Reading material on improving patient communication

Meeting with the aging process 

Aging is a physiological process, dynamic and irreversible, which occurs in the individual development of living organisms over time [8].  It is a universal phenomenon in the lives of humans from conception, and according to most biologists the aging begins from the fourth decade of life and ends with death, the end of biological life. The process of human aging is complex and individualized, occurs in the biological, psychological and social sphere [9]. The genetic code is considered the basic etiological-pathological mechanism of aging, in addition to the important role attributed to extracorporeal, biological and psychosocial factors. The biological agents include: physical inactivity, improper nutrition, psychomotor load, acute and chronic medical conditions, and the psychosocial: changes in the environment, isolation, loneliness, and lack of preparation for old age.Old age is defined as the final stage of the aging process, ending in death. It is defined by biologists and physicians as the stage of life after the age of maturity, in which there is a reduction in bodily functions and various changes in systems and organs [10].With the limits imposed, retirement age is assumed by the following: 

calendar (chronological, determined by years of age); 

biological (functional, determined in individual characteristics); 

law (statutory retirement age limit); 

economics (lack of activity, a reduction of income);  

social (related to the loss of prestige and social roles) ;  

psychological (determined by the study of intellectual function) 

Treated as a phenomenon secondary to biological aging. Changes that occur with age in the functioning of individual organs affect the mood, attitude to the environment, physical condition and social activity, and designate the place of the elderly in the family and society.Psychosocial aging, however, to a great extent depends on how a person is prepared for old age, and takes effect over time. Z. Szarota claims that the kind of people we become in old age is determined by the quality of our earlier life. Mental aging refers to the human consciousness and its adaptability to the aging process [10]. Acceptance of old age contributes to the feeling of happiness and life satisfaction, the lack of which causes the feelings of solitude and physical suffering. With age, there are increasing difficulties in adapting to new situations, followed by adverse changes in the cognitive and intellectual spheres, there occur changes in the evolution of the processes of perception, processing of received impressions, and the thought processes.  

With age, memory deteriorates, especially short-term memory, to which can now be added a new type – so-called emotional memory-cardiac memory.  Depression and stupefaction, diseases where the basic symptoms are disorders of cognitive functions are also more common in old age. Although a number of negative characteristics are attributed to the elderly, this is not the rule and does not correspond to the whole structure of their personality. There are also positive mental changes during the aging of the human body. Retrospective thinking allows older people to recall even the most distant events, to have great practical experience which they can use and share. However, they are cautious in making decisions and are able to avoid many mistakes.  

Social old age, meaning the limitation only of being old, is culturally conditioned and may vary with the change in manners. Each person living in society has defined roles, some of which disappear in old age, others become modified or continued, while brand new roles appear. Sometimes, there occurs a reversal of roles, especially in the case where adult offspring need help. This is a matter for the aged where they have to be reconciled to the loss or modification of certain roles and seek out a new role; this, to a large extent, depends on the environment within which they function, as well as the active role they create. 

With the loss of health, there is a reduction in the satisfaction with life, interest diminishes, and the sense of loneliness and danger appears. Retirement often involves a big change in lifestyle, a reduction of needs and contacts, together with isolation and impoverishment. Despite all the ‘losses’ in old age, this period can be utilized to provide a creative and useful life. 

Old people are the bearers of many family, religious and social values, and old age is a period of ‘harvesting’ from previous existence. Old age is a period of maximum accumulation of experiences and social opportunities. Seniors have at their disposal a lot of free time, and whenever they are able, they can realize themselves and help others, they can undertake new social and family roles, engage in the activities of various organizations and associations. Mostly, this depends on the earlier style of daily functioning whereby it is believed that those who were active in their youth, during their old age also attempt to live an active life, develop their interests and hobbies, or take an active part in their community associations, groups or foundations. 

It is believed that one of the most important forms of active aging, leading to a sense of usefulness and prestige, is contacts with family, relatives and neighbours. For the elderly, the family is the natural environment from which they expected spiritual, physical or material support. 

Social aging refers to how a person perceives the aging process and how it relates to the society in which they live. Everyone enters old age with an individual vision of what it means, although this period in life is formed by many aspects, for example, watching old people closely, existing stereotypes of old age, and their own expectations arising from past experience. The vision of old age created by humans is a kind of guide, according to which behaviour towards the aging process is shaped. Depending on which old age image is dominant – positive or negative, those who are aging develop a real dimension of their age. The subjective way of perceiving the aging process influences the aging functioning, life activity, and all actions and contact with other people . Modern society promotes youth, progress, development, efficiency and cost-effectiveness. It is therefore often difficult for elderly people to be personally fulfilled, active, and to have the right to take initiatives on retirement, thus accelerating psychosocial aging, manifested as depression, apathy and indifference to the environment. However, highly developed societies attempt to create the possibility to fulfil their social functioning, understood as belonging to a network of social relationships, providing social support, continuing with social roles, and the realization of interests, passions or hobbies [1]. 

The first contact with the physiotherapist and multidisciplinary team actually begins with communication. Establishing healthy communication, creating a safe social environment by making the elderly person feel that they are not alone, and small tasks given to them during the treatment process make the individual physically active, integrate them into social life, and reduce social isolation.