What is it that keeps some of our elderly healthy?

This article is written from the perspective of Swedish conditions. Hopefully, it can inspire those interested from other countries.

Research shows that if we have a sense of coherence (SOC), i.e., see meaning in existence, understand our situation, and have knowledge, it is easier to maintain health. You can be seriously ill and still experience health, and care can contribute to making everyday life meaningful, understandable, and manageable, so that it takes care of the health of the residents. Salutogenic, that which keeps us healthy, is the opposite of pathogenic, which means that which makes us sick.

Foto: Mostphotos

Salutogenic Approach in Elderly Care: Focusing on Health

The salutogenic approach is a perspective in elderly care that emphasizes the importance of focusing on health and what promotes health and well-being. By creating an environment and care that strengthens the residents' resources and abilities, one can improve the quality of life and create a more positive and meaningful everyday life.

Researcher Aaron Antonovsky has looked at what are the so-called salutogenic factors that make people experience health despite a difficult life. It is the opposite perspective to the large amount of research in healthcare and care that studies so-called pathogenic factors that make us sick.

Aaron concluded that there were three factors that contributed greatly. He stated that people who feel involved in a context that is understandable and meaningful can experience health even though they are seriously ill. He called it SOC - a sense of coherence.

What does SOC mean?

Well-being, participation, respect, and an active and meaningful existence in community with others are some of the value terms highlighted in the Social Services Act. The knowledge about SOC has been included when the law has been written and it is good knowledge to have with us when we plan the daily work at the nursing home and create a functional everyday life for our residents. SOC means "Sense of Coherence".

What is meaningful and understandable to us varies for each individual, we participate in several contexts and have several different roles during our lifetime. We who work with care and care must get past our own perceptions of what is meaningful for the elderly so we can understand what the person themselves experience has significance in everyday life.

Using the salutogenic perspective in elderly care

Applying Aaron Antonovsky's theories about the salutogenic perspective in elderly care can help create an environment and a care structure that promotes older people's health and well-being. Antonovsky's theory focuses on what is healthy and fit, rather than just treating disease and problems. Here are some ways to use these theories in elderly care:
- A central part of Antonovsky's theory is the concept of "sense of coherence", which includes three components: comprehensibility, manageability and meaningfulness. In elderly care, this can be translated into creating an environment where older people understand their situation, feel they can handle it, and see meaning in their life despite possible challenges. This can be achieved through clear and open communication, participation in care decisions and promotion of meaningful activities and relationships.
- By giving older people opportunities to be involved in their own care and in decisions that affect their lives, one can increase their sense of control and independence. This may include involving them in care planning, choice of activities and design of their daily lives.
- A strong factor for health according to Antonovsky's theory is social support and context. In elderly care, it is important to promote social networks and relationships. This can be done by organizing joint activities and opportunities for older people to interact and build friendships.
- A positive and supportive care environment can positively affect older people's health. This includes a physically comfortable environment, but also an atmosphere of respect, dignity, and empathy from the healthcare staff.
- Instead of just reacting to disease and disability, elderly care should also actively focus on promoting health and well-being. This may include health-promoting activities such as exercise, mental stimulation and proper nutrition.
- Antonovsky's theory emphasizes the importance of constantly evaluating and adapting care measures based on the individual's needs and resources. It is important that elderly care is flexible and can adapt to changes in the older person's health condition and life situation.

By applying the salutogenic perspective in elderly care, one can create a more positive and healthy environment for older people. It is about highlighting resources and opportunities instead of limitations and disease, and thereby supporting older people's ability to live a meaningful and healthy life, regardless of their age or health condition.

Mental Health

Mental ill health, especially depression is common in older people. For the staff to be attentive and interpret signals, to give the opportunity to socialize with others to create a community is important to create a sense of coherence. Socializing breaks loneliness, gives a person the opportunity to share memories and feelings that can heal both "body and soul". Physical activities and the opportunity to stay outdoors counteract both mental ill health and physical illness. The successful program "Four-year-olds at the nursing home" shows that company is better than medication, that the joy of life and curiosity of the children counteracted both depression and loneliness, that the spontaneous activities provided the opportunity to train both brain and emotional life.

The salutogenic perspective in work can be strengthened by working with IBIC and Person-centered care. These both complement each other as they take their starting point in the social and medical needs of the resident respectively.

What does a salutogenic approach mean?

Seeing the healthy: A salutogenic approach means that one emphasizes what is healthy and works well, rather than just focusing on diseases and problems. By noticing and strengthening the residents' resources and abilities, one can contribute to them feeling more involved and independent.
Meaningfulness, comprehensibility and manageability: These three components are central in a salutogenic approach. Meaningfulness is about the residents feeling that their lives and activities have meaning. Comprehensibility means that they should understand their situation and what is happening around them. Manageability is about them feeling that they have the resources and support required to handle everyday challenges.

Implementation of salutogenic approach

Individualized care: By adapting care to each individual's unique needs and abilities, one can create a more meaningful and manageable everyday life for the residents. This can mean everything from adapting activities and routines to offering support and aids that make it possible for the resident to be as independent as possible.
Strengthening the residents' resources: A salutogenic approach means that one actively works to strengthen the residents' physical, psychological and social resources. This can involve encouraging physical activity, offering opportunities for social interaction and creating an environment that promotes mental well-being.

Practical applications

Physical activities: Encouraging and offering opportunities for physical activity is an important part of a salutogenic approach. Physical activity can contribute to improving both physical and mental health and can be anything from walks and gymnastics to gardening and dancing.
Social activities: Social interaction is another central component. By creating opportunities for residents to socialize and participate in joint activities, one can reduce the feeling of isolation and loneliness, and instead promote a sense of community and belonging.
Environment and atmosphere: A pleasant and supportive environment is important for the residents to feel safe and welcome. This can mean everything from creating homely environments to ensuring that there is the possibility for both privacy and social interaction.

Benefits of a salutogenic approach

Increased quality of life: By focusing on the healthy and strengthening the residents' resources, one can improve their quality of life. The residents feel more involved, independent, and meaningful in their daily lives.

Better health: A salutogenic approach can contribute to improving both physical and mental health. By encouraging physical activity, social interaction and creating a supportive environment, one can reduce the risk of health problems and promote better well-being.

Reflection questions - salutogenic approach
Care staff:
- Do you have the conditions to work with taking care of the healthy in your residents?
- Do you ever talk about what you can do to help the residents maintain health?

Manager, nurse, occupational therapist and physiotherapist:
- What can you do to create a culture where everyday work contributes to maintaining and strengthening health in those who live with you?
- Is it possible to have a salutogenic leadership?

Resident and relative:
- Is the operation good at taking care of and strengthening the healthy in the residents?

Erland Olsson
Specialist Nurse
Sofrosyne – better care every day

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