Caring for Older People in the Community

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.

Contributors ix

Foreword xiii

Preface xv

Introduction xvii

Section 1 – Past and current infl uences on practice 1

1 Historical perspectives from past to present 3
Robin Means

Introduction 3

Family, kinship and older people 3

The welfare state, older people and the changing role of institutions 8

Towards Care in the Community 14

Modernisation muddles. 20

Conclusion 22

References 23

2 Older people's experiences: social context and contemporary social policy 27
Tina Fear and Grace Boddy

Introduction 27

Social context 27

Policy as a response to needs of older people 40

Health and social care provision 47

Conclusion 54

References 55

3 Ethical tensions for the older person and carers 61
Lesley Moore

Introduction 61

Paradigm shifts in health and social care 61

Factors influencing moral reasoning and behaviour 65

Values and beliefs 65

Signifi cant ethical theories 67

Power versus professional perspectives 74

End of life and decision-making 78

The diversities and tensions of caring 81

Conclusion 87

References 88

Section 2 – Contemporary challenges 93

4 Healthy ageing, active ageing: the challenges 95
Angela Hudson, Jane Buswell and Natalie Godfrey

Introduction 95

The context 96

Active ageing. 99

Healthy ageing 100

Barriers 100

Policy frameworks. 103

Health promotion versus health education 104

Targeted health education for older people 107

Challenges 109

Complementary therapies 110

Controversy and cultural shifts 111

Conclusion 130

References 131

Useful websites 138

5 Older people with learning disabilities 139
Kim Scarborough

Introduction 139

Defining learning disability 139

Recent policy and people with learning disabilities 141

Impact of having a learning disability 141

Communicating with older people with learning disabilities 142

Vulnerability 145

Principles underpinning services for people with learning disabilities 146

Community services and support systems for older people with learning disabilities 146

Impact of ageing on where an older person with learning disabilities lives 149

Health services and older people with learning disabilities 150

Primary care 150

Specialist community learning disability teams 151

Mental health services. 151

Health of older people with learning disabilities 151

Specifi c health issues for people with learning disabilities 153

Partnership working and consent 158

Advocacy and empowerment 159

Person-centeredness. 159

Health assessment 160

Health action plans 160

End of life care 160

Conclusion 161

References 162

Useful websites 166

6 Working with older people with dementia in the community 167
Mary Marshall

Introduction 167

What is dementia? 167

Policy context 168

Roles for nurses in the community 169

The medical view of dementia 170

Conditions often confused with dementia: delirium and depression 174

The social view of dementia 175

The citizenship view 176

Stages of dementia 176

Philosophical and ethical concerns 176

Communication. 180

Assessment 184

Working with carers 187

Working with other agencies and professionals 188

Technology 189

Challenges and rewards 190

Conclusion 199

Acknowledgements 199

References 199

Useful websites 204

Section 3 – Future challenges 205

7 Future trends. 207
Lesley Moore and Angela Hudson

Introduction 207

Signifi cant trends leading to the 60th year of the NHS 208

The empowerment of patients through the Expert Patients Programme 211

Community hospitals 213

Cancer care – bringing diagnostic technology and chemotherapy treatment closer to patients 215

The National Programme for IT 216

Telecare, telehealth, telenursing and telemedicine 218

Whole System Demonstrators 224

Moving towards seamless care 225

Partnership for Older People Projects 230

Conclusion 232

References 233

Useful websites 235

Index 237