Self-care in institutional settings. (Self-Care and Older Adults)

Self-care in institutional setting! Is this an oxymoron? The term self-care implies a degree of independence while the term institution conveys a sense of rigid control, a place where older persons go when they can no longer take care of themselves. The role of institutions in promoting self-care requires a new look at what self-care is and how caregivers in institutions are prepared to assess and promote self-care abilities of the older person with moderate to severe functional impairment while ensuring quality care.

The fastest growing segment of the population is the oldest-old, those over age 85 and most at risk for living in an institution. It is projected that this group can expect to have a life expectancy of an additional 6.44 years; 2.90 year being active, 1.25 year being moderately impaired, 1.19 years heavily impaired, with 1.21 years living in a nursing home (Manton and Stallard, 1991). The demographic changes point to the increasing importances of the concept of self-care and the need for it to be taught early and reinforced throughout life. One is never too old or too frail to participate in some self-care. The challenge to caregivers is to promote self-care in order to decrease dependency needs and to increase self-esteem, regardless of the setting.

SELF-CARE

Self-care is the deliberate action to do for oneself what is perceived necessary to accomplish personal goals. Self-care encompasses all aspects of life--educational, social, vocational, financial, and health. Most people think of self-care in relationship to their health. The goal of self-care is to promote the efficacy of the "self-system" in meeting these goals and in prolonging active life expectancy and a sense of well-being. A positive relationship has been found between self-image and self-care. Self-care enhances self-concept and a sense of well-being (Smits and Kee, 1992). "The self-system is increasingly being recognized as an important antecedent for understanding health behavior, and self-definitions may play an important role in regulating cognitive processes associated with motivation and decision making relevant to health behavior" (Hooker and Kaus, 1992).

Health is not merely the absence of disease but the sense of well-being resulting from the integration of physical, psychological, spiritual, and social aspects of the whole person. There is evidence that social and behavioral factors are better at explaining some aspects of health and aging than are biomedical factors (Estes and Binney, 1989). Persons over 85, regardless of place of residence, attributed their longevity to exercise, religion, and a positive attitude toward self and others (Hogstel and Kashka, 1989). Hence, an older person with physical limitations in an institution may have a sense of well-being resulting from the integration of a strong social-support system, an effective self-system, an acceptance of self-care limitations, and a meaning and purpose in life. Self-care, albeit minimal, provides some control over the person's life and promotes a sense of well-being (Hennessy, 1989).

The obverse of self-care is self-neglect. This phenomenon is one of growing concern with the increased visibility of the deinstitutionalized, mentally ill, homeless elderly persons and the increased number of not-so-visible reclusive older …