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Linda Nazarko discusses the vital role of assessment in care of the older person

VOL: 98, ISSUE: 26, PAGE NO: 33

LINDA NAZARKO

At the beginning of the Queen's reign, only a few hundred centenarians received telegrams congratulating them on their longevity. Last year 3,500 were sent. Life-expectancy has risen by 15 years over the past 50 years and the challenge now is to ensure that those extra years are not marred by disease or disability.

At the beginning of the Queen's reign, only a few hundred centenarians received telegrams congratulating them on their longevity. Last year 3,500 were sent. Life-expectancy has risen by 15 years over the past 50 years and the challenge now is to ensure that those extra years are not marred by disease or disability.

Kate Lloyd and her colleagues (p34) have risen to the challenge of disseminating good practice in gerontology to GP practices.

It can be difficult to separate features of the ageing process from features of diseases that, if left untreated, can lead to disability. One negative consequence of the National Health Service and Community Care Act 1990 was that assessment was seen from a social services' perspective as a tool to determine what services were required and which agency should fund them. The health care part was lost, so although people could get help to cope with incontinence or immobility, the reasons why they had developed continence problems or become immobile were not investigated.

Assessment is the best way for nurses to determine whether fatigue is the result of ageing, anaemia, declining thyroid function or other treatable conditions. It also means that nurses can look at the reasons why falls occur and implement fall-prevention programmes.

Assessment is essentially about prevention, about intervening before small problems become crises and a person's life is changed forever.

The national service frameworks are revolutionary because they concentrate on early identification and treatment. They aim to promote good health rather than treat illness. If nurses can identify the causes of falls and adopt a problem-solving approach, an older person may be spared a fracture, surgery and the loss of function that can result from an injury. If diabetes is identified early they may avoid the complications of untreated diabetes, such as heart disease.

An ounce of prevention is worth a ton of cure. It reduces the demand on secondary care and enables nurses in primary and secondary care to improve the quality of their services. Screening and assessment may prevent the disabilities that can accompany ageing.

One of the difficulties of new strategies is that they can remain aspirations unless nurses turn them into realities. It can be difficult to wade through large documents such as The National Service Framework for Older People and implement them in everyday practice, but Ms Lloyd and her colleagues have risen to the challenge and turned rhetoric into reality. Their work will enable older people to enjoy improved health.

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