Describing non-death related losses of older residents in a residential care facility

Abstract

The current study formed part of a broader study that explored and described the quality of life of older residents in a particular residential care facility in Gauteng, South Africa (SA). Quality of life is a multi-dimensional concept that includes both the subjective experiences of people as well as their social interactions and the fit with the broader environment. The broader study was requested by the management of a specific residential care facility to obtain the quality of life experiences of the residents. Upon this request ethical approval to conduct the research was obtained from the Faculty of Health Sciences of the North-West University (NWU-00053-10-S1). Different themes emerged from the broader study, such as the needs of older persons, their experiences of being actively involved, relational experiences and non-death related losses. Non-death related losses emerged from the rich data obtained during the broader study and appeared to play a major role in the quality of life of the older person. The aim of this study was therefore to explore and describe non-death related losses by means of secondary data analysis. Non-death related losses refer to an emotional response to the separation from subjectively important person(s) or things while death related losses refer to the death of a significant other. Relational losses in this study refer to the loss of a relationship between the older person and a life person, such as family, friends and also pets. A literature study was conducted on the experience of physical, emotional/psychological, financial and social losses in late-adulthood. The Dual Process model of Stroebe and Schut as well as the Task-Based Model of Worden were used because they are regarded as comprehensive and influential theories on grief. The theories of the psycho-social developmental phase of late-adulthood as described in theories on human development as well as Bronfenbrenner’s bioecological systems theory were also used. viii The broader study was conducted in a residential care facility that adopted an active ageing approach, in SA. This specific facility cares for a broad spectrum of older persons varying from frail care to the older person who can still provide in their own needs and are still fully mobile. A lifestyle consultant was appointed in this residential care facility to organise and oversee activities, varying from prayer groups, bible study groups, line dancing, choir, bingo, outings and many more. In total 74 participants participated in the broader study. The participants’, both men and women, age varied between 65 and 95 years with an average age of 73. The residents were white and the main languages are Afrikaans and English. In the original study, a qualitative, descriptive design was used with the following data collection strategies: the Mmogo-method®; the World Café; semi-structured interviews; and the Listening Group technique. The Mmogo-method® was used for the rich data that emerged on a personal level as well as the group experience. The World Café gave quick information with regards to the quality of life of the older persons by involving a large group of people simultaneously. Semi-structured interviews gave information on the older persons’ subjective life experiences. The Listening Group technique contributed in assisting the residents of this care facility to express their needs and experiences to Management. The rich data obtained from the broader study were used for the purpose of this study and enabled the researcher to do a secondary analysis of the original data to explore themes pertaining to non-death related losses, using thematic analysis. Findings indicated that non-death related losses form part of the experiences of older persons’ quality of life. Non-death related losses involved the loss of physical and cognitive abilities, interpersonal losses and financial losses. These losses appeared to cause a range of emotions with the older person. As a result of not having the opportunity to mourn these non-death related losses, people express the need for space to address this need. The potential misfit between an active ageing environment and the lack of space to mourn non-death related losses can potentially contribute to experiences of disengagement and distress. The findings are significant because older people often have to deal with accumulated losses during their lives and particularly vulnerable people could be prone to develop mental illness if appropriate spaces are not available to deal with non-death related losses. ix The findings of the study could be used to develop psycho-education programmes or therapeutic interventions such as group therapy, or individual counselling to support older persons to deal with grief associated with non-death related losses