adult client through the lens of the stages of Erik Erikson’s psycho- social stages of development. Stage 1 is trust versus mistrust (usu- ally met in infancy and has an associated virtue of hope); stage 2 is autonomy versus shame (usually met in the toddler timeframe with an associated virtue of will); stage 3 is initiative versus guilt (usually met in the preschool age and the associated virtue is purpose); stage 4 is industry versus inferiority (usually met during the school age and the associated virtue is competence); stage 5 is identity versus confusion (usually met in adolescence and the associated virtue is fidelity); stage 6 is intimacy versus isolation (usually met in early adulthood and the associated virtue is love); stage 7 is generativity versus stagnation (usually met in adulthood and has the associated virtue of care); and stage 8 is integrity versus despair (usually met in older adulthood and has the associ- ated vesture of wisdom) (Boyd, 2017). The older adult grew an appreciation of interdependence from stage 1. Acceptance of the life cycle and self-control were gained in stage 2. In stage 3, the older adult gains humor, empathy, resil- ience, and life direction. The older adult developed humility and acceptance of the course of their life to include unfulfilled hopes in stage 4. Stage 5 brings a sense of complexity to life and helps merge perception and devotion to life for the older adult. The older adult gathers a sense of relationships and comes to value tenderness and love during stage 6. In stage 7, the older adult has learned empathy and how to care for others with concern. The An essential component of mental healthcare is the therapeutic relationship between the healthcare worker(s) and the older adult client. A healthcare worker who builds and maintains a therapeu- tic relationship will be connected to the older adult client, en- hancing their ability to meet their mental healthcare needs. The older adult views connection as vital to their identity, autonomy, and self-esteem (Jack et al., 2019). Key elements in the healthcare Rapport — trust Rapport is “interpersonal harmony” rooted in mutual understand- ing and respect for another (Boyd, 2017, p. 93). This concept of rapport is critical for the healthcare worker to develop a thera- peutic relationship with the older adult in order to address their mental health needs. Trust is the foundation of the therapeutic al- liance (Carlat, 2017). How a healthcare worker establishes rapport and builds trust depends on their individual capabilities and the current presentation of the client. Connecting with the older adult can be challenging if the health- care worker harbors conscious or unconscious bias or stereotypes. Ageism is a healthcare worker’s perception and outlook based on their assumptions, perceptions, expectations, and beliefs that they form about older people, aging, and old age (Ayalon & Tesch-Romer, 2018). Ageism can negatively drive a healthcare worker’s interaction with the older adult client. The World Health Organization (WHO) has identified ageism as one of the key tar - gets for improving health (WHO, 2021). Awareness of ageism by the healthcare worker when meeting and building rapport with an older adult mental health client is imperative. An example of ageism is a healthcare worker undervaluing de- pressive symptoms reported by the older adult and failing to ad- dress them in a timely manner or adequately because the health- care worker assumes depression is common in all older adults. Ageism in this context could lead to a reduced calculation of risk, leaving the older adult client in an unsafe situation to self or oth- ers. Caution is warranted to avoid discriminating against the older adult client. The healthcare worker can decrease common pitfalls of ageism through the practice of self-examination. The principle of self- awareness is defined as a healthcare worker’s personal beliefs, thoughts, motivations, biases, and limitations (Boyd, 2017). By evaluating one’s self, often through directed questions/thoughts, the healthcare worker can break internal or external barriers that inhibit personal connection with the older adult client. Self-con- cept awareness can be explored with a series of methodical ques- tions related to what, when, and how a person has come to define themselves. The questions can be thought of as being in three
eighth and final stage, integrity versus despair, refers to the time period between being an older adult and death. An older adult client in this stage of life is juggling the purpose versus the finality of their life. This concept can be deep and meaningful, and it can drive the decisions a client makes toward their own health and the care they want/expect at the end of their life. An older adult client struggling with the fulfillment of this stage can experience high levels of despair and detachment (Sadock et al., 2015). These can be barriers the healthcare worker must consider when planning care and offering mental health interventions and treatments to the older adult. With an awareness of the theories on aging, the healthcare worker can more accurately conceptualize the client in their current presentation and use this information in the adminis- tration of mental healthcare. Self-Assessment Quiz Question #1 The healthcare provider identifies the sense of satisfaction the older adult feels reflecting on a life lived productively as which task from the final stage of Erik Erikson’s psychosocial stage of development?
a. Integrity. b. Despair.
c. Generativity. d. Stagnation. INTERPERSONAL CONNECTION WITH THE OLDER ADULT
worker forming a therapeutic relationship are rapport, empathy, and professional boundaries—all within the bounds of cultural consideration for the older adult. These elements will aid com- munication between the healthcare worker and the older adult, which in turn strengthens the therapeutic relationship, a para- mount component of mental healthcare. major categories: body image, self-esteem, and personal identity (Boyd, 2017). Body image refers to the physical attributes that make up the outside of one’s appearance and includes beliefs and attitudes about one’s body (Boyd, 2017). An example of how this idea can be self-searched is to ask questions such as “How do I see myself when I look in the mirror?” and “What do I like about my body and/or dislike about my body?” How comfortable a per- son feels within their own skin can positively or negatively affect the way they interact with others. Self-esteem, another category, is one’s perception of worth or importance, and it is a deeper view than body image (Boyd, 2017). It encompasses a person’s confidence, which can be molded throughout time. An example of how to review self-esteem is to ask questions such as “How do I feel about myself and my worth?” and “How do I talk to myself in my own head (positive or negative self-talk)?” The third category of self-concept awareness is personal identity. Personal identity is how a person sees themselves in relation to others (Boyd, 2017). An example of how to search this concept further is to ask questions such as “What words describe who I am?” and “What groups do I identify with?” and “How does my cultural or spirituality play into who I am?” By knowing more about body image, self-esteem, and personal identity, a health- care worker can have a better understanding of their own roots, which provides insight into relationships. Self-assessment takes time and humility but will benefit the healthcare worker in all cli - ent interactions. Self-awareness leads a healthcare worker closer to objective empathy, thus allowing for connection with the older adult shaped through their individualism. Spend time getting to know yourself and re-evaluate regularly. There is value in under- standing yourself and how you have changed over time, and this understanding can enhance interpersonal relationships with the older adult. Rapport and trust are assembled or hindered from the initial cli- ent meeting and transform/shift at every subsequent interaction. Other ways to increase rapport and trust are with the use of inter- personal warmth and a nonjudgmental attitude (Boyd, 2017). The healthcare worker should prepare for positive interactions prior to the first interaction with the client and work at strengthening
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