imagine the freedom...

GERATECexcellence in person-centred care

Oct

ober

201

3

It’s by valuing the timeless human qualities expressed by

elders that we find meaning, too.

READ MOREABOUT OUR EXCITING LINE UP7-10 OCTOBER 2014

Our Earth,

Our Elders

3October 2013

Moments of Insight

Diary

Books

South African Care Forum

Whole-person wellness

Caring for the whole person

Our Earth, Our Elders

Role of wisdom

The South African

Care Forum is yet another

GERATEC dream come true.

For years we’ve been talking about the need for a united voice to orchestrate all the role players involved in care for vulnerable people. I believe that private and corporate companies in South Africa should lead the social entrepreneurship arena in collaboration with NGOs. The work done on grassroots level can only be sustained with a strategic partnership and alliance between both sectors.

Really to make a difference in the complex socio-political arena of the new South Africa, it is time to harness the available energy and resources and move forward towards creating a life worth living for older and vulnerable people. Creating a better South Africa is not only the responsibility of the government. It is the responsibility of everyone who enjoys the riches, diversity and splendours of living in this country. Creating a greater consciousness of the needs of the vulnerable should be on the agenda of every caring citizen.

The South African Care Forum hopes to orchestrate this effort, and to bring in international partnerships to help make this country a better place for everyone.

GERATEC is proud to sponsor this initiative, because we believe in the greater good and in the immeasurable benefits of generosity of spirit. 

RAYNE STROEBELGERATEC MD

Cont

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Mom

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MOMENTS OFinsi htCAROL LOTTER MUSIC THERAPIST UNIVERSITY OF PRETORIA

When working with clients suffering from dementia, how do we think about moments of insight? Even sufferers in the early stages of this ravageing

condition struggle, with varying degrees of difficulty, to function at an optimal cognitive level. Does this imply that moments of insight are impossible for them?

My experience as a music therapist working in the field of dementia has taught me so much about understanding that moments of insight happen in the “here and now”.

Music is a powerful, non-verbal medium enabling

The concept of insight often refers to arriving at a cognitive explanation for something, understanding a phenomenon or experience with more clarity or gaining a deeper level of self-awareness. Moments of insight, thus, are usually linked to the realm of the cognitive.

interpersonal communication, tapping into the innate capacity we each have to communicate at other levels. And so facial expressions, a smile, fleeting moments of eye contact, humorous exchanges, an instinctive response to a song from a bygone era, whether now cognitively understood or not, are all opportunities for something to be (re)awakened within a person suffering from dementia, for whom life is an ongoing journey of loss, withdrawal and social isolation.

We work with the whole person, celebrating the soul and spirit of each individual.

Let’s think about meaning and insight as being multilayered and transcendent, not merely cognitive.

October 20134

MOMENTS OF INSIGHT

Clem Sunter reflects on the movie Quartet, featuring four retired opera singers performing at an old-age home for retired musicians.

The four sing at a gala concert on Verdi’s birthday at the home. They were only play-acting, but they were accompanied by real musicians who had reached the top of their professions in their previous careers.

The democracy of ageingThe film got to me for two reasons. As I get older, everyone gets older with me. No matter how rich you are, no matter how healthy a life you lead, you age. Julia Roberts now has lines on her face, Robert Redford’s eyes are even more crinkled and Mick Jagger cannot strut his stuff quite as energetically as he did. The memory bank grows as the future shortens and the body grows weary.

Why are we all here? Her companion in her late 80s replies: Because, my dear, we are not all there!

– Clem Sunter

5 ways in which the SACF will change the Care Industry:

EXPERT’S CORNER Do you have

a question relating to

the care industry that you can’t get

answered? The South

African Care Forum

(SACF) is your conduit

for seeking expert

opinion. If you have a

question, send it to us at info@sa-

careforum.co.za and we’ll

seek to get it answered for

you by one of the global

experts on our honorary

panel.

I spent 11 years going to a British nursing home in Salisbury, Wiltshire, to see my mother. As an only child, I would spend two to three weeks with her every year. I remember one evening in the communal dining room sitting at a round table with my mother and some of her co-residents. We were all sipping our regulation one glass of red wine when an old lady at the table says: “Why are we all here?” Her companion in her late 80s replies: ‘Because, my dear, we are not all there!’ All of us nearly laughed ourselves to death.

Just like the home in the movie, there was a lot of fun and mischief and interesting interplay between the residents and the much younger staff. I thoroughly enjoyed those 11 years and when my mother died a few years ago, I said goodbye to all the people at the home with a genuine heaviness of heart. I know, God willing, that one day through the democratic process of ageing I will be joining those ranks. Nothing can put that off.

The eternity of musicWhat does not age is the beauty of music and the passion to play it. In their advanced years, those musicians in the film did it with the same gusto as they had done in their prime. Which brings me to the second reason I loved the movie.

I was a musician. I played rock music with a friend around the UK in the 1960s. We played at the same gig as the Rolling Stones in 1964. We alternated on the stage all the way through the night and had a big breakfast with all the partygoers.

The Stones are now celebrating their 50 years together with a concert in Hyde Park. I am sure they will blow the crowd away. I came out of retirement in the parking lot of the Rosebank shopping mall the other day in Johannesburg. A busker was playing a 1960s song on his guitar at the pay point, so I offered to show him how we played it at the time. It must have been an interesting sight for some of the shoppers who came up to pay, as they did drop coins into his hat.

To quote Gene Raskin, an American folk singer, in a song made famous by Mary Hopkin in 1968:

Those were the days my friendWe thought they’d never endWe’d sing and dance forever and a dayWe’d live the life we chooseWe’d fight and never loseFor we were young and sure to have our way.

Old age is not for sissies, but it is a privilege bestowed by surviving the slings and arrows of life. Enjoy it while you can.

This is an edited version of a column on news24.co.za

5October 2013

Influencing policy

Facilitating easy access to relevant information

Providing opportunities for networking and facilitating partnerships

Creating opportunities for learning and development

Building awareness

1

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If music be the food of love…

Dia

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nts

What’s been happening in

2013?

Still coming

in 2013

To look forward to

in 2014

10-12 May Africa Alzheimer’s Conference – Johannesburg

27-28 May IFA Workshop – Yaounde, Cameroon

23-27 June IAGG – Seoul, South Korea

10-11 July Partnering for Global Impact® – Lugano, Switzerland

4-6 September Matsiqel Conference (Models of Ageing and Technological Solutions for Improving & Enhancing the Quality of Life) – University of Cape Town

11 September Alzheimer’s SA Seminar – Johannesburg

9-11 October SAIF Convention (South African Institute of Fundraising) – Cape Town

29-30 October DementiaSA Conference – Cape Town

10-13 November ACSA Conference (Aged and Community Services Australia) – Melbourne, Australia

17-20 November IAHSA Conference (International Association of Homes & Services for Ageing) – Shanghai, China

9-12 February International Positive Ageing Conference – Sarosota, Florida, USA

10-13 June IFA (International Federation on Ageing) Conference – Hyderabad, India

7-10 October Celebrating the Richness of Ageing, Festival of the South African Care Forum – Stellenbosch

October 20136

Book

revi

ews

7October 2013

Community: The Structure of Belonging

PETER BLOCKBK Publishers, San Francisco, 2008

Peter Block explores ways in which communities can emerge from fragmentation. The author helps us see how we can change the context of deficiencies, interests and entitlement, to one of possibility, generosity, and gifts. He highlights the power of small groups, and outlines six conversations. Advice is replaced by curiosity. The outcome is deep engagement. The book is a good guide to process for the South African Care Forum and other collaborative efforts.

Dancing with Dementia – my story of living positively with dementia.

CHRISTINE BRYDENJessica Kingsley Publishers, 2005

“Each person with dementia is travelling a journey deep into the core of their spirit… into what truly gives them meaning in life,” Bryden writes. She travells the world telling people her story of being diagnosed with Alzheimer’s disease. She gives a vivid description of how she experiences the world through a fog of confusion, with brilliantly bright moments in between. Alternately funny and sad, this book should be a prescibed work for every health worker in the field of dementia care.

Somewhere towards the end

DIANA ATHILLGranta Publications, 2008

This is a moving and honest memoir. Born in 1917 in England, Diana tells the story of a life well lived, loves lost, meeting some of the world’s best writers and travelling with friends to exotic and some not-so-exotic places. Her very honest portrayal of her life (such as when she smoked marijuana for the first time) engages the reader on a journey of self-discovery. Diana says it as it is, yet she manages to enthrall with her very honest and candid self-reflection and observation.

Before we say goodbye

SEAN DAVISON Cape Catley, 2009

Sean, a South African professor, spends the last days of his mother’s life with her in New Zealand. His mother, a medical doctor and psychiatrist, is dying of cancer. Fed-up with her misery, she decides to stop eating. She lives for another 36 days, her mind razor sharp until the end. Sean adores his mother and learns more about her than he ever did. The book hits hard, it poses questions to which there are no answers, it challenges and provokes and ultimately leaves one incredibly sad.

Dementia beyond drugs – changing the culture of care

DR AL POWERHealth Professions Press, Baltimore, 2010

Power’s book is a joyous read for anyone interested in what care is about. He gives truly wonderful insight into how institutionalisation can damage the soul of vulnerable people. Through a collection of the most beautiful stories, he gives the reader insight, food for thought, a reason to cry and a glimmer of hope that life with dementia can be good. The reader realises that with a better understanding from the world, life with dementia can be fulfilling and meaningful. The book is a must-read.

The core building blocks of quality – A guide to meeting the challenges in long-term care

CHERYL PARSONSAuthorHouse, 2008

With neither an index nor a list of references, this book is one of those rare gems that one stumbles upon once in a lifetime. Cheryl Parsons is a registered nurse, a manager of homes and a consultant. She writes from the heart with an astonishing knowledge of the challenges of the long-term-care industry. With practical tips, stories that everyone can relate to and very useful templates, this book will inspire and guide anyone who is bogged down by the long-term-care monster.

The mission has the following goals:

• Lobbying and influencing policy.• Promoting the rights of the care industry by

lobbying for transformation and contributing to policy processes on national and regional levels.

• Partnering with national and international organisations to advance the interests of its members and to place the care industry at the top of corporate social agendas.

• Becoming a clearing house for information.• Providing access to the latest best-practice

guidelines, research, technology, products and specialist services including regular updates.

• Initiating research and collating benchmarking data on organisational issues.

• Launching a 24-hour helpline and enlisting the services of a national ombudsman.

• Forming networks and partnerships.• Creating platforms for its members, partners

and sponsors to exchange views and ideas. • Establishing special interest groups in areas

such as HR, finance, IT, quality assurance and governance to promote sustained quality-care outcomes.

• Fostering learning and development.• Collaborating with learning institutions to

provide accredited skills development and training through seminars, conferences, webinars and study tours.

• Interfacing with members and other role players through an interactive website to promote dialogue.

• Raising awareness.• Utilising the media to increase awareness and

improve standards in the care industry.

Sout

h A

fric

an C

are

Foru

m

MORE ABOUTSACF

A new era has dawned in terms of collaborative efforts in the care industry. The South African Care Forum has been established as a nonprofit company with the vision of becoming the official voice of the care industry while growing a reputation for excellence and best practice.

Research into different forums and umbrellla organisations around the globe – including the National Care Forum in the UK, Leading Age USA, International Association of Homes

and Services for Ageing (IAHSA), International Federation on Ageing (IFA), Leading Age Services Australia (LASA), Aged and Community Services Australia (ACSA) – reflect a trend fully to service members’ needs. South Africa should not stay behind in this regard.

A survey among South African service providers revealed that existing umbrella organisations and networks are perceived to be disconnected and not necessarily meeting the needs of the industry.

Organisations on the ground wanted something different. They wanted an interactive platform through which they could connect with fellow service providers, share and learn together, and through which they could access latest research data and best-practice information that would help them raise the bar of care in their organisations.

There was a very real need expressed for collaboration, partnerships and synergy in the care industry.

The SACF has been set up to address the needs of organisations serving vulnerable people – both older people and those living with disabilities – by gathering them under one umbrella, and thus providing a united voice in respect of long-term care. This is a world trend.

As an integrated platform for collaboration and synergy, a united body offers a more powerful voice for lobbying and advocacy for the needs of vulnerable people, and creates a powerful force to help promote best practices in care.

October 20138

SOUTH AFRICAN CARE FORUM

The founding board of directors:

The South African

Care Forum is unifying

efforts and energies,

facilitating new conversations around issues

of care, and harnessing

resources for maximum

impact.Add your

voice to the conversation,

experience the power of engagement

and help raise the bar of care

in South Africa. Join the SACF.

9October 2013

HEAD OF THE DEPARTMENT OF CRIMINAL AND MEDICAL LAW AT THE UNIVERSITY OF THE FREE STATE

PROFESSOR HENNIE OOSTHUIZEN

Hennie Oosthuizen, a paraplegic due to a diving accident at the age of seventeen, graduated at the then University of the Orange Free State with a BIuris in 1983, LLB in 1985, doctorate in criminal law in 1990, and a doctorate in medical law in 1997. He was admitted as an advocate of the High Court in 1986.

Hennie lectures Medicina Forensis to law students, Ethics and Medical Law to medical students, Health Care and the Law to professional nurses on graduate level, and Medicina Forensis to postgraduate students. He is a study leader and promoter for numerous masters’ and doctoral students.

Hennie is the author and co-author of 60 legal publications and one handbook. He has delivered more than 50 papers nationally and internationally on legal and ethical aspects of forensic medicine.

He is an ethics committee member of the Medical Research Council.

He is married to Santa.

DIRECTOR: INTERNATIONAL AND CORPORATE RELATIONS, INTERNATIONAL FEDERATION ON AGEING (IFA), TORONTO

GREG SHAW

Before becoming Director, International and Corporate Relations at the IFA in 2003, Greg Shaw was the manager for residential aged and community aged-care programmes in Western Australia.

Since joining the IFA, he has had responsibility for the development of the Building Capacity in Health Care programmes in Africa, worked closely with the South African Human Rights Commission to establish the South African Older Persons’ Forum, and also represents the IFA at the United Nations.

In 2011 he convened an international forum on Sexual Safety of Older Women and this year he activities include leading a high-level meeting to examine issues around financial abuse of older people in Canada.

He has been working on the Global Thematic Consultations on Population Dynamics, Post-2015 Development Agenda, to ensure older people’s needs are recognised.

FOUNDING CHAIRPERSON, DIRECTOR: STRATEGIC PARTNERSHIPS, GERATEC

MARGIE VAN ZYL

Margie van Zyl holds a BSocSc (Hons) cum laude from the University of Natal and an MA (Social Science) from Unisa. A social worker by profession, Margie has worked for many years in the field of ageing.

Before joining GERATEC as Director of Strategic Partnerships in 2011, she was the CEO of Pietermaritzburg and District Council for the Care of the Aged. Margie has also worked for The Association for the Aged in Durban, for the Centre for Gerontological Research of the Human Sciences Research Council and the School of Business Leadership at Unisa.

A former President of the South African Association of Homes for the Aged, she currently serves as Vice-Chairperson on the Board of Directors of the International Association of Homes and Services for Ageing and is the Founding Chairperson of the South African Care Forum.

Margie has been a speaker at many international conferences.

Why Wellness,

Who

le-p

erso

n w

elln

ess

This demographic shift has numerous implications for individuals and societies, with perhaps the most vital concern being related to health-care needs and resources. Studies show that older Americans are more health conscious than other age groups. Additionally, when health promotion programmes are available, accessible and appropriate, older people participate. For example, information provided from the report, Tracking the Fitness Movement (American Sports Data Research, 2005), showed the 55-and-older market leading the way for healthy living:

• Individuals 55 and older had the largest percentage of frequent (29%) participants in fitness activities than any other group;

• The number of people 55 and older who exercise frequently has soared by 75% since 1987 to reach 14.2 million;

• 2.7 million belonged to a health club;

• More than a million lifted weights twice a week;

Why Now?

JANIS M. MONTAGUE, MGSPRESIDENTWHOLE-PERSON WELLNESS INTERNATIONAL IRVINE, CALIFORNIAJMONTAGUE@WPWI.NEWTWWW.WPWI.NET

For over 30 years, Jan Montague has focused on the advancement of whole-person-wellness strategies, processes and outcomes for individuals and organisations.Jan received her Master’s of Gerontology Studies from Miami University, Oxford, Ohio. She serves on several national and international advisory boards and has authored numerous articles for professional journals focusing on whole-person wellness and optimal

living across life stages.She owned a chain of wellness-based fitness centres, and implemented and operated Montague, Eippert & Associates, a consulting company that worked with more than 200 organisations in whole-person wellness. Jan was President of Whole-Person Wellness Solutions, Cincinnati, Ohio, and served as Vice-President of Community Life, Wellness, and Applied Research for Lakeview Village, Lenexa, Kansas.

Never before in recorded history have we had so many older people living so long. In the United States (US), life expectancy at birth has increased about thirty years, from 47 years

of age in 1900 to about 78 years old in 2010; and, demographers predict the number of people aged 65 and older to increase to 69 million by 2030.

To understand the enormity of growth within this defined market, let’s compare these figures: in 1980 there were 25.7 million individuals 65 and older in the US. From 1980 to 2050, this group is projected nearly to double, from 12% to 23% of the population.

The current data for South Africa (United Nations Population Division, 2012) shows life expectancy for females to be 54 years and 53 years for males. According to the United Nations’ data, the number of persons aged 60+ in South Africa is about 8% of the current population or 3.9 million. The 60+ population is estimated to grow to 8.4 million by 2050 or 14.8 percent of the total population.

Newspapers, magazines, television, radio, and the internet – all are constantly reminding us that the global population is ageing. Haven’t we always been ageing? Well, yes and no. Let’s start by reviewing some ageing demographic predictions for South Africa and the United

October 201310

Why Now?Life expectancy at birth, total (years)

United States South Africa

1980 2005 2030 2055 2080

90

72

54

36

18

0

Nevertheless, as the older population increases in number and age in the coming years, some fear that medical costs will surge at alarming rates.

On a positive note, many US researchers believe a comprehensive wellness model that addresses the multiple aspects of the whole person can lead not only to decreased health care consumption but improved health and quality of life (Poon, Gueldner and Sprouse, 2003).

Proponents of a vital ageing model cite data that indicate older people have increased knowledge and awareness of the importance of health management, including both traditional and alternative-medicine approaches.

The shift in perspectiveFor many ageing individuals, participation in whole-person-wellness programmes slows the ageing process and promotes independence (Vaillant, 2002). It is clear the concept of wellness for the whole person is not a new one – so why is this conscious change in perspective occurring now? Several factors are contributing to society’s radical shift to a whole-person-wellness focus:

• The high cost of global health care;

• Relevant research on successful and vital ageing;

• Increased awareness of health-behaviour-change strategies and techniques;

• Documented importance of perceived health status on quality of life;

• Increased reliance on younger family members in caregiving;

• Greater role of grandparents in parenting younger generations;

• Increased changes in global demographics.

These factors are driving the change in perspective in an attempt to keep older adults healthier, positive and proactive while ageing. At

the same time, older adults increasingly recognise the benefits of a healthy lifestyle. Together, these forces are creating the momentum towards wellness that we see today.

Transitioning to a wellness philosophy for the whole person

Wellness was first conceptualised by Halbert Dunn, MD, PhD, in the mid 1950s. In his book, High Level Wellness, he defined wellness as “an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable within the functioning environment” (Dunn, 1961).

In 1976, Bill Hettler, MD, co-founder of the National Wellness Institute, the principal organisation for wellness education, training and research in the US, defined wellness as “an active process through which people become aware of, and make choices towards, a more successful existence”. The National Wellness Institute (NWI) believes the wellness concept to be a “pathway to optimal living” and describes the six dimensions that embody personal wellness as: emotional, intellectual, physical, social, spiritual, and occupational. These dimensions are defined below:

Whole-person-wellness model

The National Wellness Institute, University of Wisconsin, Stevens Point, Wisconsin, US, provides in-depth resources to health and wellness professionals through conferences, webinars, certification courses, and publications. (www.national-wellness.org).

PERSONAL WELLNESS

INTELLECTUAL

VOCATIONAL

SOCIALPHYSICAL

EMOTIONALSPIRITUAL

WHOLE-PERSON WELLNESS

For many ageing individuals, participation in whole-person-wellness programmes slows the

ageing process and promotes independence

11October 2013

Physical Wellness

The multifaceted physical dimension is relative to each person’s abilities. The physical dimension encourages participation in activities for cardiovascular endurance, muscular strengthening and flexibility. It promotes increased knowledge for achieving healthy lifestyle habits, and discourageing negative, excessive behaviour. The physical dimension engages individuals in activities that lead to high-level wellness, personal safety, proactive self-care, and the appropriate use of the medical system.

To be physically well, individuals may participate in one or several of the following actions:

• Participating in regular physical activity;

• Eating nutrition-rich foods;• Improving functional

abilities;• Creating positive lifestyle

habits;• Being safety conscious;• Participating in health

screenings;• Being proactive for health

and safety;• Being confident in body

image and age;• Feeling joy in movement,

energised;• Feeling alive.

Whole-person wellness is a life-growth process that embodies the philosophy of holistic health. Effective whole-person-wellness programmes incorporate the wellness dimensions with personal wellness concepts that include self-responsibility, optimism, a self-directed approach, self-efficacy and personal choice. These concepts change the focus from what people can’t do to what they can. The result is fully integrated wellness of mind, body, and spirit throughout life’s journey. Simply stated, what you do, think, feel, and believe has an impact on your health and well-being.

The MacArthur Foundation’s Study Of Ageing In America (1987) provided a new framework for the study of ageing and quality of life. Spearheaded by John W. Rowe and Robert L. Kahn, the study was designed to examine the factors responsible for the positive aspects of ageing. Its goals were “to move beyond the limited view of chronological age and, to clarify the genetic, biomedical, behavioral, and social factors responsible for retaining – and even enhancing – people’s ability to function in later life” (Rowe and Kahn, 1998).

The MacArthur Foundation provided more than $10 million (R100.75m) in support, and included thousands of older adult participants. During a period of 10 years, the results from dozens of interdisciplinary research projects were examined. The combined data from those studies provided the best evidence that successful ageing is not determined by genetic inheritance. Instead, we age successfully by incorporating wellness concepts and beliefs into all aspects of our lives.

Wellness concepts affect ageing

Emotional Wellness

The emotional dimension emphasises an awareness and acceptance of one’s feelings. It reflects the degree to which one feels positive and enthusiastic about one’s self and life. This dimension involves the capacity to manage feelings and behaviours, accept one’s self unconditionally, assess limitations, develop autonomy, and cope with stress.

To be emotionally well, individuals may participate in one or several of the following actions:

• Identifying feelings and emotions;

• Coping with negative stress;• Solving problems and

concerns; • Manageing success and

failure;• Establishing personal

expectations;• Creating a positive

perspective;• Smiling and laughing;• Loving and caring for self

and others; • Demonstrating individuality,

self-efficacy (a belief in one’s ability to handle what life has to offer);

• Risk-taking, self-expression• Knowing, feeling & realising

consequences.

Intellectual Wellness

The intellectual dimension promotes the use of one’s mind to create a greater understanding and appreciation of oneself and others. It involves one’s ability to think creatively and rationally. This dimension encourages individuals to expand their knowledge and skills base through a variety of resources and cultural activities.

To be intellectually well, individuals may participate in one or several of the following actions:

• Thinking creatively;• Exploring new areas;• Stimulating senses;• Reading and writing;• Learning and interacting;• Communicating and

listening;• Practising awareness

of environment and surroundings;

• Matching, sorting, calculating;

• Strategising, planning, interpreting;

• Visualising, rationalising;• Sharing wisdom and

experiences;• Decision-making;• Defining and following

directions;• Recognising, recalling.

Whole-person wellness

October 201312

WHOLE-PERSON WELLNESS

PERTINENT CONCLUSIONS FROM THE MACARTHUR STUDY INCLUDE THE FOLLOWING:

The ability to maintain a high level of mental function was attributed to a strong social support system, regular physical activity, education and lifelong intellectual/vocational activities, self-efficacy (a belief in one’s ability to handle what life has to offer), social connectedness, and reducing feelings of isolation. The studies found that isolation was a powerful risk factor for poor health. The more frequently older people participated in social relationships, the better their overall health.

Mental function

Older adults participating in regular physical exercise and activities, not surprisingly, experienced better overall health than their contemporaries who did not, studies showed. The improvements in physical function included increased strength, endurance, flexibility, mood and balance, but also lower incidences of coronary heart disease, high blood pressure, colon and rectal cancer, diabetes and related problems, arthritis and osteoporosis; and a reduction in the number of falls.

Physical function

Study participants who approached life with a “Yes, I can!” attitude generally had the best coping skills and greatest self-esteem. Self-efficacy can be increased by undertaking a specific action or activity that challenges one’s sense of self-sufficiency, without overwhelming it. Self-confidence is also bolstered by the presence of supportive and reassuring others or the experience of succeeding at something with confirming feedback from others.

Self-Efficacy

Social Wellness

The social dimension emphasises the creation and maintenance of healthy relationships. It enhances interdependence with others and nature, and encourages the pursuit of harmony within the family. This dimension furthers positive contributions to one’s human and physical environment for the common good of one’s community.

To be socially well, individuals may participate in one or several of the following actions:

• Respecting self and others; • Valuing differences;• Connecting with people,

pets and nature;• Interacting with the

environment;• Welcoming others;• Creating relationships;• Talking and sharing

interests;• Making and nurturing

relationships;• Listening;• Being playful with self and

others.

Spiritual Wellness

The spiritual dimension involves seeking meaning and purpose in human existence. It involves developing a strong sense of personal values and ethics. This dimension includes the development of an appreciation for the depth and expanse of life, and for natural forces that exist in the universe.

To be spiritually well, individuals may participate in one or several of the following actions:

• Discovering meaning and purpose;

• Demonstrating values, morals and ethics;

• Participating in religious or spiritual devotions;

• Appreciating nature and environment;

• Reflecting and meditating;• Praying, affirming;• Listening to an inner voice;• Loving;• Being in harmony with

spirit;• Comprehending life and

death.

Vocational Wellness

The vocational dimension emphasises the importance of giving and receiving. It is the process of determining and achieving personal and occupational interests through meaningful activities. This dimension encourages goal setting for one’s personal enrichment. Vocational wellness is linked to the creation of a positive attitude to personal and professional development.

To be vocationally well, individuals may participate in one or several of the following actions:

• Recognising abilities;• Learning new skills;• Developing new interests; • Participating in lifetime

hobbies;• Practising giving and

receiving;• Identifying oneself through

titles and roles;• Creating and following a life

plan or life mission;• Discovering purpose

through service, stewardship or volunteering;

• Feeling needed.

Whole-person wellness

What you do, think, feel, and believe has an impact on your health and well-being

13October 2013

Creating an organisational plan for whole-person wellnessThe implementation of whole-person-wellness cultures, environments, services, and programmes requires a logical step-by-step process. The sequential steps include: knowledge and understanding of a comprehensive whole-person-wellness model; an operational philosophy and procedures designed to build a culture of wellness; a supportive environment; and comprehensive whole-person-wellness-focused programmes and services. Here is an outline of the various steps in the process towards achieving a whole-person-wellness culture and environment (Edelman, P & Montague, JM, 2006, 2008):

1 Learn about whole-person wellness

• Provide educational opportunities for employees and older adult clients to learn more about the comprehensive whole-person-wellness concept;

• Create a whole-person-wellness vision for the organisation;

• Examine job descriptions, policies, procedures, marketing materials and website to see if they are in alignment with your wellness vision.

2Create an operational framework and identify outcomes

• Develop a framework that consists of wellness-based goals, strategies, action steps and outcomes. Whole-person-wellness programme planning should begin with the end in mind by defining measurable outcomes;

• Outcomes answer the questions:

- Why are we doing this?

- How can we do it better?

- Are we making a difference in people’s lives?;

• Outcomes validate the programme’s purpose, reveal if the initiatives and environments are effective, and reaffirm that you are on the right path. Answers gleaned from the simple question, “Why are we doing this?” will guide the wellness-programme-planning process. Whole-person-wellness initiatives, programmes and environments will be created intentionally to achieve the desired results. An assessment can determine if the programmes and environments are actually enhancing personal wellness, and can provide direction for improving programmes and environments, by answering the question “How can we do it better?”

Identify and implement strategies for participation

• Wellness-programme planners should incorporate health-behaviour-change strategies and techniques, to motivate older adults toward maintaining or improving their personal wellness. The Transtheoretical Model of Behaviour Change is useful in this regard (Prochaska, DeClemente, and Norcross, 1992).

• The Stages of Health Behaviour Change include the following: Pre-contemplation (not ready to change), Contemplation (thinking about changing), Preparation (ready to change), Action (making changes now), Maintenance (on-track), and Relapse. To be effective, whole-person-wellness programmes should include multidimensional programming and strategies designed to engage people at various health-behaviour stages.

3

4 Create a wellness-programme plan

Whole-person wellness will not happen automatically; it must be purposeful and intentional. These initiatives require a clear thought process for planning programmes and environments that are multidimensional and designed to enhance personal wellness;

• Determine if your programmes and services are addressing the needs, wants and desires of the whole person – emotionally, intellectually, physically, socially, spiritually and vocationally;

• Are any dimensions missing (Table 1)?;

• Have multiple dimensions been incorporated into programme and service design?;

• Please review the Laugh it Off! Instructional Delivery Plan (Table 3) as an example.

October 201314

Wellness• Is a choice

• Is a way of life

• Is a process

• Isanefficientchannelingofenergy

• Istheintegrationofbody,mind and spirit

• Isthelovingacceptanceof yourself

• Istheartfulbalanceofpurposefullyblendingbody,mindandspirit.

(WellnessWorkbook, Ryan,Travis,1988)

WHOLE-PERSON WELLNESS

Utilise the following tools to set your organisation on the path to whole-person wellness.

Organise a wellness project development team

The team should consist of individuals who have the authority to initiate directives, and who will be instrumental in the successful implementation of a whole-person-wellness philosophy throughout the organisation. Team members should represent all aspects of the operation. The team should meet regularly to assist with the development and successful implementation of wellness programmes and services.

Team assignments1. Define your vision for whole-person

wellness, and state why it is important for the organisation;

2. Define whole-person wellness for your organisation;

3. Develop measurable outcomes and evaluation strategies;

4. Identify how “wellness” will be financed;

5. Conduct a Wellness Scavenger Hunt;

• Form a Wellness Scavenger Hunt team of employees and clients;

• Examine organisational areas, such as programmes and services, environment and facilities, marketing materials, culture and identity, policies and procedures;

• Conduct the Scavenger Hunt. Teams should focus on what the organisation is currently doing right, and if those actions are in alignment with the wellness vision;

• Reconvene the team to discuss findings. Determine the organisation’s stage of readiness to change. Utilise lesson plans to ensure that what you are offering truly reflects the whole-person-wellness vision.

6. Identify your organisation’s stage of readiness for change by completing Table 1, Are You Ready for Change?

7. Develop whole-person-wellness instructional delivery plans, using the format outlined in Table 2.

8. List how the various dimensions are currently addressed within the organisation, using Table 3.

5

4

3

2

1 1

2

3

4

5

1

11

12

2 2

23

3 3

34 4

44

55

5 5

PERSONAL WELLNESS

DRIVER PHYSICAL

PHYSICAL

INTELL

ECTUAL

SPIRITUAL

VOCATIONAL SOCIAL

1. Rate your wellness in each of these dimensions.1

2

3

4

5

Not so well

Kind of well

Well

Very well

Unbelievable well2. Connect the marks. Does your wellness wheel roll?

DOES YOUR WELLNESS

WHEEL ROLL?

5 Through effective outcome measurements, senior living communities and senior service providers are recognising that wellness is relevant to each individual, regardless of the person’s functional or mental status.

A variety of evaluation and assessment instruments are being utilised to determine the efficacy whole-person wellness programme.

Qualitative measures include cost-effectiveness analysis, focus-group data, testimonials, and individuals’ statements of perceived health and well-being.

Quantitative measures include quality-of-life scales, client-satisfaction surveys, cost-benefit analysis, participation-and-usage data, the Senior Functional Fitness Test, and the Fullerton Advanced Balance scale.

Most senior-focused organisations have to piece together a variety of measures to obtain a comprehensive picture of older adults’ wellness. It’s difficult to compare wellbeing across different dimensions of wellness. Several organisations use the following tool (Montague, 1994) to obtain a snapshot of an individual’s perceived wellness:

Assess whole-person-wellness plan and outcomes 6

15October 2013

Health DefinitionHealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organisation, 1948)

Table2Action

All departments are involved in the implementation of programmes and services focused on whole-person wellness.

Participants have a personalised wellness action plan.

Participants are meeting their goals.

Programmes and services are evaluated for effectiveness.

Maintenance

Whole-person-wellness concepts are integrated into everything we do.

We continue to enrich our whole-person-wellness culture.

Our decisions are based on wellness principles and they feel right.

People often comment that our organisation is noticeably warm and inviting.

Whole-person wellness is simply what we do!

Relapse

We have wellness systems in place, but no one monitors them.

Participants create wellness goals, but do not follow through.

We have a wellness-based vision and mission but we no longer refer to them during the decision-making process.

Are you ready for change?

Determine your organisation’s stage of readiness to change

Precontemplation

We are working from an illness-model framework.

We are not interested in wellness at this time.

Contemplation

We want to learn more about the wellness model.

Some employees learnt about whole-person wellness.

We are developing a wellness-based vision and mission statements.

We have committed resources to wellness.

Preparation

We are preparing for a wellness culture.

We understand the parts & pieces of wellness (multidimensional).

We have conducted an organisational wellness inventory (wellness scavenger hunt).

We have developed a wellness framework for our programmes and services.

Emotional

Intellectual

Physical

Spiritual

Social

Vocational

Current programmes/services

October 201316

• List current programmes and services that correspond with each of the wellness dimensions.

• Are you missing any dimensions?

• Are multiple dimensions interwoven into programmes and services?

Table1

Table32

WHOLE-PERSON WELLNESS

ReferencesAmerican Sports Data, Inc (2005). Tracking the fitness movement. American Sporting Goods Manufacturers’ Association.

Dunn, HL (1961). High-level wellness. Virginia: RW Beatty, LTD.

Edelman, P. & Montague, J.M. (2006). Whole-Person Wellness Outcomes in Senior Living Communities: The Resident Whole-Person Wellness Survey. Seniors’ Housing & Care Journal, Vol. 14, No. 1, 21.

Edelman, P& Montague, JM (2008). Whole-person Wellness. First national survey identifies changing expectations for LTC. Long-Term Living, April, Vol. 57, No 4, 20-25.

National Wellness Institute, accessed November 7, 2013. www.nationalwellness.org/home/definitionofwellness.asp

Poon, LW, Gueldner, SH, & Sprouse, BM (2003). Successful ageing and adaptation with chronic diseases. Springer: New York.

Prochaska, J., DeClemente, CC & Norcross, JC (1992). In search of how people change. American Psychologist, 47, 1102-1114.

Rikli, RE & Jones, CJ (2001). Senior fitness test manual. Human Kinetics: Champaign, Illinois.

Rose, DJ (2003). FallProof! A comprehensive balance and mobility training program. Human Kinetics: Champaign, Illinois.

Rowe, JW and Kahn, RL (1998). Successful ageing. New York: Pantheon Books.

Travis, JW and Ryan, RS (1988). Wellness workbook. Berkeley, CA: 10 Speed Press.

Vaillant, G (2002). Ageing well: Surprising guideposts to a happier life from the landmark Harvard study of adult development. Little Brown: Boston. World Health Organisation (1946). Preamble to the constitution of the WHO.

The desire for optimal health, to be functionally able for as long as possible, has older people embracing the concepts of wellness as a leading model of vital living.

The whole-person-wellness model promotes self-responsibility for health and well-being, within all areas of an individual’s life. This model incorporates a holistic perspective in which the whole is greater than the sum of the parts.

It integrates, balances and blends the six dimensions of wellness – emotional, social, intellectual, physical, spiritual and vocational – with concepts of self-responsibility, self-efficacy, proactive behaviours, positive attitudes and appropriate lifestyle choices.

Global societies are beginning to embrace a new perspective – vital ageing.

Today, people are more likely to be defined by what they can do, rather than what they can’t do.

Older adults are becoming role models for younger cohorts, because they are achieving desirable health outcomes by combining whole-person-wellness principles with self-responsibility for health.

Current research is showing that the whole-person-wellness model is not a passing fad. In the coming years, more and more senior living communities and senior service organisations will adopt whole-person wellness as their core operational philosophy. These organisations will set the new standard by promoting cultures, environments and opportunities for vital ageing.

We must continue to focus on the promotion of individual well-being, whole-person involvement, and the implementation of programmes and services that keep people healthy in mind, body and spirit throughout their life.

Conclusion

Integrate the wellness dimensions and personal wellness concepts into meaningful programmes and services.Dimensions of wellness• Emotional

• Intellectual

• Physical

• Social

• Spiritual

• Vocational

Personal wellness concepts• Self-responsibility for health

• Optimism

• Being in the moment

• Healing the whole person

• “Yes, you can!” attitude

• What’s right with you

• Sensory stimulation and integration

• Self-efficacy

• Self-directed approach

• Making smart choices

• Perceived wellness

• Recognising the health behaviour change process

• Being proactive

• Focusing on strengths, not deficits

Create whole-person-wellness instructional delivery plans

17October 2013

Livi

ng w

ith m

emor

y lo

ss

The well-beingConnection

G. Allen Power MD is Eden Mentor at St. John’s Home in Rochester, New York, and Clinical Associate Professor of Medicine at the University of

Rochester. He is a board-certified internist and geriatrician, and is a Fellow of the American College of Physicians and American Society for Internal Medicine. Dr. Power is a certified Eden Alternative® educator and a member of the Eden Alternative board of directors. He has lectured on dementia and other elder care topics throughout the US and Canada, the UK, Denmark, Singapore and Malta. Dr. Power’s book, Dementia beyond Drugs: Changing the Culture of Care won a 2010 Book of the Year Award from the American Journal of Nursing, a Merit Award from the 2011 National Mature Media Awards, and a must-have title in Doody’s Core Titles list for this year.

Dr. Power’s DVD 20 Questions, 100 Answers, 6 Perspectives (co-produced with Dr. Richard Taylor) won a National Mature Media Merit Award last year. He has been named one of this year’s Five Leaders of Tomorrow by Long-Term Living magazine.

Dr. Power was awarded a Bellagio Residency in Italy for April last year by the Rockefeller Foundation. Dr. Power worked in an advisory capacity with CMS and the US Senate Special Committee on Ageing in 2012 for their initiative to reduce antipsychotic drug use in nursing homes.

Dr. Power is featured in the new documentary Alive Inside, which details the power of music to awaken the abilities of people living with dementia.

He is a charter member of the International Advisory Board for Australia’s Dementia Foundation for Spark of Life.

Dr. Power is a featured contributor to Eden Founder Dr. Bill Thomas’s web log at www.changingageing.org.

He has been interviewed by BBC Television, The Washington Post, The New York Times, WHYY radio, WXXI radio and many other publications and radio shows.

Dr. Power is a trained musician and songwriter with three recordings.

One of the greatest failures of our approach to caring for people living with cognitive disorders is that our focus on structural and chemical changes in the brain has caused us to lose sight of the person whose brain is changing.

T he collection of disorders we term “dementia” does not simply refer to a loss of brain cells and function; it is also about how the person’s experience of the world is shifting. A lack of

appreciation of this last point has led to a dominant biomedical approach that fails to meet people’s needs. The biomedical view of dementia is a narrow one, focused primarily on deficits and losses; as a result, we see the person as something less than whole, who is rapidly “fading away”. With this view comes a multitude of stigmas that disenfranchise and dehumanise the very people that we profess to be helping.

While addressing the A Changing Melody conference in Toronto in 2011, Christine Bryden, who has lived with dementia for nearly two decades, described the stigma in this way:

What is the cause of the stigma and fear? It’s the stereotype of dementia: someone who cannot understand, remembers nothing, and is unaware of what is happening around them. This stereotype tugs at the heartstrings and loosens the purse strings, so is used in seeking funds for research, support and services. It’s a Catch-22, because Alzheimer’s associations promote our image as non-persons, and make the stigma worse.

Nearly 20 years ago, Professor Tom Kitwood, in his seminal book Dementia Reconsidered: The Person Comes First (1997), discussed the concept of positioning, in which even well-intentioned people view people’s actions as expressions of disease, leaving them misunderstood and ill served. This practice of positioning is fueled by the reductionist biomedical view, leading us to move quickly to “treat” behavioural expressions as manifestations of disease, often by using potentially harmful psychotropic medications. When we give people medications that have little benefit and much risk while ignoring the unmet needs at the heart of their distress, the result is often a decline in their overall health and ability. But our deficit-based view of dementia sees this decline as nothing more than an expected deterioration due to disease. So we create a cycle

October 201318

LIVING WITH MEMORY LOSS

of self-fulfilling prophecy that leads to further worsening of the person’s condition, and this downward spiral further magnifies our dread of the condition, resulting in even greater stigma and positioning.

There is a way to break out of this vicious cycle. There are two keys to gaining insight into new and more beneficial ways to support people living with cognitive disabilities. These involve redefining what dementia is and redefining our ultimate goals in care and support. Both of these steps look beyond the narrow biomedical view to centre on the perspective of the individual.

While this last concept is commonly touted as “person-centred care”, its practical application too often falls within the narrow boundaries of our biomedical paradigm. Thus, in spite of our good intentions, our actual approach is often paternalistic and centred on mitigating loss rather than creating sustained wellbeing.

A perfect example of this is the way in which we typically respond to different forms of behavioural distress. The usual approach is to view such distress as the problem, rather than a symptom of a larger need. This is analogous to using cough syrup to treat pneumonia – we identify and treat the symptom rather than the larger problem. As a result, we focus on addressing the behavioural distress, by either using drugs or with some other “intervention” designed to help calm the person.

Our approach may calm the distress in the moment, but it will not prevent it from recurring on subsequent days or weeks, because the real need has not been addressed or satisfied. Even our recent directives to reduce antipsychotic drug use fail to take into account that we cannot succeed in doing so until we offer a different approach – one that will not wear off after the “intervention” has ceased.

So how does one break out of this box? The first key is to redefine dementia in a way that recognises the whole person, not just the deficits and stigma.

This requires that we describe the changes that we see in the most neutral and nonjudgmental manner possible. In my efforts to do this, I have

Dementia is a shift in the way a person experiences the

world around her/him

19October 2013

settled on the following definition: “Dementia is a shift in the way a person

experiences the world around her/him.” Granted, this definition will not lead researchers to the discovery of any new drugs that might slow the process of cognitive loss. But it is more than a simple exercise in philosophy or a foray into “pseudo-science”. Such a redefinition is essential because it creates a mindset that helps care partners to find new insights and solutions whereas the narrow biomedical paradigm merely kept us trapped in the same inadequate care patterns.

This “experiential” definition helps us to continue to see the person with dementia as a whole person – one who may have changing cognitive abilities, but who nevertheless exists as a complete person who is trying to adapt as his abilities change. It reminds us that people living with dementia continue to problem-solve, form new memories and skills, attempt to compensate for losses, and continue to communicate, to the extent that they are able to do so.

This definition also reminds us that the subjective experience of each individual is critical to our understanding of the person, whereas the biomedical paradigm often leads us to dismiss her comments as “confused” or “delusional”. In fact, following this paradigm eventually leads us to challenge much of the conventional “wisdom” and many of our long-accepted care practices.

The second key is to redefine our goal in supporting people with cognitive disabilities. The experiential view teaches us that reducing antipsychotic drugs, while desirable, cannot be our primary goal. Neither is reducing distress our

primary goal, for the distress is only the “cough”, not the “pneumonia”.

Instead, I believe that our primary goal should be to create well-being. This concept may seem difficult to define; indeed many authors feel that no one can define well-being for another individual. However, I will share a working definition for well-being that can lead us to an entirely new approach to daily life and care, and create a path to sustainable success.

A 2005 white paper developed by a group of US culture change advocates has been developed into what is now called the Eden Alternative Domains of Well-Being™. The seven identified domains are: identity, connectedness, security, autonomy, meaning, growth and joy. While there may be many ways to define well-being, I use these seven domains because they have two useful advantages: (1) they are quite comprehensive, and cover most of the territory encompassed by other definitions, and (2), unlike many other definitions of well-being, these domains can exist independent of one’s medical health or one’s degree of cognitive and functional ability.

Thus we can enhance these domains of well-being, not only in healthy individuals, but also in people with chronic illness and disabilities, even inoperable cancer or advancing dementia. And while cognitive loss may challenge the ability to preserve these domains for oneself, an enlightened care environment can help maintain them, even in the face of advancing illness.

The important implication of that last statement is that if these domains of well-being can be enhanced in all people regardless of underlying health and ability, then we have a moral obligation to do so. A close examination of our systems of support for people living with dementia – whether in skilled care or in the community – shows that we are seriously deficient in fulfilling this obligation.

The upside to this realisation is that we now have a new paradigm for supporting people that can help us find real solutions to distress that have previously been invisible to us. Setting a primary goal of well-being creates a whole new landscape of care that has gone largely unaddressed up to this point

Combining our two keys – adopting an experiential view and setting a goal of enhancing well-being – helps us to find the unmet needs that lie beneath even the most-difficult-to-decipher behavioural expressions. We can now redefine these expressions as symptoms of eroded well-being, and proceed to restore those losses.

From a practical standpoint, this means that we need to stop focusing on how to correct the behavioural expression that we see. Instead, we turn our backs on the “behaviour” and instead attend to the domains of well-being. This is not a quick-fix remedy; there are none in dementia. But with this approach, as well-being is restored, the distress will subside; and now it will not continue to recur, because the underlying needs have been fully addressed.

It is not easy to step out of problem-solving mode and follow this new path; our instincts often draw us back into our old reactive patterns. However, through the physical, operational and personal shifts espoused by culture change organisations like the Eden Alternative, care partners can learn how to modify our systems of support and enhance these domains of well-being for each individual.

As a result, they will become more skilled at creating sustainable results, improving meaningful engagement and eliminating potentially harmful medications. And this will significantly improve the lives of people with dementia, and those of their partners in care as well.

October 201320

Well-being can be enhanced in all people regardless of underlying health and ability

LIVING WITH MEMORY LOSS

Tim

eles

s hum

an q

ualit

ies

Our Earth,

Our Elders

DR NADER ROBERT SHABAHANGICHIEF EXECUTIVE OFFICERAGESONG, INC. & FOUNDER OF PACIFIC INSTITUTE

Dr Nader Shabahangi is chief and cofounder of AgeSong. He ensures that the company’s vision drives its decisions and plans for elder-care services.

In 1992, he founded the Pacific Institute, a nonprofit organisation that helps elders live meaningful lives.

He is an advocate for marginalised groups and creates programmes aimed at caring more comprehensively for elders. Dr Shabahangi is a frequent guest lecturer, including presenting at international conferences focusing on ageing, counselling, and dementia.

In 2003, he authored Faces of Ageing, a book challenging stereotypical views of the ageing process and of growing old. In 2008, he co-authored Deeper Into the Soul, a book aimed at de-stigmatising and broadening our understanding of dementia. He co-authored Conversations With Ed, a book challenging readers to look at dementia in different ways, in 2009 and in 2011 he wrote Elders Today, a photo essay describing the opportunities awaiting us in our second half of life.

Last year he edited Encounters of a Real Kind, a compilation of stories highlighting his innovative Gero-Wellness programme in which psychotherapy interns work with frail, forgetful elders in an elder community.

Dr Shabahangi received his Doctorate from Stanford University and is a licensed psychotherapist.

O ur earth, our world and home, needs elders. It needs their soulful qualities. It needs the wisdom elders afford us, the teachings they can give us. Elders are those elderly

people who have turned to values that have stood the test of time.

Having lived through life’s trials and tribulations, facing their mortality as they face their end of life, elders have evolved enough to express timeless human qualities such as equanimity, acceptance, patience, compassion, kindness, thoughtfulness, gentleness, calm, empathy and mindfulness. These words describe an attitude, a disposition towards life, the world, people and events, one that’s often hard-won through experiences spanning emotions from ecstatic moments of joy to deep, often extended periods of suffering.

Timeless qualities express that which is essentially human. They speak of what we often call the soul – that which is immutable, that transcends time, trends and culture. In today’s global culture with its multiplicity of attitudes and approaches to life and its unprecedented access to information and knowledge, an awareness of and focus on timeless human qualities can help us navigate through the thicket of offerings and so help us remain close to what matters most.

Understanding and experienceThe search for such depth in life is not to be derived from ideas or theoretical contemplations alone. Rather, the search for depth and meaning and the importance of timeless human qualities are to be found also in our work with elders and the dying.

We see time and again how humans understand

Our inability to value elderly people, particularly those with dementia, reflects our loss of the soul dimension of life, argues psychotherapist and eldercare operator Nader Shabangi. By valuing the timeless human qualities expressed by elders we find meaning, too.

21October 2013

their lives based on their actual experience, and not merely on what they imagine or comprehend intellectually. Elders with their long life experience and continued learning could and should therefore have a special role in helping guide our societies. Yet, elders have lost the role of guides and advisors. In Western cultures in particular, elders and older people are often tucked away in senior communities or stay isolated in their homes.

Looking past needs to see the personOur mainstream attitude towards older people is very visible in our so-called assisted-living communities, where many of the oldest of our elders live today. Rather than being held in the highest possible esteem, elders in assisted living are mostly cared for as if they have little to offer. Elders are seen through the lens of the assistance they need, not through the lens of who they are as human beings.

Such an attitude exists because many of us have lost sight of the timeless human qualities that are often most clearly expressed by our elders.

Our inability to see the essential value of our elders relates to our having lost sight of the soul dimension of the human being, of the timeless human qualities that make us human.

Beyond the pathology of dementiaWe use the medical diagnosis of “dementia” to describe a state of being. Forgetful elders are called demented, and what is meant is that they are no longer with us, that their mind has left and that they have become people who are no longer fully human. Another viewpoint is to see dementia as a shedding

of the unimportant, a concentration on what is essentially human, and a time to focus on the care of a human being’s soul.

Working with forgetful elders constitutes soul-work. We need to consider what makes us essentially human, what comprises a human soul. Do the daily tasks of living, our name and identification numbers, our material possessions, our degrees and certificates, constitute our essential humanity? Hardly. If we lose those elements that do not make up the “soul” of a human being, what do we really lose? Is a human being no longer fully human if all that is unimportant is (at last) gone?

Forgetfulness might just allow us to forget the superfluous and help us remember our core humanity. Rather than speaking of dealing with dementia, we could speak of living closer to our soul.

Timeless human qualities: the soulBeing with the elderly in their last years of life affords insight that helps us arrive at an alternative view on everyday life. Whereas so-called mainstream values, and often those propagated by television programmes and news, promote ideals such as achievement and success, speed and youth, possessions and image, individualism and self-assertion, a different picture of priorities emerges in the presence of true elders.

With them there is little talk about achievements and successes of the past, and no desire to move speedily along or pine for any other age than the present one. Rather than a desire for possessions and individualism, a longing for connection and relationship expresses itself at this stage of life.

Appreciation of the presentIn listening to and being with elders, we notice an appreciation of the present moment above concerns about the past or the future. Focusing on the moment relates to elders’ ability to be attentive and mindful to what occurs in and around them. They begin to notice more of the so-called little things often overlooked in our busy lives, such as people’s sensitivities and feelings, the beauty and diversity of nature, the sounds and smells of the environment.

A different sense of timeElders often go through life more slowly. We often perceive more deliberate and thoughtful actions, from simple movements such as getting a glass of water to walking to the store. It is as if the actual doing is an end in itself, not simply a means to something else. Walking to the store seems as much about the process and enjoyment of walking as it is about the goal of reaching the store and completing the task at hand.

October 201322

TIMELESS HUMAN QUALITIES

How we look at elders is of special

importance in caring for and being with

those who have become forgetful.

An elder once pointed out to a young care partner that he felt he was experiencing every moment so much more vividly and intensely than ever before in his life. Subjectively seen, he felt as if he had just as much time ahead of him as any younger person has simply because he experienced “time” and the present moment so much more intensely and deeply.

Gratitude for all that manifestsFeeling thankful for all that manifests in life is a consistent theme for many elders. A smile, a touch, an acknowledgement are met with a gratitude not often found in everyday interactions between people. This gratefulness extends also to an acceptance of one’s state of being, to feeling grateful for the people one meets, with whom one shares a life, for the so-called little things one is able to experience and which often go unnoticed.

Patience with the processKierkegaard stated that a human being’s soul resides in patience. In being patient we accept or flow with life unfolding as it does, rather than being rigid about the way we want it to unfold. As such, we can either live in a constant tension with life or submit to the process as it unfolds in and around us.

Elders have often learned to respect the way life unfolds in its own ways. They have relinquished their desire to control the process. This relinquishment might also be understood as the ability to endure suffering when we humans do not get our way.

Patience thus refers to the ability to stay present with the process and value the process for its own sake. Rather than focus on some goal, the way towards the goal is valued in its own right.

This also speaks of an acceptance of what is present rather than a focus on what is lacking.

Kindness towards lifeOne of the obvious qualities of most elders is their kindness towards others, especially children and animals. This kindness extends to helping each other by means of a smile, an encouragement, a reassurance offered.

Perhaps because elders had to endure so many of the vagaries of life, they have experienced also how being kind to others has left them feeling better as well.

In many thought and spiritual traditions, kindness is considered a foundational quality often understood as the essence of love.

Kindness also reveals itself in a person’s ability to listen, to be truly with others in what it is they are sharing. Such an attitude allows the other the space to explore and discover for themselves rather than being interrupted and distracted by the listener. Elders can be truly amazing listeners.

Mindfulness as a way of beingIn going more slowly, paying attention to the so-called little things of life, and in the appreciation of the present, the main attributes of mindfulness can be found.

Mindfulness refers first and foremost to maintaining a calm awareness of oneself and the world in which one lives. Being calm is a requirement for being attentive and present to oneself and the world around one.

Again, it is elders who most exemplify such calmness and presence. In eldercare communities especially we notice how elders watch the goings-on around them with interest and attentiveness. They move with a slowness that allows them to see and be with what appears in front of them and also to experience themselves at the same time.

Living in harmony with our planetHumans will have to change their understanding, attitude and behaviour towards our planet if we are to have a future here. Those human qualities that have stood the test of time and that once allowed people to live in harmony with their home, might be a good starting point in our search for a different approach to living with one another and on our planet.

These timeless human qualities are most visible in our elders. Such attributes, if adopted by those younger in years, might indeed influence our societies towards a more sustainable way of life.

For example, an attitude of gratitude or mindfulness alone would – if lived as a principle by those making major policy decisions – allow for a different approach towards ideas of continued development and growth. Rather than thinking that we need more material security and wealth to attain contentment, we would focus on other, more soulful priorities to achieve fulfillment. Similarly, a world established in a spirit of kindness would look very different from a world based on continued self-assertion and self-advancement.

23October 2013

October 201324

The role of

The

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regi

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Wisdom

BORN ON 23 JULY 1943 IN GRAAFF-REINETMATRICULATED AT BOTHAVILLE HIGH SCHOOL (1960)OBTAINED D PHIL (PSYCHOLOGY) AT THE UNIVERSITY OF STELLENBOSCH (1978)REGISTERED PSYCHOLOGIST (COUNSELLING AND EDUCATIONAL) (HPCSA)

Career:• Teacher-psychologist, Dept of National

Education• Lecturer and Senior Lecturer, Dept of

Psychology, University of Stellenbosch• Senior Lecturer, Dept of Psychology,

Deputy Director and Associate Professor at Institute for Child and Adult Guidance, Rand Afrikaans University

• Professor, Head of Department, Dept of Psychology, and Dean of Faculty of Community and Health Sciences, University of the Western Cape

• Professor, Head of Department, Dept of Psychology, University of the Free State

• Retired in 2003

Associations:• National President of Alzheimer’s SA

Married to Dr Roosmarie Bam; Two children: Michiel Heyns and Dr Marianne Johnson

PROF PIETER MALAN HEYNS

Health workers need to be wise in maintaining quality of life for a patient with Alzheimer’s disease

Caring for a patient with a progressive dementia poses an extreme threat for the quality of life of the family caregiver. How can the caregiver therefore cope and maintain some of his or her quality of life

under these circumstances? Questions such as this one have been the focus of the field of Positive Psychology.

Positive Psychology examines the dynamics and manifestations of: • Psychological strengths

• Resilience

• Coping behaviour

• Happiness

• Satisfaction with life

• Well-being

This article focuses on the positive psychological constructs of quality of life and the role of wisdom in maintaining quality of life in the presence of a severe stressor. This particular study formed part of an extensive research programme on the well-being of caregivers by the Department of Psychology at the University of the Free State in Bloemfontein. The results are based on interviews with nine women, all members of a support group for caregivers and involved in the caring for a patient with dementia.

Quality of life can be construed as the experience of well-being and satisfaction through:• What has been achieved and experienced in the

past;

• Present experiences that are in harmony with important values in life; and

• The experience of a successful striving after the attainment of realistic future goals.

25October 2013

THE FAMILY CAREGIVER

Carers find that important values are threatened when they are caring for a patient with dementia. That’s because carers have no or little time for socialising, hobbies, attending concerts or partaking in community affairs.

But more importantly, the all-consuming and encompassing nature of the care-giving task darkens the caregiver’s perspective on the future. Important goals often have to be forfeited. There is no anticipation of an extended holiday, visits to the children, or the attainment of long-cherished goals.

Tomorrow is feared more than looked forward to. And even hope is under threat.

It can be asked how wisdom could possibly counter these threats. But what is wisdom? Although it is a very difficult question to answer, we fortunately have the contribution of Paul B Baltes and his co-workers from the Max Planck Institute in Berlin.

After their extensive research into the nature of wisdom, they suggested that wisdom can be defined as an expertise in the conduct and meaning of life. As such it is a key factor in the construction of a “good life” (Baltes & Staudinger, 2000).

Baltes and his colleagues defined the Berlin Wisdom Paradigm.

Before an exposition of the paradigm is given, it should be pointed out that wisdom is such a complex construct that what follows is merely a very superficial application of the wisdom parameters.

After all, an essential element of wisdom was pointed out centuries ago by Socrates when he stated: “If there is one respect in which I am wiser than others, it is that I understand my own ignorance – that I know that I do not know”.

In this study caregivers were questioned on their coping endeavours / mechanisms / behaviours and their responses were related to the following five criterions of the *Berlin Wisdom Paradigm:

• For some the lack of knowledge was agonising: “His incomprehensible behaviour is becoming more and more difficult for me to handle. Sometimes he looks at old photos and cries. Other times he does not notice them at all.”

• Some defensively avoided knowledge about the disease: “I do not read about Alzheimer’s. It scares me.”

• For others it was the thorough knowledge of the nature of this destructive disease and an understanding of its dynamics that enabled them to reconcile themselves with the situation and to find meaning in their caring task: “When I learned that he had Alzheimer’s, I understood… it is good that one knows”.

• Another caregiver said: “When people misunderstand my husband’s behaviour (who displays inappropriate, uninhibited social behaviour), I become like a hen caring for her chicks. I hurt on his behalf”.

• Knowledge about the phases of the disease facilitates preparedness for the future: “Whenever you succeed in manageing the current phase, then the next phase arrives. But it stays difficult…”

1Rich factual knowledge

• How do you handle the patient’s socially inappropriate behaviour? Should the patient still be exposed to community activities with the hope that the community will be educated enough to recognise and respect a person with dementia, or is social withdrawal the better option, with resulting social isolation? “When he makes a fool of himself in public, I am embarrassed and often just walk away.”

• Do you tell white lies? “I got so upset when he repeatedly asked how far Bloemfontein is. How do you answer that when he is sitting right here in Bloemfontein? Now I know I should simply have said 350km! What does it matter…”.

• Do you inform the patient about the diagnosis, just to have to repeat the painful process the next day? A caregiver was advised: “Do not hurt yourself: Your mother will be terribly upset, and cross with you; you will be upset, and tomorrow she will not remember a thing”.

• Should the patient be institutionalised? If so, when? How? What practical steps do you take to admit the patient?

2Rich procedural knowledge

*The Berlin Wisdom Paradigm: A Conceptual Analysis of a Psychological Approach to

Wisdom by Konrad Banicki

October 201326

Notes:1) Retha Marais; retha@drsmarais.co.za

2) Prof Malan Heyns, National President, Alzheimer’s SA, pmheyns@lantic.net.

References:Grobler, ME (2005). “Die toepasbaarheid van die Berlynse wysheidsparadigma in die lewenskwaliteit van versorgers van pasiënte met Alzheimer se siekte” Unpublished MA thesis, Dept of Psychology, University of the Free State, Bloemfontein.

Baltes, PB & Staudinger, UM (2000). Wisdom: A metaheuristic (pragmatic) to orchestrate mind and virtue toward excellence. American Psychologist, 55(1), 122-136.

Wisdom can help a caregiver to realise:• That elements

of the past are irrevocably gone;

• That a complex set of factors needs to be considered to find meaning in the present task of care giving; and

• That to deal with an uncertain future, faith in a Higher Hand brings hope.

• The lifespan context plays a role in the understanding and acceptance of the situation: “The doctor explained to me: You were married to Husband A, with his personality and talents. Husband A is busy changing into Husband B who is also going to change. I loved Husband A when we got married, I love Husband B no less, but in a different way” .

• The caregiver should nurture the following social systems to maintain his or her quality of life:a) The marital and family relationships when everybody is still well. The healthier the pre-morbid relationships, the more meaningful the care-giving task.• A woman said of her

husband: “The caring is very difficult, but I will continue to do it. He was a good man”.

b) Friends and the formal support group. The caregiver can become very lonely. Maintaining social contact is important.• “The support group

every month helps me a lot.”

3Lifespan contextualism (lifespan development, themes and contexts)

• The relativity of values can cause frustration: a caregiver, emotionally dependent on her ill mother, was offended when the mother moved to a nursing home.

• A notion of the relativity of priorities facilitates sacrifice if necessary to maintain quality of life: “I remembered our visit to a nature reserve and treasured the ideal to go again. I believed he would get better and then we could go. Then I realised it’s stupid to hope for that. He will not get better and it can never happen”.

• Relativity enables a different perspective: “Instead of being irritated by my husband’s inappropriate jokes, a lady laughed and remarked that a little laughter brightens a gloomy day”.

• Relativity consoled a caregiver who realised during a support group meeting that she suffers less than some of the others: “I am caring for my mother and not my husband, I can financially afford to hire extra support services. Things could have been worse”.

4Relativity of values and life priorities held by individuals and society.

• Uncertainty manifested itself in questions such as: “What will happen to him, should something happen to me?” and “Will somebody look after me like I am looking after him?”

• Uncertainty was also often evident in the ambivalence between the usually unexpressed wish that the patient must rather die than suffer any longer and the fear that the patient might pass away.

• The role of spirituality, as a way to cope with the uncertainty, was almost always a dominant factor for all the caregivers in this study: “I have patience, but the Lord gives me more now. Without Him I will not cope. He has a purpose with it all, He gives me strength and He will not leave me alone” and “If I did not believe in an Almighty Father, I would have become crazy” and “Often I prayed: Lord, give me strength, give me insight, tell me when”.

5Recognition and management of uncertainty.

ANSWERS TO THESE QUESTIONS ARE NOT EASY TO COME BY. IT WAS EVIDENT

THAT THE SUPPORT GROUPS PLAY AN IMPORTANT ROLE IN ALLOWING THE

CAREGIVERS TO DEBATE THESE ISSUES AND TO SUPPORT EACH

OTHER IN THE INEVITABLE DECISIONS THAT HAVE

TO BE MADE.

THE FAMILY CAREGIVER

An exciting line-up of academic workshops with international speakers will inspire you

Remember to book the date!

CELEBRATING THE RICHNESS OF AGEING

FOR A LINE-UP OF ACTIVITIES AT THE SOUTH AFRICAN CARE FORUM FESTIVAL

7-10 OCTOBER 2014ART | THEATRE | DANCE | MUSIC

@ PAUL ROOS, STELLENBOSCH

w www.sa-careforum.co.za

+27 21 461 3820 +27 21 461 6328 info@sa-careforum.co.za

R3 500 for duration of festivalCOST

The International Federation on Ageing (IFA), together with thousands, if not millions of NGOs globally, broadly exist to serve and advocate with and on behalf of older people. We work to connect experts and expertise in an effort to help influence and shape effective policy. We work ‘with’ government and other stakeholders, recognising that it is through effective partnerships and a shared understanding that the lives of older people are improved.

Our Vision

The South African Care Forum is a new non-profit company supporting the care industry in South Africa, which serves the needs of older people and people living with disabilities, both in residential care and in the community.

Through our members and affiliations, the South African Care Forum aims to become the official

voice for the care industry and grow a reputation for excellence

and best practices.

Greg Shaw - Founder of SACF

“SOUTH AFRICAN CARE FORUM PRESENTS

August 2013AA

GERATEC’s range of services, which can be customised to fit your exact needs.

CATERINGWe provide healthy, nutritionally balanced meals that nourish and nurture. We ensure that the diverse and ever-changing needs of the older person are met through accurate and regular nutritional assessments. Nutritional status affects quality of life as well as duration of life. Since the correct level of nutrition also correlates with the degree of independence, we maintain a fine balance between meeting the individual’s nutritional needs and respecting the individual’s food preferences. All this at a reasonable cost.

CARINGOur values of compassion, respect, integrity and innovation form the foundation of our holistic approach to care. We believe that empathy and sympathy are the key ingredients to understanding the experiences of those we care for. We strive to provide the best care to those in long-term-care environments by ensuring that we keep up to date with the latest research, techniques and information. By focusing on meeting the needs of each person on an individual basis, our interdisciplinary Care Team provides services we can be proud of.

HOUSEKEEPINGOur aim is to inspire a culture of “This is my home” in each care facility that centres on it being a clean, healthy and pleasant place to live in. Quality products are used and housekeeping staff are trained to deliver the finest cleaning service. Our service standards are maintained through monitored maintenance, cleaning and scheduled deep-cleaning programmes. Our housekeeping service is complemented by a laundry service.

MANAGEMENTFull management of care centres is provided by our multidisciplinary team. The quality of service is monitored through regular audits and client satisfaction surveys. Our operational audits are scheduled regularly and the results are monitored by the management, ensuring that the service standards remain consistent. Regular evaluation of systems and processes implemented ensure that we continually improve on operational standards.

TRAININGGERATEC is the only South African company specialising in the holistic care of older people. Our varied personnel training courses are specifically aimed at dealing with their particular needs. The programme is also geared to comply with the Skills Development Act. We believe that every member of our staff is instrumental in reaching your goals. That is why our training encourages an ethos of being visible, friendly, professional and helpful.

GERATEC Contact details:The Boulevard Office Park, Block C - Ground Floor, Searle Street, Cape Town 8000

PO Box 5342, TYGER VALLEY, 7536Tel: +27 21 461 3820, Fax: +27 21 461 6328

www.geratecza.cominfo@geratecza.com

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GERATECexcellence in person-centred care

We provide a full spectrum of services to the care industry through our commitment to developing people, based on the principles of the Eden Alternative and in partnership with national and international role players.