Giving elderly patients a choice in their own care can better support them in their course of illness.
Giving elderly patients a choice in their own care can better support them in their course of illness.
In March, Duke-NUS Medical School published a study that suggested social support from family does not equate an all positive effects on seniors’ mental health. With extensive experience and work on the ground with senior patients, Medical Social Workers (MSWs) Ow Yong Lai Meng and Peter Lee from Singapore General Hospital (SGH) provide insights on effective approaches.
Lai Meng is a Principal Medical Social Worker (Researcher) with expertise in qualitative social research. He said about the study: “It established a link between family support and mental state in older adults, but not necessarily a negative impact. We must be cautious not to generalise the results to all types of social support received by patients.”
MSWs provide formal social support, such as Medifund assistance, referral to hospice home care and family counselling, whereas support provided by patients’ family members and key caregivers are considered informal support.
“It is essential for providers of social support, as well as government and voluntary agencies, to be aware of underlying issues and not look only at the physical and practical needs of the elderly."
- Ow Yong Lai Meng, Principal Medical Social Worker (Researchers), SGH
“The study looked at the latter,” said Lai Meng, “Further studies can explore more and give us better understanding about the reasons behind the elderly patients’ experiences, as well as better insights for application in care and policy-making.”
Peter, a Master MSW (Clinical), has observed first-hand how a social support effort may be well-intentioned but does not create an entirely positive effect on their wellbeing.
He shared the story of an 81 year old local elderly patient, who had a serious chronic illness and was physically frail, due to be discharged. “The treatment team did not feel he was fit to live by himself in his one-room rented HDB flat in Redhill, and wanted him to be admitted to a nursing home. The patient adamantly refused and threatened suicide. He also declined any home care arrangements.”
The patient was finally discharged home and a follow-up visit showed him coping reasonably well. Despite his struggle to live on his own, he was happy to be among his old friends with whom he could socialize over a cup of coffee, in the neighbourhood where he had lived for decades.
“One has to have the right attitude in engaging the elderly, by being respectful and treating them as individuals who are capable of making decisions,” Peter said. “It is important to listen to what they want and to hear their concerns. That way, we can work out a support strategy for them, which will allow them a sense of control.”
“To have adequate care and be able to function socially, each elderly has to be treated as an individual with specific needs, and not just as an old person."
- Peter Lee, Master Medical Social Worker (Clinical), SGH
Lai Meng echoes Peter’s sentiments: “It is essential for providers of social support, as well as government and voluntary agencies, to be aware of underlying issues and not look only at the physical and practical needs of the elderly.
“For MSWs, this element of social support is important and in our practice we are guided by principles which value the best interest of patients.”
In caring for patients, MSWs are constantly tailoring services to the individuals’ needs. Personalisation is a concept in social work that involves caring for the individual such that patients have choice and control over their care.
Options are explored with patients and their caregivers based on their needs, preferences, and in a way that works for them. Family members are encouraged to hear the needs of patients and encourage independence in patients where possible.
Peter underlined that the right assessment of the elderly’s needs is the determining factor for forming appropriate assistance and support. “To have adequate care and be able to function socially, each elderly has to be treated as an individual with specific needs, and not just as an old person,” he said.
