Nursing Older People

Realities of Practice

Heather Elbourne, Andrée le May, Heather Elbourne, Andrée le May

• Publisher: Taylor & Francis
• Year: 2019
• eBook ISBN: 9781498735209
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

This practical guide helps student and practising nurses to understand the impact of their care when working with older people. With stories from older people who have had varied experiences of health care and nursing, chapters are underpinned by five key principles: providing patient-centered and dignified care, shared decision-making involving family and friends, multidisciplinary care, improving well-being through companionship and a sense of value, and an appreciation of both the challenges and rewards of working with older people.

This book offers:

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• Stories which reflect the complexity of care and health experienced by older people and their journeys.

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• Topic-oriented chapters which provide a series of evidence-based readings which use the most up-to-date research evidence merged with national and international policy and practitioner experience.

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• Practical tips and key messages for working with older people.

The volume can be used to help nursing students and practising nurses to understand better how their care might impact positively on older people's health and well-being. This situates the reader within the world as experienced by older people.

1 About this book

Andrée le May and Heather Fillmore Elbourne

This book is guided by the following principles:

• Older people should receive dignified care; in order to do this care must centre around the person.
• Families and friends need to be included in care and care decisions to minimise isolation either of the older person or of the family member/friend.
• Older people require care from multidisciplinary teams, and nurses need to form an integral part of these teams.
• Companionship and feeling valued can increase feelings of mental well-being, and these are important parts of nursing care.
• Nursing older people can be challenging but also vastly rewarding.

Our aim is to help nursing students and practising nurses to understand better how their care might impact positively on older people’s health and well-being. To do this, we have decided to first situate the reader within the world as experienced by older people by describing key facts about the ageing population, their health, and nursing (Chapter 2) and telling some stories based on older people’s experiences of health and social care (Chapter 3). We believe that this approach will make it easier for readers to understand the impact of nursing and how nursing can be best structured if nurses start from the client’s and their family’s perspectives. Stories are a powerful way of showing what life is like for people in different circumstances, and we use them in the remaining chapters to develop empathy and understanding related to clinical situations. We have deliberately chosen stories that focus on the common difficulties of older age and emphasise that nurses form part of a team of health- and social-care workers.

One of the greatest fears expressed by older people is what will happen to them as they become functionally, physically, mentally, and/or socially more dependent on others as they grow frailer and less able to do the things they used to do. For many older people, and their families, friends, and carers, this change in independence brings with it unfamiliar risks and challenges. Understanding and managing such risks may be one of the most daunting aspects of ensuring that care is truly person-centred and works for the benefit of each individual person. In Chapter 4 Imogen Blood explores risk taking and risk management. We have deliberately situated this chapter early in the book since we believe that understanding and managing risk sensitively is crucial to the provision of high-quality care and the promotion of increased quality of life.

This book is not a comprehensive textbook of elderly care/geriatric nursing; rather we have picked commonly occurring consequences of the ageing process to explore how nurses might provide evidence-based, person-centred, responsive care to older people in these circumstances. In Chapter 5 we focus on the notion of staying healthy in older age by covering topics such as exercise, mental agility, and social interaction. This is complemented by Chapter 6 where Khim Horton focuses on common difficulties experienced by older people including falling, incontinence, loneliness, and pain. In Chapter 7 Samuel Searle and Ken Rockwood discuss frailty as an independent geriatric condition that includes both physical and psychological decline and too often goes unnoticed as symptoms are attributed to the ageing process. This chapter is essential to nurses as the ability to identify frailty in its early stages is key to developing specific interventions that may delay or prevent further functional decline and other negative outcomes—such as acute illness, falls, hospitalisation, and death. Catherine Evans and Caroline Nicholson discuss end-of-life care in Chapter 8 making the critical point that dying and death are integral components of living in older age.

In these issue-specific chapters (4–8) experts have provided evidence-based readings using the most up-to-date research evidence merged with national and international policy and practitioner experience to highlight the best practice that a nurse can deliver in conjunction with the patient, their family, and the multidisciplinary/multi-agency team. We have deliberately used a blend of evidence sources—from patients, families, and clients; from the research literature; from policy directives and clinical guidelines, and from best practice and education to reflect the ways through which practitioners learn and function. Our thoughts on what comprises good practice are based on the concept of ‘mindlines’ (Gabbay and le May, 2004, 2011)—internalised, multiple sources of evidence, which are collectively reinforced, partly tacit, guidelines-in-the-head that clinicians use to flexibly guide and develop their practice.

We conclude in Chapter 9 by drawing together key points from the previous chapters which we believe will help nurses to understand better how their care might impact positively on older people’s health and well-being.

References

1. Gabbay J and le May A (2004) Evidence-based guidelines or collectively constructed “mindlines”? An ethnographic study of knowledge management in primary care. British Medical Journal 329 (October 30) 1013–20.
2. Gabbay J and le May A (2011) Practice-Based Evidence for Healthcare: Clinical Mindlines. Routledge, Abingdon.

2 Thinking about the ageing population

Heather Fillmore Elbourne and Andrée le May

Introduction

As more and more people live longer their chances of needing care increase. There are several reasons for this which largely focus on the individual older person, their lay carers/families, and/or their environmental/social circumstances. An older person may need more care when acutely ill than they did when they were younger; or they may be generally frailer in older age and need more help and support with activities of living and staying physically and mentally well; or they may not have familial or social support readily available; or they may be living with long-term, often multiple conditions that require continuing care and support. Each of these circumstances, taken individually or together, will impact on a person’s physical and mental wellness.

Knowing more about ageing and its impact can help nurses to positively affect the health and wellness of older people (Andrews et al. 2015, Nunnelee et al. 2015), so before we think more about providing care and support to this group there are a few key facts that we need to consider. First, changing demographics means that there are more older people than ever before in almost every country in the world—older people are the fastest growing demographic cohort in the world (WHO 2015a). Second, older people are not only living longer, but they are also living longer with more complex health- and social-care needs (Wolff et al. 2002, Abellan van Kan et al. 2010, Rockwood and Mitnitski 2011). Third, there is both subtle and blatant ageism around us all in our work and everyday lives, and nurses need to understand how that might impact on older people and their care and how to minimise or, preferably, erase ageism by challenging negative stereotypes (Martin et al. 2009, Officer et al. 2016). Fourth, increased numbers of older people, with more complex health- and social-care needs, require increased levels of skilled nursing care; however, finding such nurses in sufficient quantities is becoming increasingly challenging. This chapter is largely about these four things.

Population ageing

Worldwide our population is ageing at an unprecedented rate. Globally, there is an increasing number of older adults alive, and they are living longer than at any other time in the history of humankind (Rechel et al. 2009, WHO 2017). Evidence from the World Health Organization (WHO 2009a) tells us that, on average, most people can expect to be alive and healthy into their 60s and beyond (Box 2.1). Our global population is ageing and growing due to a reduction in global death rates and birth rates: this has social, health, and economic consequences that we have not faced before.

Box 2.1 Some population facts (WHO 2009a, WHO 2015b, 2017)

The world’s population is growing and ageing:

• Between 2000 and 2015 global life expectancy rose by five years—this is the fastest rise in human lifespans since the 1960s.
• Globally average life expectancy is 71.2 years. For women, it is 73.8 years, and for men, it is 69.1 years.
• Actual life expectancy varies amongst adults and countries, with Japan having the most extended lifespan at 84 years and Africa having the shortest life expectancy of 50 years (although this is increasing).

Simultaneously, at the opposite end of life:

• Fertility rates have declined in most countries around the world due to social changes such as the emancipation of women, growing economic prosperity, the availability of birth control, medical advancements, and public health campaigns.
• Worldwide, although a minority of nations have increasing fertility rates, globally fewer babies are being born.

Whilst the significant increase in life expectancy means that there has been an overall improvement in health and living conditions around the world it brings with it several challenges for those involved in making health- and social-care policy and delivering care.

‘Population Ageing’ has become a standard idiom of our time and refers to the entire population growing older. Unlike individual people who age with each passing birthday, populations age when the percentage of young people in the population is less than the percentage of older adults in the population i.e. when fewer children are born than there are adults alive. Population ageing results in:

1. an increasing number of older people in our societies;
2. a reduction in the proportion of children;
3. a decline in the proportion of people of working age (~16–60 years) who can support those who do not work (WHO 2009a).

This demographic shift influences many of our societal, moral, and economic trends. For instance, it is unlikely that the increased numbers of older adults needing care and support will be matched by an adequate increase in the amount of resources (financial and human) that are available for this group to use (Kingma 2007, World Health Assembly 2011, Humphries et al. 2012, Nuernberger et al. 2018). Any shortage of working-aged, tax-paying adults is likely to result in less public money to support care and means that there will be fewer people to provide that care either in paid or in voluntary employment. This may be compounded by the reduction of familial care associated with the break-up of the nuclear family, easier national and international migration resulting in increased geographical distances between family members and less informal social support within communities (World Health Assembly 2011, Abhicharttibutra et al. 2017). These population changes and their resultant challenges have been building steadily since the post-World War II baby boom ended in the late 1960s (Butler 1969, WHO 2011, Beard et al. 2016) and are unlikely to change barring any unexpected or catastrophic occurrence. Meeting these challenges requires widespread progress in redefining and constructing health- and social-care systems to meet the complex needs of this group of people (Abhicharttibutra et al. 2017, Blood 2013, Buchan et al. 2015)—a group of people that spans 40 years and the various experiences and norms of those four different decades: for instance, the experiences and needs of the oldest old will be very different to those of the latest generation to enter older age—the baby boomers (see below).

Think about this …

Economics is important!

Conceivably one of the driving forces behind increased attention to older people is that the latest generation to enter older age have money to spend! In general, the baby-boomers are entering their senior years financially stable with disposable income, thus resulting in an unprecedented, vast and relatively untapped market. Perhaps this is why stakeholders (peripheral to those attentive to health- and social-care service needs) e.g. in the field of commerce, appear to have quickly accepted the burgeoning importance of the increasing number of older people in our societies and have swiftly adapted to target this group as consumers from increasing attention to leisure opportunities to capitalising on life-style improvements. Next time you go to newsagents check out the magazines targeting older people you can see on the shelves. Flick through them and see what articles and features there are.

However, we remain ill-prepared to meet the needs and demands of what will quickly become one of the world’s new population ‘no...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Acknowledgements
• 1 About this book
• 2 Thinking about the ageing population
• 3 Stories of older age
• 4 Risk taking and risk aversion
• 5 Staying healthy in older age
• 6 Common difficulties experienced by older people
• 7 Frailty and comprehensive geriatric assessment
• 8 Living and dying in old age
• 9 Conclusions
• Appendix: Stories of the health challenges associated with older age from the healthtalk-on-line website
• Index