Caring for Older People in the Community (eBook)

Angela Hudson, MSC (Gerontology), PG Dip HE, BA (Hons) Open, RN, Senior Lecturer, Faculty of Health and Life Sciences, University of the West of England, Bristol. Angela's background is in working with older people in rehabilitation settings. Her interests lie with long-term conditions and their impact on the older person's health and well-being. She is currently Project Lead for a Blended Learning Project within the university focusing on the provision of education for long-term conditions. Angela has been involved in a number of projects including the facilitation of Action Learning Sets with four groups of community matrons. She is currently working with two local primary care trusts to deliver case management workshops. Lesley Moore, MA, RN, Diploma of Nursing (Wales), Cert Ed (FE), RNT, Florence Nightingale Scholar, Fellow of the Higher Education Academy, Churchill Fellow, National Teaching Fellow, FRSA, Senior Lecturer Faculty of Health and Life Sciences, University of the West of England, Bristol. Lesley's background was in intensive care and recovery nursing for both the NHS and military sectors before becoming a clinical teacher and a nurse teacher. After majoring in social ethics, Lesley's research interests have focused on ethics and work-based learning. As an informal carer, she supported a close relative at home having renal haemodialysis. As a result of this experience, she is aware of the vulnerability of the older person with a long-term condition being cared for in the community during the transition of change in the NHS.

Caring for Older People in the Community 1
Contents 7
Contributors 11
Foreword 15
Preface 17
Introduction 19
Section 1: Past and current influences on practice 21
Chapter 1: Historical perspectives from past to present 23
Introduction 23
Family, kinship and older people 23
The welfare state, older people and the changing role of institutions 28
Towards Care in the Community 34
Modernisation muddles 40
Conclusion 42
References 43
Chapter 2: Older people’s experiences: social context and contemporary social policy 47
Introduction 47
Social context 47
Policy as a response to needs of older people 60
Health and social care provision 67
Conclusion 74
References 75
Chapter 3: Ethical tensions for the older person and carers 81
Introduction 81
Paradigm shifts in health and social care 81
Factors influencing moral reasoning and behaviour 85
Values and beliefs 85
Significant ethical theories 87
Power versus professional perspectives 94
End of life and decision-making 98
The diversities and tensions of caring 101
Conclusion 107
References 108
Section 2: Contemporary challenges 113
Chapter 4: Healthy ageing, active ageing: the challenges 115
Introduction 115
The context 116
Active ageing 119
Healthy ageing 120
Barriers 120
Policy frameworks 123
Health promotion versus health education 124
Targeted health education for older people 127
Challenges 129
Complementary therapies 130
Controversy and cultural shifts 131
Conclusion 150
References 151
Useful websites 158
Chapter 5: Older people with learning disabilities 159
Introduction 159
Defining learning disability 159
Recent policy and people with learning disabilities 161
Impact of having a learning disability 161
Communicating with older people with learning disabilities 162
Vulnerability 165
Principles underpinning services for people with learning disabilities 166
Community services and support systems for older people with learning disabilities 166
Impact of ageing on where an older person with learning disability lives 169
Health services and older people with learning disabilities 170
Primary care 170
Specialist community learning disability teams 171
Mental health services 171
Health of older people with learning disabilities 171
Specific health issues for people with learning disabilities 173
Partnership working and consent 178
Advocacy and empowerment 179
Person-centeredness 179
Health assessment 180
Health action plans 180
End of life care 180
Conclusion 181
References 182
Useful websites 186
Chapter 6: Working with older people with dementia in the community 187
Introduction 187
What is dementia? 187
Policy context 188
Roles for nurses in the community 189
The medical view of dementia 190
Conditions often confused with dementia: delirium and depression 194
The social view of dementia 195
The citizenship view 196
Stages of dementia 196
Philosophical and ethical concerns 196
Communication 200
Assessment 204
Working with carers 207
Working with other agencies and professionals 208
Technology 209
Challenges and rewards 210
Conclusion 219
Acknowledgements 219
References 219
Useful websites 224
Section 3: Future challenges 225
Chapter 7: Future trends 227
Introduction 227
Significant trends leading to the 60th year of the NHS 228
The empowerment of patients through the Expert Patients Programme 231
Community hospitals 233
Cancer care – bringing diagnostic technology and chemotherapy treatment closer to patients 235
The National Programme for IT 236
Telecare, telehealth, telenursing and telemedicine 238
Whole System Demonstrators 244
Moving towards seamless care 245
Partnership for Older People Projects 250
Conclusion 252
References 253
Useful websites 255
Index 257