Outcomes of Home Based Services provided to 90 Years Old Aama

(Name has not been disclosed to protect the confidentiality of our member)

When it comes to elderly people, they have a finite set of activities to perform. As was the case with Aama,  a 91 years old senior citizen.

Aama’s second son along with his wife stepped up to look after her. In due course they started to realize that the amount of time being invested on her was not sufficient. Additionally, occasional visits by their close relatives fell short of adequacy. They were aware of the ill-impacts prompted by low interactions and sedentary lifestyle. Therefore, found the need to contact Bihani for home-based service (HBS) so that Aama could engage in activities that could help boost her over all well-being.

Prior to the interventions provided through HSB, Aama shied away from having conversations with newcomers unless approached first. She also had difficulty in breathing. For her age though her physical strength allowed her to walk independently around the house.

After assessing Aama’s needs and strengths, suitable interventions were planned out. Such interventions included capacitor techniques- mainly abdominal breathwork to improve her breathing, psycho-social support or counselling so that she could feel more comfortable to talk and express her thoughts, feelings and her past experiences, Tai Chi to increase her physical mobility, reading sessions to boost her concentration, walking together to further engage her in social conversations and finally art therapy such as coloring and drawing to help improve Aama’s hand-eye coordination and making origami to help boost her memory power.

Several visits during the first phase of HSB, remarkable observations and improvements in Aama were visible. Aama was more comfortable talking with people around her. One of her daughters-in-law claimed that she was surprised to know that Aama initiated several conversations with her and other family members. In one of the visits, she even asked our team member to give her a shoulder massage, which proves the fact that she felt comfortable enough to seek help from others. Abdominal breathwork on the other hand, helped her sleep better, as she quotes “ah, malai tah abo sutna sajilo huncha.”

As second phase commenced, the team formulated interventions as per Aama’s needs. There was a special focus on abdominal breathing technique. This particular method was performed with the most frequency, adding to almost 10 sessions. It shows the necessity condition of this technique to ease Aama’s breathing

Art Therapy incorporates Coloring, Writing, Origami as an effective technique to improve Hand-Eye Coordination, neuron coordination, as well as to strengthen the grip, especially for elderly people, who are not accustomed to performing such activities. 7 spells of Coloring, 3 sessions of Writing were carried out. On the later sessions, she grew more comfortable to color more than one object at a time. She eventually developed a firm grip when practicing the aforementioned activities.       

Aama was introduced to a handful of digital games. She derived profound joy from one in particular called the Ant Smasher. Her happiness was clearly obvious by the level of excitement she exhibited. On one occasion, when one of Bihani’s team members took their phone out to take photos, she instantly reckoned with joy that she was going to play her favorite game. This in itself was a great achievement for the team as her happiness is what matters the most in the end.

Another core intervention included communication, expression, self-awareness and use of coaching game through associative cards that helped Aama to be more relaxed, expressive and have intended conversations with others. The coaching game associative cards used were from “Points of You” a creative and effective tool. In the game, Aama chose the cards of ‘ego’, ‘gratitude’ and ‘result’, and placed it on top of corners that represented past, present and future respectively. The three cards suggest that at some point in her past, she had been influenced by her ego, her current is full of gratitude, and the future holds a potential result in relation to her past and present situations. This suggests that Ratna Aama felt at ease talking about the incidents that had occurred in her life and the expectations for her future.

Other recreational activities included three sessions of book reading and TaiChi each, a couple of finger-hold session, and a session of acupressure. Soothing Music was always on in the background while performing abdominal breathing. Apart from that, she loved listening to folk songs by Narayan Gopal and Arun Lama played to her by the members of Bihani.

The third phase gave even more attention to Aama’s breathing because her son had observed vital benefits in respiration, thus suggested to perpetuate such interventions. Abdominal breath work was once again the main highlight being conducted 16 times. Signs of improvement incorporated steadiness in her posture and having deep and relaxed breathing patterns.

Befriending activities included digital game such as the ant smasher and talking tom, conversation exchange, making origami boat, airplane and fish, walking together, gardening. She was quite intrigued by cartoon characters, specifically beloved cartoon characters like Tom and Jerry. She enquired about their antics.

Capacitar techniques such as yoga (Bhramari and Udgeeth Pranayama yoga), finger holds to release emotion were also conducted with aama. The most observational changes included that of Aama’s level of communication. Aama became more receptive of her surroundings, and members of her family. She opened about her likes and dislikes, and also about festivals such as Dashain and Tihar. Also, she was impressive with her simple finger calculation skills however, had a hard time calculating negative numbers. Her ability to write her initial letter of her name in Devanagari script was admirable.

One of the new interventions that was introduced to Aama was photography. Aama was taught to take pictures in the DSLR through its basic mechanism. She took the picture of the flamingo statue that was on the table and she seemed thrilled to have known that she took the picture. She genuinely enjoyed taking pictures.

The fourth phase continued with its prime focus on Aama’s breathing, and interventions that propelled her overall wellbeing. Aama’s breaths per minute (BPM) was tracked to be deep and relaxed. The abdominal breathing technique prompted her BPM to rise from 20 BPM to 22 BPM which is considered as mean BPM for her age.

Befriending activities such as conversation exchange, walking together; introduction to a new musical instrument followed by art session which includes coloring and drawing were also included. The session for conversation exchange took place 6 times. In each of this session, Aama initiated conversation while walking together with the team of Bihani- talking about the neighborhood, the blooming flowers, the neighbors’ dogs and the warmth of the sun. In one particular visit, Aama remarked about the flowers blooming in her neighbors’ garden. She said, “kati dherai ful fuleko” with each passing session, Aama seemed to be more open and engaging in conversations. 

Another intervention saw Aama being introduced to Ukulele, a musical instrument. Aama was taught to play the instrument. Initially, she bore slight difficulty holding the instrument but eventually strum its strings up and down on her own. Aama went over two chords in particular- E minor and C major. She seemed avid when this session was conducted. She said, “Ramailo vayo. Kati majja le bajdo raichha yo ta.”

Other Capacitar techniques included Tai Chi that was conducted once, elderly flexibility exercise that includes shoulder rotation stretch, chest bend stretch, chest stretch, and knee raise was all completed, with repetition. Other intervention included emotional freedom techniques, finger holds to release emotions, acupressure which were all conducted once each in 24 visits. Additionally, yoga was also conducted to help boost Aama’s mobility to walk around the house independently. 

Aama now spends at least an hour engaging in such activities, two days in a week and is now more open and welcoming to newcomers and thrives in her element.

This article was transcribed by Sarya Thapa Magar and Pristna Dhakhwa