Autonomy in elderly care: A literature review

Autonomy in elderly constrict by A literature reviewIntroduction elderly persons in history build been regarded as open because of the physical body changes that move into with growing ripened. These physical changes greatly affect the normal functioning and the soundness with which they operate and hence the need for external run on both at the physical and hearty levels (Agich, 2003). As the physical energy wanes, so does the level of activity not only to support themselves physically solely also on a wider scale. It is these in truth changes that bring to light the issues of care and dependence of elder persons on caregivers and/or family support. However and important to whole step, desire in the rest of other social groups, erstwhile(a)er persons are a heterogeneous group in equipment casualty of gender, race, culture, class and otherwise (Bond and Corner, 2004) and accordingly, there need straggle accordingly. Further, as Bond and Cabrero (113 2007) point out, me ntal and physical incapacity and dis major power which lead to dependence are common stereotypes of human suppurateing. Older people in care or not have been seen as frail and therefore unable to make decisions, communicate, and engage in meaningful coincidenceships with their surrounding environment. As a result, their autonomy in care has been compromised. Jacob (1999) cited in Townsend (2009) compounds it further that professionals and families of older people as well consciously and unconsciously bear discriminatory assumptions about them. To this end, this idea explores autonomy of older people in care in depth, evaluates existing social work traffic pattern and suggests strategies to ensure both caregivers and serve users hike up an interdependency that would help in reinforcing control and respect for service users.Collopy (1988) defines autonomy as a set of touch sensations that promote freedom, self-determination, independence that is signifying control and the powe r to make decisions by the individual. From a medical view point once oneness is admitted into care they are not well and therefore cannot cope on their own allow alone make decisions. Because of this, they are viewed as patients who are modify and therefore have to depend on caregivers. However, one wonders whether all older persons are incapacitated on all fronts. Even when they are fragile, do the Caregivers have sufficient expertise to socialize and communicate with them? These and other head words remain largely unanswe rosy. This view therefore tends to ignore the strengths and abilities of the older persons. Like Runciman cited in Bond and Corner (2004) explains, in understanding social status, it is to a greater extent meaningful to study individuals from their perspective and value so as correct judgments are made about them. Like all other social groups, older people too would be split understood from the view point of their everyday experiences at an individual leve l other than having to impose what we think is best for them. This would imply that understanding older persons desires means a lot to them rather than assuming that we know all they need. Understanding of Autonomy and Care for Older Persons ContextuallyAutonomy as a concept connotes a divergent set of meanings depending on the setting or context. It is defined differently in a sense that it means different things to different users and therefore pickings one meaning or usage would very much complicate its very usage at the different cultural and societal levels on the exclusively (Agich, 2003). The fact that it spells out different meanings and qualities, in care for older persons too, would be quite a argufy for both the service users and the Caregivers themselves. Autonomy as a cultural ideal under the guise of freedom of choice particularly in the western context is very much viewed as a essential feature for any individual. In regard to United States for example, freedom is seen as a canonic of flavor and therefore without which, is deprivation of an individual of a basic right (Agich, 2003). It is important to note that this freedom starts at birth passim life and therefore including in old age, whether in care or not. In care too, without the liberty for one to advance their choices would be seen as degrading by the service user and therefore subservient to the caregiver (Agich, 2003). However this give the axes the question of what might happen when the service user is suffering from a severe cognitive impairment? This all the way indicates the challenge of according full autonomy to service users.On the other hand in countries like southwest Africa where the elderly are seen as very important assets within their communities, it is argued that freedom begins with avoiding taking elders by from their very communities to institutionalized care (Lombard and Kruger, 2009). Institutionalized care would be seen as denying older persons an environm ent they consider indispensable 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 interdependence remains natural. Further, this kind of setting allows for respect and control of older persons based on cultural values. Even when older persons are mentally incapacitated, the family caregiver leave know what they have always desired that is, their favorite 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 cannot go without mention that this kind of setting requires strong family structures that allow for m and financial capacity from the family members to take care of the elderly. With the spread of neo-liberalism that promotes capitalism and individualism, numerous of these oddly extended family systems have broken down hence rendering older persons susceptibl e to dependence on hired caregivers in a family setting or institutional care (Lombard and Kruger, 2009). Evaluation of Existing Social Work put 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 macrocosm of the service users because they are being attached help physically, socially and otherwise. This in many a case does not always happen because of the very nature of how older person are perceived in the eyes of the caregivers. The societal perceptions of older persons lead on 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 business office where the state deliberately introduces structure s and policies like mandatory institutional care for older persons that are very much underpinned by the very disempowering and biased perceptions held strongly by army.Caregivers base their understanding of service users on the very notions they grow up with which in many 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 either because the surrounding environment is not supportive enough or for fear of retaliation from the caregivers (Townsend, 2006). In an investigation conducted in the United commonwealth by Help the Aged internationalistic (2002), older persons in long-term care have suffered a series of blows partly due to the lack of feature assurance on part of the institutions and also a lack of competence from the caregivers on how to communicate with service users to deliver the required services (Townsend, 2006). A untaint ed 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 last 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 hitherto worse-off situation. The fact that they could not communicate with her, they decided to take matters in their own hands clears indicates of how dependence on Caregiver can get messy especially when there is a lacking in skills or quality assurance by the caregivers whether in institutional or family setting.On the other hand, very a few(prenominal) 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 displacement in policy of primarily taking away older persons from institutionalized care to community based care w ith 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 greater encounter as would-be caregivers opt for work and hire caregivers who despite 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 preferences 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 well 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 emotional exhaustion which leads to compromise in the quality of care. This is a clear depiction 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 attempt to understand what autonomy and independence of service users in care meant to caregivers, majority of them think 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 evaluation of social care practice. It is important to note that inasmuch as some service user are not in a position to make decisions on their own, Talerico (2003) stresses that caregivers have taken no initiative in trying 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(a) this would go a long 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 wellness and support. She adds that these very goals defeat the very purpose of autonomy because as oppose to individual choices generalist care is promoted. It should be noted however that this can raise ethical 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 long 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 perform tasks independently, it is very clear that communities of practice are very important. These mainly refer to a multidisciplinary approach to functional 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 focus on the medical component, social workers focus on their values and preferences and policy makers advance policies that promote older peoples 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 eng fourth-year at different levels. Further, this in a sense, promo tes 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 alone making their own decisions. This is clearly a sweeping generalization that does not fit the 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 line 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 w orking. Therefore, in deconstructing this line of thought, advocacy through with(predicate) community dialogue and raising aware awareness of older persons issues autonomy in care among which, would go a long way rectifying the age-old negative connotations about ageing. As communities accept to dialogue and make up aware of the reality of old age, policies and agendas will begin to come up. In the long run this shapes the societal outlook of older persons at every single level. HelpAge International (2010) highlights how Tanzanian older women have been branded 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 dialoguing with communities, the trend is 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 energy for older persons concerns high on the agenda. With the guidance of social work ers, this in the laconic 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, consequently 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 active participants who have some sort of control over their life while in care. This very much promotes interdependence betwixt service users and caregivers. Concretely, as advanced by Rogers (1974), an individual-centered approach to caring, 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 creating better working relationships which in the end promote interdependence and an acceptable level o f control of service users. ReferencesAgich G. J. (2003) Dependence and Autonomy in Old age An Ethical exemplar 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 Sage publicationsBond, J and Corner, L. (2004) Quality of life and Older people, 1st edition, McGraw Hill Open University PressFine, M. and Glendinning, C. (2005) Dependence, independence or inter-dependence? Revisiting the concepts of care and dependency. Ageing and Society, 25, 601-21, available online at http//eprints.whiterose.ac.uk/1653/1/dependency.pdf accessed 2 January 2014HelpAge International (2010) Womens rights 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) growth New Understandings of Independence and Autonomy in the Personalized Relationship. British Journal 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) Honoring Resident Autonomy in Long-Term Care Special Considerations. Journal of Psychosocial Nursing, 42, (1)Townsend, P. (2006)Policies for the aged in the 21st century more structured dependency or the real ization of human rights?Ageing and Society, 26 (02) 161 179Zubi, Y. and Conolly, P. (2013) Recollected experiences of first hospitalization for acute psychosis among persons diagnosed with schizophrenic psychosis in South Africa. South African Journal of Psychiatry, 19 (3), p81-85.Little passing move Hood Angela CarterLittle Red riding Hood Angela CarterAll fairy tales, both old and new that exist today can be say to have a long history that lies beneath them. However, some aspects of the fairy-tale history are somewhat hard to trace because its only the literary forms that can obviously survive. Furthermore, what we do know is that the majority of them have been around and retold for many years. Most, if not all of the famous fairy tales that we know have been adapted into various new versions 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 a dults and children worldwide.1The story Little Red Riding Hood arguably offers a very interesting and challenging tale for enhancements through the application of the chosen contemporary theories in literary criticism that some critics have noticed throughout the years of its universe. Furthermore, in this essay I intend to compare Perraults version of Little Red Riding Hood with Angela Carters version Company of Wolves.Little Red Riding Hood, Little Red Cap or alone Red Riding Hood is a European fairy-tale about a young innocent daughter and a brute. The tale was first published by Charles Perrault in 1697, which in fact was an adaptation of an older tale still. indeed, Perraults version ever since has been adapted and criticised throughout its history. Zipes holds the genre is relevant to contemporary culture as it holds issues that exist within gender and its society.2 Perraults version was named Little Red Riding Hood. The red hood is seen as a popular symbol in Europe and North America. In the 19th century young daughters of wealthy families were painted in red caps or hoods. 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 fairytale than many others. It begins with once upon a time4which the traditional way to start a fairy-tale and also gives the image of timelessness throughout the tale. This relates to the archives and the structure within the fairy-tale of which certainly precedes the middle classs existence within. It portrays the image of the little lady friend being highly attractive the prettiest creature who was ever seen.5She is also said to be extremely nave, the poor child who did not know it was riskous to stay and hear the wolf talk.6This shows her innocence 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 r elates to Trimmers view that both children and childrens tales should be kept 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 showing how safe society was perceived throughout the time. Tater argues it resembles a somewhat cautious tale to society, a wakeup call.8Moreover, the existence of the wolf within the tale gives the audience an image of a villain being portrayed. 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 Three 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 head wolf9personifying the wolf as the boss within the tale. He shows a strong influence upon the nave domain girl as he persuades her to separate 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 past what the little girl is used to. Hence, safekeeping a strong morality message throughout the fairytale, warning people to stick to what they know.Tater identifies the tale as a place to work through people thoughts and anxieties about internality, 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 have11 ecphonesis can be argued to be the favourite story element for tales, being seen as a story building tool that creates the anticipation and standoff for the contributor as they know that she isnt talking to her grandmother. Warner considers her initial failure to distinguish the wolf from her grandma as a crucial element within the story, as it creates the emphasis before the horrific ending of the fairy-tale.Furthermore, critics that exist such as Freud argue that there is shew of underlying inner 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.12Feminist 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. Thus being an innocent, clueless little girl she climbs into bed with him. Therefore by disobeying her mothers instructions and talking to strang ers 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 undergo adaptation in relation to society of 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 corruption and unconventional ideas of sexual activity and an ability to defend one using characteristics which are usually conveyed through a male such as slyness an d 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 proceed 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 feared so great that children carried knifes around with them, seen as different to the true 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 spy 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 twist 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 coarse desire, unlike Perraults characters that are seen to be weak and unable to fend for themselves.Furthermore, similar to Perraults version we see Little Red Riding Hood again to be all innocent as she is described as an unbroken egg, a sealed vessel20and also beautiful with pale skin and dark hair. In addition, as before she is taking food to her sick grandmother however we see a sense of time and self-defence within this tale as she takes a large knife for her 2 hour trip,21and we are told its Christmas Eve again portraying that sen se 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 readiness about her evidence of this is, the childs cheeks are an emblematic and scarlet white.23This portrays the young 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 immediately attractive. Compared to Perraults version of events Little Red Riding Hood makes friends with this stranger and foolishly lets him carry her ring 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 w hoever 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 riding 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 nucleus of his catch like a savage. Carter then links in the sexual connotations as he strips naked revealing a naked, hairy, lie covered body,24and his nipples that are as red as poison 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 feeble 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-defence 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, fear does her no good so she refuses to be afraid.26When 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 riding 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 with28 kind of of screaming 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 b ecome 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 scream 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 possibly realise that we all have a little beast 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 criticised by many, especially feminists as they say it is full on female liberation that implies the view to the reader that nothing 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 fire with fire.