Does Asking for Help Make Me Look Helpless?

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1 Does Asking for Help Make Me Look Helpless? 28th ANNUAL MAINE GERIATRICS CONFERENCE June 14, 2018 Susan Wehry MD

2 Thanks for Being here

3 Goals Spark a conversation Foster new approaches

4 Objectives Describe impact of healthy dependence List ways to negotiate need for help and desire for independence Discuss shaping of self-perceptions of dependency and implications for service delivery

5 Outline Terms and concepts My Story Policy Implications Clinical Applications

6 Definitions & Key concepts Autonomy, Independence, Dependence

7 Paired Conversation Autonomy & Independence

8 Autonomy To To To To To choose self-determination be responsible Dignity of risk fail privacy 8

9 Not Independence 9

10 It s my right! 10

11 Older adults views on Independence At home, in nursing homes and assisted living communities

12 Independence Accepting help at hand Doing things alone Having family, friends, and money as resources Preserving physical and mental capacities

13 Many FAces of dependency (BALTES) Structured dependency Physical dependency Behavioral dependency Learned helplessness Learned dependency Selective optimization

14 FEars Fear of dependency > Fear of death > Fear of illness Remaining independent = staying in one s own home

15 My Story

17 Don t you hate getting old?

18 Skateboard?

19 Learning Circle

20 Finding an Optimal Balance between Reliance on others and Desire for independence is a fundamental task across the lifespan

21 Policy and Practice Implications Shift from oversimplified dichotomy Acknowledge older adults conception of independence "problems" of older adults and care partners don t fit Recognize dynamism and multidimensionality of self-determination

22 Policy and Practice What are key personal and social factors and processes that shape support relationships? How do older adults perceive their strengths and problems? How do they evaluate support relationships?

23 Personal Control Langer and Rodin Personal choice, enhanced responsibility and control Shift from only needing help to using personal skills and resources Subjective: Self-efficacy, sense of control Objective: Actual mastery

24 There s NO Place Like HOme Social isolation, alienation, and disempowerment are common if it becomes the site for intensive medical treatment and service intervention

25 Collective Living : The encircling agency of others Enable social interdependencies to flourish Increases Conviviality Social interaction Participation Strengthens sense of purpose, self esteem, belonging

26 Personal control Current research: Wellness enhanced by opportunities to rely on others and ask for and receive help Increased physical activity Increased social engagement Better perceived health Pain management

27 Clinical Applications

28 Individualize support Strengths Values Specific 28

29 Goal setting Personal Specific

30 Create control points Time you come How you spend time Present options clearly realistically without personal bias 30

31 Identify Health Goals...get out of the apartment and back to doing things for myself. 31

32 Healthy (Inter)Dependency Interdependence is a mutual give and take that shapes most human relationships The ability to experience closeness and intimacy in the context of autonomy and self-reliance Predicts spiritual well-being

33 Asking for help Can Enhance Functioning Younger adults sought more help. Young adults interpreted help-seeking as adaptive Older adults interpreted help-seeking negatively Unless rewards for seeking help are substantial, individuals may not seek assistance

34 Music in surgery Clinical applications

35 Believe-Be Interested-Be Helpful Be Clear = Recovery

36 Thanks for coming Please stay in touch

What Matters to Us. Making the best use of our social and financial resources together. Rick Wilson. 16 th October 2014

What Matters to Us. Making the best use of our social and financial resources together. Rick Wilson. 16 th October 2014 What Matters to Us Making the best use of our social and financial resources together Rick Wilson 16 th October 2014 1 Summary Introducing Community Lives Consortium Long spoons and the jaws of doom Discussion