- provides a space devoted to the conceptual framework known as Hodges' model. Read about this tool that can help integrate HEALTH, SOCIAL CARE, INFORMATICS and EDUCATION. The model can facilitate PERSON-CENTREDNESS, CURRICULUM DEVELOPMENT, HOLISTIC CARE and REFLECTION. Follow the development of a new website using Drupal (it might happen one day!!). See our bibliography, posts since 2006 and if interested please get in touch [@h2cm OR h2cmng AT yahoo.co.uk]. Welcome.

Monday, December 18, 2006

Beware Reflex Moves and the Triple Whammy

[Shorter posts to follow...!] In the past working as a community mental health nurse, I had several referrals in which a house move proved a key contributing factor to mental health problems. I'm surprised that moving residence is not ranked higher in terms of most stressful life events. For older people though an often initial trigger to ensuing chaos is bereavement and the degree of stress this causes is obvious and well documented. It was Simmel the sociologist who highlighted the vulnerability of the dyad - the couple:

"for its life, the dyad depends on both its members; but for its death, the dyad depends upon only one"

Whether marital partners or not, we often take this relationship for granted. Key really is the word of choice here, because listening to the 'patient' tell their story you really wonder what prompts such a vulnerable person to put their keys on the market and re-locate? Often still in grief and depressed they are certainly not able to think clearly and make effective decisions.

If you work in health and social care this scenario will not be news to you. Whatever your employment status though you may (sadly) have personal experience when a parent has died leaving your mother or father alone. For many decades now families are tending to live further and further apart, fifty miles or more - transcontinental even.

Following bereavement the cry goes up “come and live near us, we’ll look after you!” Usually for reasons of longevity that call is to 'mum'. Statutory services don’t hear about the instances when this move is the best thing since sliced-bread, but they certainly do when it goes wrong. We can describe it in many ways, but the importance of place, space, geography, community, in short - home has repeatedly been stressed.

Helping pick up the pieces on many occasions three features stood out:

1. The changing demographic – ageing population
2. The highly personal, subjective, narrative, and qualitative content that arose in session
3. The special circumstances of the older person and their capacity to negotiate this critical conjunction

Plus: my need in 1997 to learn HTML.

Given population trends surely this problem will become more common? What do we know about this dislocation? How frequent does it happen, what are the time-scales, personal and family outcomes, what are the socioeconomic consequences?

Surely it is nothing other than pure sentimentality to say:

"I miss the squeaky garden gate, the GP (family doctor) I knew for twenty years, the people who stopped and chatted on the front, even that nuisance-dog-next-door-but-one?"

Is there a double whammy effect? 1. People previously very well medically for their age suffer acute anxiety and depression. Suddenly pathological age = chronological age; and the negative impacts this can bring. 2. While people who may have had stable longer-term chronic conditions develop additional emotional problems, possibly resulting in hospital admission?

Could there be a triple whammy? [Surely not. Enough already!]

Well, that re-location also means of course that it is a new health and social care team who must help this person and their family make sense of the situation and find their feet again. This 3rd whammy will have its own subtleties. The former doctor-patient relationship may not previously have been tested to this extent. The situation can also impact the health of other relatives. The case for electronic health records also comes to the fore.

Beware Reflex Moves website title imageAll this resulted in the now very dated website ‘Beware Reflex Moves'. The title announced itself and captures the situation precisely. Creating the site helped me learn HTML and check out the use of frames. It is not maintained, although I really would like to follow this up!

Being able to air this pet research question at the Ideas Factory in October, other people were certainly interested. Their research questions concerned the quality of care and support that follows 'sudden' versus 'anticipated' deaths in palliative, primary care and related care environments.

I must do a Hodges' matrix. One aspect to highlight would be INTERPERSONAL: counselling, psychotherapy POLITICAL: access to counselling services for >65s. Can anyone help out? Any tutors with a class of students who could take the existing website content and do an update - re-design?

At this time of year loved ones and the rest of humanity are always in our thoughts. Take care and beware those reflex moves ....

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