Key Questions - Care of the older person

Linda Nazarko, MSc, PG Dip, BSc, RN, OBE, FRCN, is visiting research fellow, London South Bank University, and visiting lecturer, King’s College, London.

1. Why do you need specialist skills to nurse older people?

Older adults are different from younger adults, since ageing affects anatomy and physiology and also outlook on life. Older people are more likely to have sensory deficits such as hearing or visual problems, and are more likely to develop cognitive problems; 25% of 85-year-olds have dementia. In addition, older people are more likely to have long-term conditions, complex care needs and are more likely to take medication. Ageing increases the risk of a person suffering adverse drug effects.

Older people are more vulnerable to infection. They can quickly lose mobility, continence and confidence if nursing care is not of the highest quality. Nurses with specialist skills can enable older people to recover and to function to capacity. Practitioners who lack specialist skills may consider that reversible changes cannot be treated.

2. What are the best ways to promote continence on hospital wards?

The most important thing to do is to recognise that incontinence is a symptom and not a disease. Nurses need to establish why each individual has continence problems and then use a problem-solving approach to promote continence. Many problems that cause incontinence are simple, and helping people to become mobile and use the toilet makes a huge difference. If the older person depends on nurses to take them to the toilet then it is vital to respond quickly as older people get less warning than younger people and find it difficult to wait. Nurses can start by learning how to do assessments - continence advisers or link nurses can provide details on education and training.

3. What can be done to prevent falling?

Falls can lead to loss of confidence, immobility, fractures and even death. Every year 310,000 older people in the UK sustain a fracture because of falls. Every five hours one older person dies because of a fall. NICE guidance requires nurses working with older people to develop and maintain competence in assessing and reducing falls risk. Falls prevention entails assessing factors relating to the person, the environment and care. Once problems have been identified, these should be modified whenever possible. If it is not possible to reduce risk factors nurses should use harm-minimisation strategies. They should ensure that they access training to help develop these skills. Some older people require specialist assessment and treatment. Each NHS trust is required to have a falls prevention service to carry out in-depth investigations on the reasons for falls and plan treatment to reduce risks.

4. How is it best to manage confusion in older patients?

It is important to establish if the older person is normally confused. Older people can become confused after surgery, and moving patients from ward to ward also increases this risk. Sometimes medication to treat pain, such as tramadol or codeine-based analgesics, can cause confusion. Sedatives and hypnotics can also increase confusion in older people. The older person may have an infection, although this can be difficult to diagnose. It is important that a person who becomes confused is assessed by a nurse specialist or a doctor so the causes can be identified and treated whenever possible.

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