Low Self-esteem in Elderly

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Running head: SELF-ESTEEM

Low self-esteem in Elderly
"Never be bullied into silence. Never allow yourself to be a victim. Accept no one's definition of your life, but define yourself" (Harvey Fierstein). There are numerous circumstances which lead people to feel down and worthlessness. As age increases elder people are secluded and stigmatized by society that they are good for nothing. This lowers their self-esteem and isolates them from others. Self-esteem is defined as how person perceives himself. Positive self-esteem is characterized as useful evaluation of self, which makes one to feel commendable and glad. Low -esteem is characterized as negative image of self, which gives sentiments of uselessness and disgrace (Baumeister et al., 2003).
During my clinical rotation at psychiatric hospital, I encountered a 70-year old lady. She was admitted on 14-04-2014 with complain of psychosis and later diagnosed with schizophrenia. Her history revealed that she was widow and suffering from psychosis since 8 years. Patient verbalized that she feels weak, unworthy, rejected, discouraged and isolated. She is totally dependent on her family members for her activities of daily living (ADLs). She thinks that she can't do anything productive for her family and always censured by them. According to her, she is depressed because her family was not accepting her due to her mental illness. She was punctual in her prayers and helped her to cope with difficulties of life.
Self-esteem has lots of influence on our society. Human being needs appraisals and feedback to make positive perceptions about self. According to Mann, Hosman, Schaalma and Vries (2004), Positive self-esteem can prompt better well-being. Poor self- esteem is connected with mental issue and social issues. Not only that positive self-esteem helps person to build relationships with others, it also increases social interaction and abolish the feeling of loneliness. My patient had low self-esteem which made her unable her to interact with others which raised different social issues in her life.
Religion is important element in context of self-esteem. Faith in religion helps to increase strength and well-being which in turn have positive association with self-esteem. In difficult situations like disease or depression people strongly connect themselves with religion which provides them strength and boost their self-esteem. Study shows that religious practices improve physical and mental conditions in elderly (Idler & Kasl, 1997). Religion may help person to socialize with others (Belzen, 2010). As seen in my patient, she was punctual in her prayers and verbalized that prayers provide her strength to deal with her disease.
In old age self-esteem decreases abruptly (Robins & Trzesniewski, 2005). In East they believe that elderly with low self-esteem can uplift their self-esteem by performing ADLs freely which also enhance their satisfaction with life. A study conducted in Taiwan shows that when nurses assist elderly in ADLs, the feeling of disgraced and shame developed among them (Chang, 2009). In west, when there is any conflicts; they can't cope up easily and end up in disharmony, which make their self-esteem low (Rodgers et al., 2009). As in eastern context, dependency can lead low self-esteem as seen in my case scenario as my patient was weak physically. She was not able to perform ADLS and was rejected by her family which makes her self-esteem down.
Several reasons are responsible to cause low self-esteem in elderly. In old-age many events take place like loss of spouse, changes in role and physical dependence which makes their self-esteem low (Robins & Trzesniewski, 2005). If person's perceptions and feelings about themselves are negative, they feel uneasy, dissatisfied and incapable to relax which make them experience low self-esteem (Sorensen, 1998). Research shows that unemployment and less interaction are responsible for low self-esteem (Fairfax, 2014). Some of the factors were present in my patient like loss of spouse, negative feelings about self, less interaction and physically dependent which permits her self-esteem low.
Low self-esteem does not show its impacts apparently, however, it has devastating consequences on a person's life. Depression and weak inter personal relationships can develop as a consequence of low self-esteem (Orth et al., 2009). Low self-esteem may trigger suicidal ideations in older people (Jhang et al., 2014). In my opinion low self-esteem can create feelings of worthlessness and depression which was evident in my patient which further leads to less participation and makes her personality anti-social.
Self-esteem could be connected with different models. Ibrahim Maslow has proposed need hierarchy theory, in which he talks about five levels of needs. Firstly, psychological needs which incorporates the need to fulfill the crucial natural drives, for example, "food, water and shelter". Secondly, safety needs which arises once physiological needs are fulfilled. They allude to the requirement for a safe working environment (free from any dangers). Thirdly, social needs which arises once security needs are met. Social needs indicate that you feel connected with others (valued and acknowledge by others). Fourthly, esteem needs which incorporates the requirement for self-worth and endorsement of others. Lastly, self-actualization is the highest level in Maslow hierarchy. In this stage person reaches to its greatest level of potential. If psychological, safety and social needs are fulfilled then he can reach to positive self-esteem and self-actualization. To relate this model with my patient, her social needs were unmet like she doesn't feel connected to her love ones which lowered her self-esteem (Kaur, 2013).
According to vulnerability model, low self-esteem can create depression (Orth & Robins, 2013). A person with low self-esteem can become depress in lack of social support and positive regard from significant others. During discussion with patient it was evident that feeling of worthlessness make her depresses because of her less interaction with others.

To change patient negative feelings and to reduce low self-esteem we can provide several interventions at distinct levels. At individual level, different counseling sessions can be arranged for patient and their family members. As in my patient lack of family support was evident so in my opinion more meetings of patient and family would increase bonding between them. Research suggests that cognitive behavior therapy and group therapy plays a vital role in modifying patient way of thinking and problem solving skills (Jhang et al., 2014). We can encourage patient to change their negative thoughts into positive thoughts by instructing them to repeat positive thoughts in their mind and taking positive feed backs from others (Copeland, 2014). Patient can also recall any positive event of her life which provides her strength and feeling of self-worth. In my opinion we can encourage people with low self-esteem to verbalize their feelings. It was evident in my patient that initially she was not participating in discussion but when I provided proper platform and encouraged her then she started sharing. At community level, different hospitals can work together to plan some strategies for patients like certain outings which enhance their social interaction and provide them platform to ventilate their feelings. We can make different social groups which arrange different preventive programs so it may provide positive sense of being (Taft, 1985). At national level different policies and laws can be formed which provide different health facilities to elderly (Taft, 1985). In my opinion, government should build more institutions for elderly because elderly population is increasing rapidly.
It is concluded that low self-esteem is common problem among elderly and it has a huge influence on society. We can view self-esteem in different context for instance social and religious aspects. Different factors like negative thinking, loss of spouse, physical dependence, and less interaction can cause low self-esteem. Low self-esteem has lots of destructive impacts like depression and suicidal ideations. Maslow hierarchy model helps us to understand how self-esteem develops and what strategies we can provide to uplift it. I will like to end with a well-known quote that "Self-esteem isn't everything; it's just that there's nothing without it." (Gloria Steinem)
















References
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