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Toni Talks about PT Today

Loss of Identity

Published April 1, 2008 7:11 AM by Toni Patt

Last week in the electronic version of ADVANCE Deborah Cox, MSN, CRNP-F tackled the topic of identity loss and the elderly. She explained how entry into a long term care facility such as an SNF causes an individual to lose his or her identity. Instead, the patient becomes the admitting diagnosis. Ms. Cox further shows how the system contributes and promotes this loss that can bring on feelings of depression and isolation. (To read the article from the ADVANCE Website, click here.) 

The majority of long term care patients are elderly. It never occurred to me that the very actions being taken to them were actually creating a new set of problems from identity loss. I can see how it can happen. For example, in therapy we tend to refer to our patients by diagnosis. This is more a function of confidentiality protection.  We are then able to talk about patients without fear of loss of confidentiality. But, as Ms. Cox points out, we need to remember the patient is more than a body part or diagnosis.

Think of it from the patient's point of view. The entire world has been turned upside down. In a short period of time the patient has been removed from home, lost control of the decision process and instructed to ask for help before doing anything. Going to the bathroom becomes an ordeal. Changing positions or going from bed to chair requires the assistance of someone else and usually happens according to someone else's schedule.  

As most SNF rooms are doubles, there is also a loss of privacy. I've heard countless complaints about roommates who have too many visitors, leave the TV on all the time or don't sleep at night.  Many patients talk about missing their pets.  These pets take on additional significance to an elderly person who has no other companion. Since most SNFs don't allow pets to visit, the patient is cut off from an important part of life before admission.  I guess when I'm the patient my request to see my horses will not be well received.

Therapists can either contribute to the problem or address it. I can no more heal someone just by touching them than I can levitate them with my gait belt.  But I can help the patient maintain a sense of individuality by asking questions, listening to answers and providing choices about therapy. I let my patients choose whether to walk or exercise first. I bribe them to get out of bed with a promise of a trip to the bathroom.  Sometimes therapists are the only ones who will do this so it is an attractive option. I ask patients how they met their spouses, where their children or grandchildren are and where they are from. Not only does it help the patient but I get to hear great stories of times I can only imagine.

Depression is a common co-morbidity of the elderly. It's sad to think that in our well-intentioned efforts to help them, a new problem is being created. I can't imagine how I'd respond if the situation were reversed.  I'm healthy and I would have trouble with it. The elderly have additional problems with loss of hearing, poor vision, fear of falling and in many cases difficulty communicating due to aphasia. I've always joked about being the cranky old lady who swings her quad cane if she doesn't get her way. Now I'm starting to wonder if there might not be a grain of truth in that.

Therapists can help. We spend a lot of time with our patients in the long term setting. While working on increasing functional mobility we can also be asking questions and listening to the answers. We refer to our patients by name. We can provide choices. Granted this is a small dent in the overall SNF experience, but every little bit helps.


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