral at the end of the story of not talking to strangers and staying to paths in life you are familiar with Bettelheim says it deliberately threatens the child with its anxiety producing ending.15Moreover, the tale of Little Red Riding Hood has been seen to abide adaptation in relation to society o f the time. Hence, in comparison to Perraults version, The Company of Wolves by Angela Carter. This can be found in her selection of short stories within Bloody Chamber.Throughout the short story Carter retells the famous fairytale in a somewhat gothic light. It is said to convey the completeness of subversion and unconventional ideas of sexuality and an ability to defend one using characteristics which are usually conveyed through a male such as craft and confidence.16However, unlike the Perraults version, it takes place in a mountainous country on Christmas Eve in the dead of winter. Thus, in comparison to Perrault there are no flowers or sunshine present for the little girl to get distracted by on her walk to Grandma.Angela spends the first part of the story telling the reader terrifying folk tales of wolfs and werewolves that bombard society and slide by to do ruthless and evil deeds that live to kill. Clearly it adapts with the time within the story when food would be scarce and these creatures are said to lack the ability to listen to reason.17They are portrayed as forest assassins, grey members of a nightmare.18They were worshiped so great that children carried knifes around with them, seen as different to the professional Little Red Riding Hood who isnt even warned of the dangers that she could encounter on her journey. In Carters version, the wolves are disguised as men and have to become naked to become a werewolf within the tale, If you detective a naked man in the forest run as if the devil were after you.19Moreover this can be seen to link to Perraults version, as it holds the notion of sexual tension and desires and involves the wolf as a sexual predator, a symbol of both danger and desire. However, Carters version holds a braiding within the tale in that the young girl is able to triumph, by adapting her new found sexual desires and power and thus, gives in to notions of somewhat vile desire, unlike Perraults characters that are seen to b e weak and unable to fend for themselves.Furthermore, kindred to Perraults version we see Little Red Riding Hood once once more to be all innocent as she is described as an unbroken egg, a sealed vessel20and also beautiful with pale kowtow and dark hair. In addition, as before she is taking food to her vile grandmother however we see a sense of time and self-defense within this tale as she takes a large knife for her 2 hour trip,21and we are told its Christmas Eve again portraying that sense of time and place. However, due to her naivety and the way she has been brought up se doesnt think she is in danger as she is too loved to ever feel scared.22She is portrayed as the most beautiful and young girl in the family thus they want to keep her young. However, the difference between this girl and Perraults version is that she has a notion of menstruation and sexual homework about her evidence of this is, the childs cheeks are an emblematic and scarlet white.23This portrays the youn g girl as being on the verge of puberty and menstruation, thus adding to the idea of her vulnerability. This is further shown when she bumps into the wolf in the forest who is in fact a hunter and finds him at present attractive. Compared to Perraults version of events Little Red Riding Hood makes friends with this stranger and foolishly lets him carry her basket which has her knife in. After a long walk, and when she has told him were she is going, he bribes her with a kiss for the winner of whoever gets to grandmas house first. Liking this idea she agrees and allows him to leave with her basket, this gives the image of bargaining with the notion of seduction. Unlike before little red ride hood shows her adolescence and sticks to the path shes on. However, she walks slowly to ensure he gets his kiss again showing her sexuality and desires.The wolf arrives at the grandmothers house as a completely different person that we have just witnessed before he is chewing meat of his catch like a savage. Carter then connect in the sexual connotations as he strips naked revealing a naked, hairy, lie covered body,24and his nipples that are as red as envenom fruit.25He then devours her. However disgusting this image, it is portrayed as somewhat attractive and sexually arousing. The grandmother within the tale is old and wonky as in Perraults version also, however, she lives alone with her dog and bible. In the past she has lived her life as a devoted Christian and wife. She throws the bible at him showing some self-protection which the original grandmother doesnt even attempt in Perraults version, sadly though this isnt enough to help her against the wolf that is upon her. He then disposes all evidence and waits for the girl to arrive.Unlike the little girl in Perraults version upon her arrival in Carters short story she immediately realises that something isnt right and senses danger in grandmothers house, timidity does her no good so she refuses to be afraid.26Whe n she arrives there are uses of the same rhymes within the Perraults version, thus showing connections within the adapted version. However, in this tale the girl sees the wolf as strange, unknown creature and thus gives him his owed kiss and starts to undress herself. It is argued by Bettelheim that we can see Little Red Riding Hood wear her desires and sexuality literally on her sleeve. This is seen through her cape, as it portrays a sexual readiness and again symbolising menstruation and blood that she will shed when she loses her virginity. She shows a somewhat sexual power that allows her to intoxicate the lustful creature, small breasts gleamed as if snow had entered the room.27Evidently, the seduction gets reversed and we see the power shift as the girl becomes the sexual creature within the tale. This can be seen as the reason why grandma and the original little red move hood didnt survive, she was old and lacked wit and tactfulness, Little Red Riding hood refuses to be weak and vulnerable as she survives and sacrifices her virginity to save her life, showing that self-defence that the original girl didnt have. She comments on the wolves teeth as in the original but when the wolf says all the better to eat you with28instead of screech and having her fate decided, she laughs and says im nobodys meat29, Bacchilega interprets this meaning as acting out sexual desires offering her flesh not meat, hence sacrificing her body to him sexually then burning her cape in order to become one of the werewolves herself and adapt to his kind. The cottage is then surrounded by wolves howling a marriage song and the girl engages in a marriage ceremony conducted by the choir. Thus feminists state that she does not call upon god or call out or get eaten. She freely exercises her own sexual power, trusting her own nature.30This then leads to sleeps in grannys bed, between the paws of her tender wolf.31A disturbing image towards its audience.It is also interesting to see that Carter uses a werewolf instead of a wolf that is used in Perraults version. Timmer states that this produces a moral message to its audience, whether that be children or adults that people should not judge others, people arent always what they seem.32Thus using a half wolf half human villain within the story allows us to identify with the wolf as people and maybe realise that we all have a little living creature in us at some point.In conclusion, one of the many adapted versions of Perraults implies that sexuality is not something within our society that should be something we loath, fear or runaway from and a bad end, which we see within the Perraults version comes only form those in servile situations. Through Carter, we see the young girl take the power into her own hands and use it without fear or shame in order to survive unscathed unlike Perraults version, what ends in tragedy from both the grandma and Little Red Riding Hood. However, both versions are heavily criticise d by many, especially feminists as they say it is full on female liberation that implies the view to the reader that zero else in the world will save you against such horror and the only way to survive is through temptation, desire and the ability to fight assoil with fire.