Accentuating the Positives - Issues in wellbeing, ageing and memory loss from an OT perspective

1. Accentuating the Positives -Issues in wellbeing, ageing and memory loss from an OT perspective Karen Wood, OT Gwynedd & Mon Memory Clinic

2. Aims of the talk An overview of how the changes that can occur in ageing and development of memory problems may have an impact on wellbeing How some older people, people with memory problems and caregivers view their situation Discuss how occupational therapy can have a role in promoting wellbeing

3. wellbeing 2012 Dodge et al: difficulties in defining wellbeing “subjective well-being consists of 3 interrelated components: life satisfaction, pleasant affect, and unpleasant affect. Affect refers to pleasant & unpleasant moods & emotions, whereas life satisfaction refers to a cognitive sense of satisfaction with life.” (Diener & Suh, 1997)

4. Ryff, 1989 looked at constituents of well being: autonomy; environmental mastery; positive relationships with others; purpose in life; realisation of potential and self acceptance. Other dimensions: ability to fulfil goals; happiness; life satisfaction

5. Rogers, 1961, looked at wellbeing in terms of “the good life” each person strives towards becoming a “fully functioning person” - open to experience, is trusting in his/her own organism and leads an increasingly existential life: “adjectives such as happy, contented, blissful, enjoyable, do not seem quite appropriate to any general description of this process I have called the good life...adjectives which seem more fitting are [those] such as enriching, exciting, rewarding, challenging, meaningful. This process of the good life is not...a life for the fainthearted. It involves the stretching and growing of becoming more and more of one’s potentialities. It involves the courage to be. It means launching oneself fully into the stream of life...”

6. “each time an individual meets a challenge, the system of challenges and resources comes into a state of imbalance, as the individual is forced to adapt his or her resources to meet this particular challenge” (Kloep, Hendry & Saunders, 2009) “when individuals have more challenges than resources, the see-saw dips along with their wellbeing and vice-versa”(Dodge, Daly, Huyton & Sanders, 2012)

7. Ageing Physical changes Psychological Cognitive Economic Social

9. Development of memory problems; dementia – the double whammy... Memory Concentration Visuospatial & constructional skills Executive function Language

10. Effect on: Self image & Expectations Roles & Occupations Relationships & Responsibilities

11. Experiencing the negatives • Gwen – mood, reporting cognitive problems, • Lily – early dementia • Tom – cognitive problems • Elizabeth – Tom’s wife & caregiver • Mair – early dementia

12. Is it all bad? • Maturity • Experience • Freedom • Time • Knowledge & skills • Ability to adapt • Resilience

13. Against ageism “The aged are an asset not a liability to society because of the invaluable contribution they can make by virtue of their accumulated wealth of knowledge and experience” (UN 1982)

15. Some inspiring older people • Helen Mirren • Paul McCartney • Buster Martin • Mary Berry • Terry Pratchett • Some of my best friends...

16. What is Occupational Therapy? “OT takes a person centred approach to both mental and physical health and wellbeing, enabling individuals to achieve their full potential. OT provides practical support to enable people...to overcome barriers that prevent them from doing the activities (occupations) that matter to them. This helps to increase people’s independence and satisfaction in all aspects of life.” (COT)

17. Occupation “refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day to day tasks such as self care, work or leisure” (COT) Occupation should be a “synthesis of doing, being and becoming” (Wilcock 1998)

20. Assessment • Of skills & abilities, limitations & needs – person’s perspective & objective view • Functional – application to activities & occupations • Home environment • Holistic

21. Interventions • Person centred – according to the individual, their situation & environment • Identify realistic goals • Aim to optimise independence & wellbeing through use of meaningful activity & occupation • Practical problem solving • Affirmation & reinforcement

22. Real life

23. For individuals

24. Gwen Said she would like to : feel brighter & more motivated, return to gym, start baking To have kitchen assessment, start going out for walks – setting targets, reported she needs to be “pushed”, positive reinforcement, challenge negative thoughts, facilitate exploration of community resources/amenities

25. Lily Said she needs: to be more confident using her mobile; to be able to use her microwave to cook chicken pieces; forgets times of the buses; feels lonely Assessed using appliances; demos & practice, she has written instructions. Bus timetable highlighted. Agreed to be referred to memory club & Age Cymru befriending project

26. Tom & Elizabeth They have different issues, abilities & needs but these have to be looked at together Tom finds that forgetting day and date undermines his confidence. He does use a diary but not effectively. Elizabeth – would like Tom to be able to recall what he has to do in the day and not have to worry about him when she goes out or visits family who live away. She would like him to have more structure and intellectual stimulation. The couple are aiming to move closer to family

27. To help Tom recall day and date – calendar clock; set up “information hub” & routine for checking & taking medications. A dictaphone/memo minder may be useful for recording events when out. Strategy leaflets given to Tom & potential activities discussed. Elizabeth signposted to local caregiver & community resources and discussed potential resources in new locality; caregiver issues discussed as well as general safety & driving

28. Mair Has a genuine sense of wellbeing She feels her memory problems do not significantly affect her life as she can: Carry out most of her daily activities, her daughters visit frequently with their children who she helps to look after. She attends chapel and a local club and has friends who visit. She had a good marriage and has happy memories that she enjoys sharing. Mair did not wish to have any OT interventions as she feels her family provide any reminders and no safety issues were reported or identified at the time of the assessment.

29. How do they relate to wellbeing? • Person centred – according to the individual, their situation & environment • Identify realistic goals • Aim to optimise independence & wellbeing through use of meaningful activity & occupation • Practical problem solving • Affirmation & reinforcement

30. References • Dodge R, Daly AP, Huyton J, Lalage DS: The challenge of defining wellbeing. Intl Journal of Wellbeing 2 (3) 222-235, 2012 • Rogers C: On Becoming a Person, 1961; Constable new ed 2004 • Doble SE, Santha JC, Occupational well-being: Rethinking occupational therapy outcomes. Canadian Jnl of OT no. 3 vol 75 June 2008 • COT website • CMOP accessed off www.munchkinandflan.com

31. Cheers & thanks for listening!