Singapore Social Work: Life and End of Life Issues

Singapore Social Work Eldercare
Your Name
Course and Section
Professor’s Name
April 28, 2023
Question 1 (40 marks)
Anthony is a senior social worker in an eldercare social service agency. The center provides home-based palliative care for older adults who are terminally ill and who wish to spend their last several weeks or days at home wherever possible. As most team-mates are relatively new in palliative care and support, Anthony was tasked to deliver a two-session continuing education. The first session aims to equip the staff members with an analysis of the aging process at the end of life. In contrast, the second session is more skills and application-oriented in learning how to engage better older adults who are terminally ill. The overall objective of continuing education is to equip the staff members with knowledge and skills in working effectively with elderly clients at their end of life.
(a) Identify and describe the early and late signs of the end of life.
(10 marks)
Patients nearing the end of life may exhibit early and late signs that indicate the progression toward the end of life. Early signs include declining physical health, where patients may experience increased fatigue, a need for more sleep and rest throughout the day, and a general decrease in energy levels. Another early sign is decreased appetite and weight loss. Older adults approaching the end of life may show a reduced interest in food, resulting in noticeable weight loss. This decline in appetite can be attributed to the body's decreased metabolism.
Additionally, social withdrawal is common among patients nearing the end of life. They may exhibit a decreased desire to connect with others and participate in social activities that were once enjoyable. Lastly, as the end of life approaches, patients may experience increased pain or discomfort related to their illness or condition. They may also have heightened sensitivity to pain, which can be challenging to manage.
In the later stages of the end of life, distinct signs indicate the imminent approach to death. These late signs include changes in vital signs such as blood pressure, heart rate, and respiratory rate. Fluctuations in these vital signs can signify that the body's systems are gradually shutting down. Cognitive and neurological changes may also occur, with patients experiencing confusion, disorientation, or delirium. Communication and recognition of loved ones may become difficult. Respiratory changes are also evident, with irregular breathing patterns such as periods of apnea or agonal breathing. Breathing may become shallow or labored. Skin changes can be observed, with the skin feeling cool to the touch, appearing pale or mottled, and showing signs of increased moisture or perspiration. Decreased urine output and generalized weakness are other late signs, with the kidneys functioning less effectively and physical strength and mobility significantly declining.
(b) Select and analyze THREE (3) critical theories that elucidate the illness experience and attempt to explain how the elderly might deal with later life and end-of-life issues.
(15 marks)
Atchley's Continuity Theory:
In Atchley's Continuity Theory, older adults strive to maintain a sense of consistency in their self-concept, roles, and relationships as they age and face end-of-life issues. Social workers can support patients by understanding this need for continuity and assisting them in maintaining their sense of identity and dignity. This can be achieved by actively involving older adults in decision-making, acknowledging their past accomplishments and experiences, and validating their continued relevance and importance. By emphasizing the continuity of their values, interests, and connections with others, social workers can help older adults navigate the challenges of the end-of-life phase while promoting a sense of purpose and meaning.
Erikson's Psychosocial Development Theory:
Erikson's theory suggests that older individuals reflecting on their lives may experience either a sense of happiness, known as ego integrity or disappointment and despair. Social workers can play a crucial role in facilitating a positive reflection on life by providing opportunities for older adults to share and process their life stories. Through reminiscence therapy, supportive conversations, or life review activities, social workers can help older adults find meaning and acceptance in their life experiences. By promoting a sense of fulfillment and accomplishment, social workers can assist in fostering ego integrity and a positive outlook on life, even in the face of end-of-life challenges.
Kübler-Ross's Five Stages of Grief:
Kübler-Ross's theory outlines five stages that individuals often experience when confronted with the reality of death: denial, anger, bargaining, sadness, and acceptance. Social workers can recognize and support older adults navigating these stages during the end-of-life process. When individuals initially face the prospect of their mortality, denial may serve as a defense mechanism. Social workers can provide a safe and supportive environment for patients to express their emotions and address their fears and concerns. Anger and frustration may arise as individuals grapple with the inevitability of death, and social workers can assist in validating these emotions and providing coping strategies. Bargaining may involve seeking meaning or making peace with the situation, and social workers can help individuals explore their beliefs, values, and spirituality. Sadness and grief are natural responses, and social workers can provide emotional support and connect individuals with appropriate resources. Finally, social workers can help patients reach a place of acceptance, acknowledging the reality of death and finding ways to make the most of their remaining time, fostering a sense of peace and resolution.
(c) Select and apply THREE (3) essential skills in working with older adults who are terminally ill at the end of life.
(15 marks)
Active Listening:
The ability to actively listen to older adults who are terminally ill is a crucial skill for healthcare professionals, including social workers. By actively listening, professionals can create a safe space for patients to express their wants, concerns, and fears. This helps patients feel heard, understood, and validated, fostering rapport and trust. Through active listening, healthcare professionals can gain valuable insights into patients' needs, preferences, and goals, enabling them to provide more effective support, guidance, and communication.
Demonstrating Empathy and Compassion:
Demonstrating empathy and compassion is an essential skill when working with older adults who are terminally ill. This skill is not limited to social workers but should be practiced by all healthcare professionals. By showing empathy, professionals can validate patients' emotions, understand their unique experiences, and provide support and understanding. Compassion involves a genuine concern for the well-being of patients and a willingness to alleviate their suffering. These qualities help create an environment of appreciation, care, and emotional well-being, which is crucial for older adults facing end-of-life challenges.
Ability to Collaborate with the Interdisciplinary Healthcare Team:
Collaboration with the interdisciplinary healthcare team is vital when working with older adults who are terminally ill. Social workers and other healthcare practitioners should work together to ensure comprehensive and holistic care for patients. This collaboration involves effective communication, sharing of information, and joint decision-making. By collaborating closely with other professionals, social workers can advocate for patients' needs, coordinate care plans, and ensure that patients receive appropriate medical treatments, non-pharmacological therapies, and support for their physical, psychological, and spiritual well-being.
Question 2 (30 marks)
Sally, a 75-year-old elderly, recently had a fall in her toilet and sustained a hip fracture. She was admitted to the hospital and underwent surgery. As she requested to see a Medical Social Worker, she was seen by Mark for counseling and financial assistance. Sally is worried that she does not have any savings. As such, Mark did a financial assessment and tried to explore the relevant eldercare schemes that Sally might be eligible for.
On top of that, he also did a depression screening and felt that it would cripple her recovery. As Sally lives alone in a 2-room rental flat with another roommate, she has no caregiver to monitor her activi...