Esther Zeller, December 1, 2005



“An Elder is a person who is still growing, still a learner, still with potential and whose life continues to have within it promise for and connection to the future. An Elder is still in pursuit of happiness, joy and pleasure and his or her birthright to these remains intact. Moreover, an Elder is a person who deserves respect and honour and whose work it is to synthesize wisdom from long-life experience and formulate this into a legacy for future generations.”

J.C. Weiss

Many senior adults or elderly individuals sustain losses and deficiencies from physical and cognitive disabilities.  When these losses and deficiencies change the senior adult’s existing environment into one that lacks safety and is no longer feasible, greater dependency on others for care and survival becomes crucial.  At this point in an elderly individual’s life, he or she may find the accommodations of a long-term care facility necessary.

As a person ages, one’s relationships to others continues to effect one’s image and concept of one’s sense of self.  Although the circumstances of incurring losses and relocating to a long-term care environment are unique for each elderly individual, the frequent result is an erosion of the senior adult’s sense of self.  It is essential that effective therapeutic interventions be used to help construct an atmosphere with a richer quality of life that will help return some lost sense of self to the senior adult in these circumstances

Canadian senior adults who lived in long-term care facilities in 1996/97 totalled 184,300.  This number comprised 5% of all Canadian senior adults who were 65 years of age and older and 18% of all Canadian senior adults who were 80 years of age or older.  Although this percentage shows that a majority of Canadian elderly did not live in long-term care facilities, it is still a significant number of people and it is estimated that by 2031 the number of senior adults living in long-term care could range from 565,000 to 746,000.

Long-term care facilities for the elderly have changed significantly from its first beginnings.  The emphasis has changed from the biomedical model, to a more holistic view of the resident, to the biopsychosocial model.  There is now much more importance given to the elderly individual’s personal experience, behaviour, relationships and culture to increase their quality of life and not just focus on survival of life.

Presently LTC facilities range from residential houses with 15 residents, to huge multi-storey buildings that accommodate hundreds of elderly individuals and couples.  The level of care ranges from independent living with meal services, laundry, programs and medical monitoring, to secure hospital wards with 24 hour nursing and medical attention. The economic level ranges from government subsidies and under $1,000.00 a month to over $8,000.00 a month.

The kinds of problems the elderly individual brings into long-term care can be grouped into the general category of losses.  There is the loss of familiarity from previous living arrangements, where cherished items and memories remained that the senior adult probably accumulated over a period of time.   This loss of familiarity could add to a feeling of alienation.   The loss of past relationships with friends and family could create tremendous loneliness and add to a feeling of isolation and anxiety of socialization.  The loss of past daily activities and daily structure could add to a feeling of disorganization and chaos.  The loss of physical wellness could also contribute to altering a senior person’s positive self-image.

Living in LTC could also contribute to a loss of independence, autonomy and decision-making.  Add all of these losses to the possible loss of memory; add depression and apathy and what remains is little of who the elderly individual remembered him or herself to be.  The senior adult becomes alien and foreign to him or herself.  With all of these losses, the individual’s self-image, self-esteem or sense of self, may start to erode and disintegrate.  The senior adult in LTC may find him or herself in a deep depression and feel that he or she is in a losing period, end stage and shouldn’t bother anybody with his or her concerns and frustrations, but just wait quietly for death.  The thought of seeking psychological help could be considered a weakness and taboo.

A senior adult’s 3 most common reasons for entering a long-term care facility are, physical disability, depression, and cognitive disability.  The most common physical disabilities of the elderly are heart disease, stroke, cancer, incontinence, kidney disease, diminished mobility and dexterity, arthritis, and bone fractures from falls.  Although the partial or complete loss of verbal communication is often one of the losses resulting from stroke, it can be considered a debilitating category on its own.  Aphasia is the loss of knowledge of words and dysarthria is the loss of physical ability to speak.

Depression, frustration and at times aggression may be linked to isolation, dependence and loss. Depression decreases mobility and social interaction thereby placing the person at risk for physical, psychological and social impairment.  This increases death and morbidity.  Depression is found in 15 to 50 percents of residents in long-term care depending on how depression is defined.

Cognitive impairment refers to a loss of previous mental abilities and can include problems with orientation, concentration, memory, language, calculation, insight and judgment.  Executive functioning diminishes.  This is the ability to plan, sequence and integrate abstract information needed to carry on with daily living.   Dementia including Alzheimer’s disease is one of the most pervasive conditions leading to cognitive deficiencies afflicting the senior adult in LTC.  Dementia usually results in a reduced ability to perform daily activities and in most cases leads to the need for care.  Dementia afflicts approximately 5% of 75-79 year olds, to more than 20% for the 85-89 year-olds.  Every third person over 90 years of age suffers from moderate or severe dementia.  Over 50% of those in long-term care suffer from this disorder.  Memory loss is a pervasive component of the above conditions and is most likely a contributing factor to isolation, depression and loss of self in the elderly in LTC

It is possible to preserve and partially improve mental capacities and coping skills that are affected by dementia with daily activities that delay the onset of behavioural disturbances and reduce caring time.  Art therapy would be one tool that may help to stimulate and preserve mental capacity.

What is important is the need to establish an intimate relationship between the senior adult and a therapist that will meet the needs of the elderly individual.   Verbal therapy  alone with this population may not be as effective as art therapy, which blends visual and verbal therapy to establish the best level of emotional and psychological functioning for the person.

The Older Adult has a long life of experience to draw from.  The greatest challenge the aging person has is coping with his or her losses, and reassessing his or her capabilities.






Loved ones

Movement (stroke, Parkinson’s)



Hearing impairment

Lose ability to:


Visual impairment

Process info.


(macular degeneration, cataracts)

Understand info.



Learn info.


ADL (activities of daily living)

(executive functioning)


Speech (aphasia, dysarthria)




  • Proper nutrition and hydration
  • Consistent and carefully monitored medication
  • Physical exercise
  • Mental exercise
  • Social interaction



  • Choices
  • Decisions (Autonomy)
  • Accomplishment (Self-esteem)
  • Social interaction; individual or group
  • Exercising mind and memory with associations (Using one’s past experiences and one’s imagination)
  • Exercising OADL (Other Activities of Daily Living: Listening, Independently acting on instructions given.)



  • Stimulates memory
  • Provides an environment for reminiscence and life review
  • Develops a sense of community through social interaction
  • Reduces loneliness, depression and anxiety
  • Offers opportunity to express feelings about aging, illness and loss
  • Increases ability to focus
  • Increases feeling of accomplishment and energy level
  • Engages care providers to feel pride with visual accomplishments of the older adults