The combination of aggressiveness and seniors could be bizarre for some. However, the fact remains that aggression and aggression can be found in every target group of social work, including seniors. Indeed, social work with older people brings certain problems and critical moments that could trigger aggression. Social changes represent an increased burden and risk for the elderly from a health point of view. Changes that disrupt social relationships are particularly challenging. It can be e.g. retirement, death of a loved one, change of residence, or transition to social inclusion. In the professional article, the author's reflections on the issue of aggressive clients in a facility for seniors in the context of the field of social work are also presented to a greater extent. However, we note that the presented text also has a practical focus, which can inspire and educate the professional public when working with aggressive clients in a facility for the elderly.
The social worker strives for the best possible adaptation of the senior within the framework of social change while maintaining continuity to the conditions before the change. In other words, he tries to include elements in the adaptation process that would help the client to adapt. In practice, this can be in the form of providing an activity, a subject and a contact that would not "detach" the senior from his previous life. The prerequisite for ensuring such a state is working with seniors, where building trust and a sense of security is at the top of the goals of working with the client. In this way, there is a significantly greater chance of obtaining information about the senior's experience and perceived needs. Especially in institutional care, this aspect is essential for ensuring the best possible quality of life for clients in the facility. In addition, the social worker ensures the client's contact with family and close people, to whom he can interpret information about the current state of the senior. Ensuring contact and an active life, as far as health circumstances allow, is essential for the client's mental health.
Long-term frustration, lack of contact with loved ones, health problems, dissatisfaction with housing and living conditions can all cause anger and aggression in a senior. In particular, when excessive control is added, constant pointing out of shortcomings and pointing out motor and cognitive changes, the resistance of seniors is somewhat greater and usually in the form of verbal aggression. In residential facilities, the staff and conditions of the facility are prepared for physical and mental handicaps. In this professional article, we will specifically focus on retirement homes or facilities for seniors. Institutional care, accommodation and a wide range of services are provided here. Nursing, nursing, rehabilitation, but also cosmetic services. One of the most demanding tasks on an emotional level is providing care in the last moments of a client's life and arranging the necessary arrangements for the client's funeral. A social worker provides and performs a wide range of activities for his clients in a facility for seniors, and in addition to the services mentioned, there are many others. These are administrative work, planning, public information, work on adaptation mechanisms, development of intergenerational programs, provision of volunteer programs, coordination of stays, social and psychosocial assistance, managerial activities, supervision of the observance of human rights and ensuring the quality of social services.
Specifically, we can classify work with aggression and aggressiveness as social and psychosocial help. However, the goal of social workers is to prevent aggressive behavior and ensure client satisfaction. That is also why they implement and influence the mental health of clients through various activities and types of therapy. These activities keep clients mentally well and effectively fill their free time. Activities thus prevent possible frustration, restlessness and aggression. It goes, for example for the following activities:
- Seasonal activities: by seasonal activities we mean activities connected with the current season and with the holidays that belong to the given period of the year. It can be balls, Easter and Carnival parties, Christmas gatherings, or New Year's parties.
- Creative and creative activities: activities where seniors draw on paper, cut out pictures and create different things. Creative activities give space for self-expression and provide a feeling of satisfaction from the completed work and the created thing.
- Board games and entertainment: seniors in facilities for seniors generally like playing board games, where they are often motivated by the feeling of victory, but also by the pleasant feelings they experienced in the past while playing them and which return to them while playing. However, as part of the entertainment, the social workers also play their favorite music, film or TV program for the seniors, or plan a knowledge quiz.
- Smaller trips: walks, sitting for ice cream, coffee, lunch, but also trips to interesting places in the vicinity are also planned with mobile seniors.
- Meeting of children with seniors: in some facilities for seniors, we can also see great cooperation with leisure centers, where children visit seniors in the facilities as part of visits to the centers and communicate with seniors, or create a mutually interesting program together.
- Activities with elements of therapy: social workers care about the psychological and physical comfort of their clients, and in addition to the mentioned activities, they often consider therapy as a suitable part of activities for the client. In such activities, however, it is appropriate to state that the social worker is not authorized to use a type of therapy when working with the client, for which he does not currently have a valid certificate from an accredited entity. However, in many facilities, social workers still use the term "activity with elements of therapy" for the legality of therapy, despite the absence of a certificate of competence. However, such an activity cannot be considered therapy under any circumstances. "De facto", however, the skills of the social worker and the tasks performed within this activity can show similar results. However, "de lege lata" it still cannot be considered therapy. We note that the currently valid legislation is set appropriately, since in the case of work with a client, which is psychological and therapeutic in nature, it is necessary to have knowledge and experience of such procedures within the framework of therapy, which would in no way bring the client unpleasant feelings, or even psychological and physical harm to health. However, a social worker can use e.g. activities focused on listening to music and playing musical instruments (activity with elements of music therapy, dance therapy), drawing on paper, cutting out and creating objects (activities with elements of art therapy), simple work in the garden, cooking, cleaning, sewing (activities with elements of occupational therapy), use of therapeutic aids, aromatherapy, sandplay therapy, or going through objects from the clients' past and talking about them (reminiscence activities). In some facilities for seniors, special relaxation rooms are even set up, where relaxation, meditation, or lighter physical exercises take place, which ensure inner peace and relaxation.
- Animotherapy: recently, professionals in social work in social facilities for seniors have particularly highlighted the importance of animotherapy. Animotherapy is often a significant event for clients and a diversification of life in the facility. It has many positive effects on the mental and physical health of seniors and is often a reason to be happy. Therefore, social workers are increasingly looking for individual forms of animotherapy. Animotherapy can be implemented directly by a therapist who is invited to a facility for seniors, but it can also be partially provided in another way, namely by providing a suitable animal to the facility, which would make the life of the seniors more pleasant and not overburden the staff of the facility. It can be aquarium fish, a parrot, a rabbit, a hamster, or even a cat.
We see the provision of a varied range of activities in the facility as an important factor. Because a satisfied and happy client equals a client who is not currently frustrated and consequently neither aggressive. Regular venting of negative emotions and anxiety is therefore essential in seniors' care. Many therapies are based on their simplicity and the element that should cause the client to feel the presence. Not only senior age clients are still "trapped" in their mind and experience more what is happening in their head than what is currently happening in their physical environment. Such awakening is not only fun, but also an important aspect of ensuring enthusiasm for life, which gives clients energy and strength to deal with the troubles they are analyzing in their heads. In addition, this represents a possibility when the client can open up more and the helping professional can react better in the future to possible experiences of anger and aggression of the client and simultaneously modify the individual care plan, which would reflect new authoritative findings (Matoušek, Koláčková, Kodymová et al., 2005).
When working with seniors in relation to aggressive behavior, we must not leave out theories of aging. Old age is the last developmental period of a person, which begins after adulthood. Old age and the process of individual changes that it brings is special due to lifestyle and biological prerequisites. The World Health Organization distinguishes individual periods of old age. Old age is defined as age from 60 to 74 years, old age as age from 75 to 89 years and longevity from 90 years. Several authors and experts agree that age over 90 can be referred to as longevity. This age is already associated with significant types of several diseases. The social services facility and the facility for seniors try to ensure that clients in individual periods of aging eliminate negative factors during aging by improving the environment and a suitable way of living in the facility. There is a theory of the speed of life, which says that the length of life is dependent on the speed of the body's energy output. Life in the facility should be a bit "slower" and calmer with the provision of necessary comprehensive care. We also include dealing with aging and preparation for the given period of life as part of comprehensive care. This process is often difficult for several clients and they also need psychological help. In this area, however, it has been demonstrably proven that the best solution for dealing with old age is to ensure contact with children (ideally grandchildren), who represent a "light" for clients of senior age in a sometimes demanding life. Such contact not only prolongs the life of seniors and ensures better mental and physical health, but also logically affects the overall mood of the senior, and thus is a direct preventive measure against the emergence of aggressiveness and aggression (Oláh et al., 2012).
Aggression is considered one of the forms of inappropriate behavior in facilities for the elderly and in social service homes. However, we must not forget that even an inappropriate reaction to aggressive behavior is in this context inappropriate behavior and aggression, it only incites and can even trigger another form of aggression in the client. In Venglářová's publication "Problematic situations in the care of seniors" we can also find specific steps to manage the aggressiveness of clients in the elderly or describes how it is appropriate to respond to verbal and physical assault by an elderly client. We will briefly summarize all the points he proposes. According to this author, the most important thing is to try to prevent conflict. The staff and social worker in the facility for seniors already know how to predict the behavior and reactions of clients at a certain level, therefore they know how to predict the development of the situation and know the stimuli and activities that could provoke the client. Most often, in such unpleasant situations, seniors feel fear, shame, embarrassment and sometimes even pain. In such an experience, the reaction of the senior can be in the form of escape or defense. When running away, it is important not to discuss the situation further with the senior, because our efforts to solve the problem may provoke a reaction from the client in the form of aggression. The next point describes the ideas of the staff, which often come into conflict with the clients. When working with a client in senior age, it is necessary to realize what we want to achieve and the approximate time to achieve the goal. If we have planned to achieve a goal with a senior client in too short a time, we get stressed if it is not fulfilled, which can cause anxiety in us. Time pressure and slippage can be worrying in this case, moreover, the client may not necessarily understand our goals and may not consider them important either. The social worker should therefore be aware of the wishes of the clients and try to accommodate them as much as possible in the facility. On the other hand, however, the social worker must also comply with the facility's standards and e.g. arrange for the client's bath through the caregiver in cases where he vehemently refuses. When the client expresses himself aggressively, even in such a case, it is necessary to remain calm and not exert opposing force or not to enter into a conflict with the client. Despite the fact that a person has a tendency to fight or run in the event of an offensive action, it is necessary from our position not to escalate the conflict and aggression. Even before a direct explosion and aggressive or attacking behavior, we can stabilize the escalation of unrest with an appropriate reaction after identifying non-verbal expressions that may signal impending aggression. If the client gesticulates conspicuously, stomps his feet, looks straight into our eyes, bangs on the furniture, clenches his fists, has tics, or behaves unusually, there is a high probability that he is dissatisfied with something and needs to be calmed down. Calming influences on the client can be verbal and non-verbal. Among the non-verbal we include slowing down the pace of speech, a calm way of speaking, reducing gesticulation and avoiding topics that could be unpleasant. Verbal influences include directly asking about the client's needs, asking about the reasons for anger and the situation.
Most clients respond positively to interest in their person and represent, in addition to solving the problem, a way to establish a relationship with the client. Sometimes, however, it can be beyond our power to handle the client's inappropriate behavior, and therefore we should not hesitate to call on a colleague for help. The reason does not have to be only the physical superiority of the client, but also the usual effective methods of the colleague and mutual support. However, if we call someone else to help, we should assure the client that he can leave the situation at any time. Clearing the "air" is sometimes more appropriate than suffering an injury. It is more appropriate to wait until the client gets out of trouble and after some time open the problem again.
In the case of clients with impaired communication, it is possible to alleviate the situation, e.g. holding hands, smiling and spending time together, which will significantly shift the atmosphere and the problem towards its mastery. However, we should also perceive the human side of how a social worker regularly solves clients' problems. A social worker is also just a person who can experience a post-traumatic reaction after the aggression of his client. This is when a conversation with a colleague is the best help, who can provide us with the necessary help and support and learn from the situation and take into account new findings in the intervention plans. The final stage in dealing with aggression is to document the client's aggression. Our memory does not always have to be 100 percent when it comes to remembering the details of the incident, and therefore it is advisable to document the case in written form so that it can be accessed again if necessary to clarify the details (Venglářová, 2007). Problems in communication and interaction can also appear later, and if, despite talking about the incident, there was no correction, clear rules need to be established. It is naturally unpleasant for a social worker if a client repeatedly curses, physically attacks, or attacks and destroys property or other clients. Such behavior is inadmissible and cannot be tolerated, and the next conversation with the client should be conducted only by a person whom the client respects. It can be a nurse, doctor, facility manager, etc. (Mlýnková, 2011). With seniors, however, it is necessary to a certain extent to tolerate their possible signs of verbal aggression. Even if many directors of facilities for the elderly and social service homes do not admit it, elderly clients often suffer from depression. Naturally, directors or social workers are not to blame for these depressions. Depression is the most common negative phenomenon we encounter in older people. When we talk about depression, we are talking about morbid sadness, anxiety, inner tension, apathy, depression, low self-esteem and fatigue. These accompanying signs and manifestations of depression are related to overly self-critical assessment, exaggeration of one's own failure, or one's own inappropriate reaction. These signs may be related to an excessively critical evaluation of the situations in which the client gets and got into during his stay in the facility.
Depression, according to its English name "despirit", takes away a person's spiritual power to live and deforms the client's social life. As social workers, we should be on the lookout for depression in clients of a facility for seniors, because first and foremost we are concerned with ensuring care, satisfaction and the best possible quality of life in the facility. In the very issue of the phenomenon of aggression and aggressive behavior, depression is a possible trigger of aggression, because depression is often preceded by a feeling of hopelessness, dissatisfaction with life, while a person reacts to this feeling by resisting, which we can often see as aggressive manifestations. However, the client can also react to the mentioned feelings with apathy, in which case the client stops showing interest in his surroundings and falls into severe melancholy, where his activation becomes significantly more demanding (Křivohlavý, 2011).
Author: PhDr. Roland Sivok
List of references
KŘIVOHLAVÝ, J., Aging from the point of view of positive psychology – the possibilities that await, Grada Publishing 2011, ISBN978-80-247-3604-4
MATOUŠEK, O., KOLÁČKOVÁ, J., KODYMOVÁ, P., Social work in practice – specifics of different target groups and work with them, Portal Praha 2005, ISBN 80-7367-002-X
MLÝNKOVÁ J., Caring for the elderly – textbook for the field of social work, Grada Publishing 2011, ISBN 978-80-247-3872-7
OLÁH, M., et al.: Methods of social work in practice, Bratislava: VŠZaSP st. Alžbety in Bratislava, 2012. ISBN 978-80-8132-039-2
VENGLÁŘOVÁ, M., Problematic situations in the care of seniors – a guide for health and social workers, Grada Publishing 2007, ISBN 978-80-247-2170-5