CULTURAL AND SPIRITUAL ASPECT OF GERIATRIC CARE

Key points in Geriatric Care as Socio-cultural and its health relation

• Spirituality provides a sense of connection to self, others, nature and God and is important in crisis and
illness.
• Cultural competence involves knowledge of you own and other cultural group.
• Suffering is a part of human condition &is experienced in physical, emotional and spiritual ways.
• Suffering is reciprocal, involving not only the patient but his/her family.
• Hope plays a role in spiritual well-being
• Culturally and Spiritually competent care requires self-perception and self-care of healthcare professionals
• Communication among culture.
• Cultural rituals provides sacred elements that support patients and families during time of illness and
transition.
• Cultural difference that affects health care:
1.) Language barriers leading to miscommunication
2.) Illness perception & health management practices
3.) Misinterpreted behavior by HCP & stereotypes

Ethico-Legal aspects of Geriatric Care

• “that it is for your own good vs. old persons autonomy.
• Clinical research consent validity e.g. Dementia may be legally incompetent to give consent
• Caregiver conflict between beneficence (acting in patient's best interest) & autonomy (freedom to choose)
• Patient’s choice versus family members decision.
• Competency
→ Legal term that refers to the ability to fulfill one’s role and handle one’s affairs in an adequate
manner.
• Decision making capacity
→ Ability of a person to consent to or refuse a specific medical treatment or procedure.

• Factors that affect Decision making capacity

1. Appreciation of the night to make a choice.
2. Understanding of the risk and benefits of the medical intervention and lack of intervention.
3. Ability to communicate about the decision
4. Stability over time
5. Consistency with the person’s usual belief and values.

MENTAL HEALTH ISSUES IN THE ELDERLY

WHO Statements on Mental Health of Elderly

• Mental health and well being are as important in older age as at any time of life.
• 15% over age 60 y/o suffer from mental disorder.
• Life satisfaction
→ Self-evaluation of life as a whole influenced by socio-economic, health and environmental factors.
→ If dissatisfaction may contribution to risky health behavior (e.g. Inactivity, Vices)
LATE-LIFE DEPRESSION
• Check for Depression in early life.
• Range from Mild symptoms to severe symptoms.
• Symptoms of Anxiety may co-exist with depression
• Consequence:
1. Heightened pain and disability.
2. Delayed recovery from medical illness or surgery.
3. Worsening of medical symptoms.
4. Risk of Physical illness
5. Increase use of Healthcare
• Observe for Psychosocial factor
1. Personality attributes
2. Life stressors (e.g. Trauma, Disability)
3. Social stressors (e.g. Loneliness, Lack of social support)
• Treatment:
1. Physical exercise 3. Psychotherapy
2. Pharmacotherapy (SSRI) 4. Nutrition management

- Transfer to psychiatric service when suicide risk is high.

SUICIDE IN ELDERLY
• Risk factor: Widow/widower, Having other mental disorder, physical illness & bereavement.
• Suicidal thought may be attributed to social isolation, depression, loneliness and functional decline.

Questions that are critical to ask?

1.) Some people won’t to know everything about their conditions and others do not. What do you prefer?
2.) Do you prefer to make your own decisions about medical care or would you prefer that someone else make
than?
3.) To whom do you talk about your health care decision?

Effect of Lockdown in the elderly

• Isolation vs. restriction of liberty will benefit them (Greatest risk of dying of the virus).
• Abuse prone from Children and other family members.
• May suffer from lack of access to medication and food.
• Impact to working elderly (6 million individuals)
• Seniors living alone, still needs to go out.

Adaptation & Self-management (Perception of Elderly)

1.) Keep moving
2.) Keep learning (Self-determination & resilience)
3.) Adopting avoidant coping behavior
4.) It feels good to do good
5.) Power of prayer → Relaying on Spiritual power
6.) Social participation