AVANCES DE INVESTIGACION

Broadening the possibilities of reformulating a project in oldage: A proposal of approach

Franco Garritano* & Florencia Aldana Gastaminza**

* Professor in Psychology (UNLP). Member of the research projects. E-mail: frangarritano182@gmail.com

** Professor in Psychology (UNLP). Member of the research projects. E-mail: florgastaminza@gmail.com

Introduction

The meanings that have circulated, and still circulate, around old age, often assign a negative charge, postulating this stage of life as a period biased by lack: production, vitality, possibilities, resources, contributions, of time. Conceptions about those who cross this age group are usual subjects with inventive possibilities to do and think limited, interests already realized and difficult to incorporate in radical changes that characterize the contemporaneity. That is to say, historically, most of us have visualized old age as a certain type of irreversible and unfavorable change according to a decline in vital functions, which is understood in a course linked to the passage of time (Ferrero, 1998). The very concept of old age appears as "place of arrival", as a terminal station where the only expectation is death (Petriz, 2007). The background lies in that old age is felt as a micro-time to be quietly traveled, waiting for an imminent final state, anticipated by deterioration and decline, where the focus and social perception is already focused on future generations, in relation to the legacy that these elders can give as gifts.

The analysis then has been focused on the painful confrontation between the subject and a new dimension that crosses time, body and social roles (Petriz, 2008). In this way, time passes to be tinged with a personified very finely, limited to the time that remains to live. The body, on the other hand, assumes a new figuration by the physical changes, internal and external, that causes some restrictions as well as impacts by the emergence of self-images unknown until then. And in the same way, the cessation or diminution in genitoras functions, providers, labor, etc. Turning to more reserved statutes in relation to those historically performed, implies a new significance in social roles.

Then we agree that there has historically been a negative and deficit consideration of aging associated with involutions, functional constraints, biological processes and as the last section of life soon to end, thus generating limited representations and imaginaries and tinged with prejudices about the inventive possibilities of the gerontes. The potentiality to act on their own lives and that of their peers within the gears of a subjective and creative production, is thus neutralized by criteria linked to losses and not to possible transformations.

The political and historical reasons related to the cause of the consolidation of these meanings around old age and fundamentally "the old ones", exceed the interests of this work. However, it is necessary to rescue them because they are the reason for the classic configurations and the vestiges of current shadows that continue to fall and operate on the inventive power that nests in the aging process.

On the contrary, from our professional training in Piscology as agents of Mental Health, we consider that the period of old age is a vital moment and fundamentally a process, where multiple psychic jobs come into play since there are many novelties that have to be elaborated. Conceiving aging as a process and not as a stage, implies not only a consideration on the diligence, dynamism and eventual value that this vital moment has, but also an ethical positional taking in order to reflect and act on a new way of working and learn from, for and with them. That is to say that we opt for a dynamic, open and fundamentally exposed to possible resignifications and changes of subjective positions within the activities developed in group devices specifically tailored to promote the empowerment of the subjects' possibilities.

Based on these considerations on aging, we take homologously as a process also the orientation, thus founding the two essential edges to diagram the activities. We start from the theoretical approach of the Operational Theoretical Model in Orientation (Gavilán, 2006), which conceives orientation in a broad and comprehensive sense, understood in terms of a process throughout life that allows interventions at different moments of transitions or changes related to problems of choice to provide answers to these new demands and challenges that arise in the current context.

This not only contributes to the paradigm of Mental Health that seeks to promote the best and greater possibilities of choice and service on the dimensions of health and education, but it is a contribution to socially repositioning the Germans as citizens with rights, possibilities and fundamentally, a time to come not limited to the static but to the productive-inventive from the joint participation. And when referring to productivity and invention, we mention the possibility of learning from them, linking conceptions between generations, experiences and desires through joint activities whether playful, formal, situational, group, individual, etc. In the same way, we believe that when thinking about the "stimulation" that seeks to promote these institutions, it must be understood in any case not as the simple granting of accumulated experiences or a simple increase of resources, but it lies in an inventive power, creative and able to produce an event that founds what never was before, establishing a new subjective order (Lewkowicz, 1997).

This approach allows us to think precisely about new strategies and intervention modalities when working in institutions for care and stimulation of older adults, which will be exposed below in the framework of the project mentioned above (presented to a day center for adults senior citizens of the city of La Plata in 2017) as an innovative proposal in the exercise of activities and educational workshops.

Theoretical Operational Model in Orientation

The Operational Theoretical Model in Orientation defines the orientation as:

"the set of strategies and tactics employed by the psychologist and / or psycho-pedagogue specialized in Orientation so that the orientated or subject of the Orientation, individually or collectively, through a comprehensive, reflective and committed attitude, can develop an educational, work, personal project and / or social throughout life " (Gavilan, 2006: 194).

It is based on three axes that make up the classic "guiding trilogy" articulating with each other (Gavilán, 1996): processes, social imaginary and prevention.

First, we conceive the process in its three aspects of macroprocess, microprocess and specific process, which refers to the different ways of intervening from the orientation in the life of the subjects individually and / or collectively. We thus distinguish the macroprocess, which implies that the sociocultural environment influences their choice and their life, so that the subject does not elaborate an isolated project. The microprocess is defined in those significant cuts within the continuum, in which the subject must make a choice. And finally the specific process, is that intervention carried out individually or in groups with those subjects who need a more personalized intervention at the time of the election.

Secondly, prevention includes the three levels of Gerald Caplan (1980), that is, primary, secondary and tertiary prevention. Specific prevention and multiple non-specific prevention are the strategies chosen to perform; the first one aims at prevention based on the symptom and the second is aimed at modifying aspects that make up lifestyle, habits and attitudes.

Last but not least, the social imaginary is included. This is shaped by social imaginary meanings, which orient and soak institutions, producing senses in the subjectivity of social subjects as itinerant fragments of them (Castoriadis, 1989). In this sense, the imaginary produces ways of doing, thinking and feeling of all the citizens, crossed by discourses and expectations.

This model allowed us to think about the traverses that involve the gerontes in their social development, and from which to understand the implications when thinking about strategies to guide institutions to empower and accompany them in movements of care and stimulation-creation. In a time when ideas, representations and roles begin a resignificative course, personal choices take a differential status from which it is possible to work strategically from mental health, so that new subjective elaborations, mediated by historical and group communication, emerge in disruption to the classic conceptions that even the elderly themselves have become accustomed to believe. From there, the motivation towards educational workshops and activities that are pledged by groupality and mutual recognition also emerges, thus recovering the nuclei of communication, narrative and social support. The orientation, then, is based on political pillars that assume the imaginary socio-historical dimensions that go through the aging process and in preventive consents of promotion in relation to population mental health.

Aging Process

We then return to the conception of aging understood as an active process, given that it allows us to account for the particular and subjective interweaving of each subject and its history (Ferrero, 1998). All this implies a psychic reorganization with respect to the identification check made by the Ego as a psychic instance, based on the work of historicization and the work of mourning. This process of reorganization is the concrete possibility of retaking contact with the experiences and beliefs of life in order to elaborate, subjectively and accompanied, a singular synthesis to resignify the vital moment where it is.

The specificity of the aging process lies in the fact that it confronts people with multiple losses associated with narcissistic bastions, links, socially acquired positions, autonomy, etc., in a body that confronts them with the timeless unconscious desire referred to what they feel that wants to do and can not. It is a stage where the duels and changes to be made come from all fronts: the body, the social position, the image, the links, the relationship to work, the unrealized projects, etc.

In this sense, the process of historicization has a central value in the processing of changes imposed by old age. The Ego has the task of transforming the partial documents of memories into a construction that provides the sensation of temporal continuity: "I am still the same despite the changes". The history of the subject allows to establish a relationship between chronological time and the subjective register, creating a coherent history in which it is recognized beyond the changes.

For this psychic work to be possible, it is necessary that in society spaces be provided for the identificatory reconstruction, which allows the old age not to be lived as a "stage", anguishing, inert, linked to the impossibility and limitation historically conceived. It is in this sense that the work of psychologists takes on a relevant and innovative value to design these spaces that propitiate and enable the creation of new forms. Through the thoughtful and thinking approach to the process that transits and crosses the subjects, it is possible to configure inventive spaces for the spiritual memory and narrativity of the lived and imagined forms of existence to live, in a device that favors communicating and sharing as axes dialectics about the psyche in its process of historicization.

Psychologists in the field of the gerontes

The study on old age, since the twentieth century, has taken great relevance from the different disciplines since population aging is a factor that poses new scenarios and challenges to science and society in general, calling both the production of scientific knowledge as the implementation of accompanying political measures.
Psychology is no stranger to these new discoveries and attempts to address the aging process, and it is from this position framed from the paradigm of complexity, that the role of psychologists becomes essential to contribute to the well-being and development of the population, always positioned from an interdisciplinary ethical approach and aiming at the design of integral strategies.

In recent years, resources and intervention spaces have been diversified and expanded, where mental health professionals are influencing. The psychologists, from the contributions of Santamaria (2004: 9), have different areas of intervention and possible participation:

• Functional, cognitive, psycho-affective, social and personality evaluation.

• Psycho-stimulation, validation and reality orientation therapy with people suffering from cognitive impairment and / or dementia.

• Intervention in residences and day centers.

• Psychological support in palliative care.

• Evaluation and neuropsychological rehabilitation of language and other cognitive functions.

• Memory training programs.

• Training programs in social and emotional skills.

• Emotional support groups with relatives of Alzheimer's patients and other chronic pathologies.

• Treatment of incontinence and sleep disorders.

• Selection, training and prevention of stress in professional caregivers.

• Information, training and emotional support of informal caregivers.

• Programs of Psychomotricity, Music Therapy and Body Expression.

• Reminiscence and validation therapies.

• Environmental treatment of demential symptoms (disorientation, wandering, delusions, hallucinations)

• Evaluation of institutional environments.

• Prevention and coping with suicide and geriatric depression (behavioral, cognitive-behavioral, interpersonal, psychodynamic models).

• Design, planning and evaluation of social programs (social support, volunteering, intergenerational coexistence.

The possibility also present of intervening in residences and day centers appears as the foundation that allowed us to think about making contributions for the practice and theory in the field of the elderly in general, and in an institution functioning as day center in the city of La Plata, in particular. The tools and possibilities to intervene are very diverse and are subject to the particularities of the institution and the recipients. Based on our expectations and the pretensions of day household authorities, a team study was undertaken to create the most viable activities, educational workshops and measures to be developed in view of the contribution on the orientation and mental health of the center's users.

Project presented to Day Center for Older Adults in the City of La Plata in 2017

We start from conceiving the specificity of the day centers, as devices typical of today's society, which seek to move away from more "depositary" and welfare conceptions typical of geriatrics, asylums, residences and other classical modern institutions. The day centers are destined to the feeding, control and maintenance of the health, hygiene and ambulatory recreation of older adults with self-assessment or average dependence. The purpose of these establishments is based on avoiding prolonged hospitalizations in order to prevent the dissociation of the same from their family and / or social nucleus.
The place occupied by the team of psychologists in this particular institution consists of an attendance of two days a week, in 6hs divided according to the educational workshop to be developed. The functions performed are limited to the deployment of the group educational workshops and the activities involved, as well as their planning and subsequent evaluation. The tasks referred to the transfer, disposition and convocation are carried out together with the nursing staff and assistance that the organization has. In the same way, the nursing professionals as well as the transitory doctor, are participants in the final evaluation process to have their respective opinions given their training, particular activity and time spent with the users.

Foundation of the educational workshop

The educational workshops offered for the Day Home are set up with the objective of being spaces for the elderly to reconstruct their identification project, directing them to invest new wishes, in tune with a group of peers and professionals accompanying them.

From our theoretical conception, the psychic apparatus is conceived as an open system with a tendency to self-organization, that is to say, it is a construction throughout the evolution. The subject is not constituted once and for all, neither in his childhood, nor when he acquires a more or less stable identity in adolescence. The permanence and change is what goes through the being in becoming in all stages of his life. Specifically in old age, we bet that subjects can live the "plus of life" as an active temporality, giving value to that time investing a project that keeps them linked to life and meaning content.

The value of the educational workshops as an approach modality, lies in its novel, relaxed presentation, with multiple variables to put into play, generating feelings of commitment and solidarity, dynamic and convener. Its structure seeks to be avant-garde compared to other devices because of the large amount of resources that can be used, enabling constant innovation, modification and, fundamentally, the possibility offered to the same subjects to create and deploy the same space.

In this way, we consolidate two essential characteristics of all the aforementioned that make up the proposed educational workshops. On the one hand, the possibility of including multiple educational workshops that point to different areas of interest (music, crafts, literature, theater, etc.) to be developed, and in turn, different ways of implementing them. On the other hand, the existence of transversal axes from which all the educational workshops are designed and which will serve as compasses to guide and sustain the dynamics of the same. These last axes are made up of:

• Enable the historicization work.

• Favor the unfolding of narrative identity

• Promote creative deployment.

• Strengthen the feeling of belonging to the Day Home and peer group.

• Generate an innovative space for communication and shared learning.

Design and Planning of the Educational Workshops

The design and planning of the educational workshops will be developed taking into account the psychic processes that are put into play in the aging process, in order to function as a space that can empower them. Likewise, the design will be based on our pedagogical knowledge, training and professional performance as teachers. This guarantees a perspective of approach based on contributions and specially constructed techniques to have the capacity to plan, considering in the first place the specificity of the recipients and their needs.

Beyond the circumstances that cause elderly people to arrive at the Day Home (whether they are decisions made or not), the fundamental objective is to capture interest and motivation, the desire always operative, to generate a rich and positive experience in the institution. The situation of ignorance or loss of meaning about why it is there, can deepen in the old the ideas of: old age as a period of decline, deterioration; personal ideas such as "a burden", annoyance; ideas about the institution as a "deposit".

On the contrary, by focusing on the desire and sense of being there unique of each senior citizen, it is intended that attending the Home be constituted as a new act of autonomy, producing that they themselves wish to go, finding each one the underlying motivation that the summon to build new projects.

The planning of the educational workshops has to do with this theoretical framework. However, they are open to change depending on how they work in that particular group and its singularities. The aim is to carry out evaluations on how they felt in the educational workshop, what they would change, and to propose that they themselves develop their ideas for the design of future educational workshops.

To finalize and with respect to the themes that would constitute the educational workshops, we enumerated a series of alternatives that we considered propitious to develop, from our knowledge, aptitudes and previous experiences:

• "Decorative Art": works with painting, cold porcelain, collages, wood techniques, etc. and other materials, in promotion of motor skills and making of significant figures.

• "Monthly Olympics": "say it with mime", memory games and general knowledge, board games, cards, etc.

• "Chatted Cinema": screening of films and subsequent sharing of opinions and reflections, through open debates and discussion on central themes.

• "Inscripted": read theater and staging of theatrical fragments for all those interested, in search of an explicit body-narrative activation that evokes the imagination.

• "Let's go back a little bit": making a personal notebook with stories, memories, photographs, symbolic papers, signatures, etc., as concrete materiality of its history and personified memory in a format suitable for graphic sharing and creative elaboration.

• "Tales that i tell": general oral reading of short stories (subsequent productions about it); invention of own stories and poetry (individual and group); imagination and relaxation, etc.

• "Body Movement": body stimulation from dances, games, group heating techniques, coordinated movements, etc.

• "Musical Expression": techniques of sound stimulation and musicality, identification of rhythms and sounds, singing, group productions through instrumental music used in other educational workshops, etc.

Structure of the educational workshops

Each educational workshop will have 3 moments: beginning, development, closing and evaluation. The duration of the same and the spatial arrangement to be used, are subject to the provisions of the establishment with possibilities to make the modality more flexible to the requirements. In turn, the specific planning of each workshop would be sent in advance to the directors for their review and approval. However, in general terms, the proposed times would consist of:

1) Start:

In the beginning, innovative activities will be carried out for the presentation of the participants and educational workshop participants. Likewise, a relaxed atmosphere is created favoring the conditions for all to participate, the animation and the cohesion of the group. The purpose of the meeting and the proposal are clarified.

2) Development:

The specific activity is launched, keeping track of how it develops and looking for the most appropriate dynamic possible. The intention is that throughout the deployment of the activity in question, the Germans feel increasingly comfortable and can appropriate it, proposing interventions and innovations.

3) Closure and Evaluation:

Evaluation where everyone has an opinion about the group dynamics, the production quality of the educational workshop and the coordination. Finally, a synthesis of what has been worked is proposed, with a common exhibition of the productions. An exchange of opinions is also proposed, which will seek to promote open questions so that the elderly can express their feelings about the educational workshop, how they felt before, what they expect from future meetings, what would change, etc., appealing to the educational workshops they are community spaces created and recreated by all together.

Final thoughts

As a final mention, we think it is relevant to highlight that what unites all the educational workshops, in their heterogeneity and diversity of activities that they go through, is that they point to the strengthening sense of the narrative identity (Iacub, 2011). It offers an integration of meanings and meanings of oneself, which allows the subject to see himself as a coherent whole in a future crossed by changes, losses, mutations, etc. The narrative identity allows to elaborate the novelties and to explain the ways in which a subject evaluates the changes that produce discrepancies in the identity, granting a sense of continuity, that in this particular device, allows to articulate with the shared and group experience.

That is why the proposed educational workshops are configured as an innovative alternative, in which the intersection of the dimensions of orientation and the aging process takes place in a dialectic that produces subjective movements. Psychology has much to contribute from its involvement in mental health and evolutionary moments throughout life, given its ethical commitment and discipline with the social phenomena that cross the current times.

We consider that our contribution to the therapeutic and orientative community in mental health can derive from our particular proposal -although not unprecedented in the framework of current therapeutic reformulations and extensions- as a contribution to think about specific interventions within the institutions that are resignifying in the current context. From our perspective and critical thinking about the being and doing of psychologists, we aim to promote experiences and projects in harmony with this new ethical, political and fundamentally social worldview to revalue the aging process at the population and institutional level.