Current and future nurses must have the skills to care for older people with access to specialist expertise and support, argue Jonathan Webster and Nicky Hayes
‘We treat everyone as an individual’ or ‘we treat everyone the same’ are phrases frequently heard from nurses caring for older people. But what does ‘treating everyone the same’ mean and how is ‘individualised nursing care’ reflected in practice?
Recognising and respecting diversity is central to care. This includes respect for old age and recognising that older people are not a homogenous group. Age itself isn’t a barrier to healthcare and old and young alike have equal access. These fundamental principles underpin our practice, so we don’t need to defend them by saying we treat everyone the same. It’s
not ageist to acknowledge that older people’s needs may differ from those of younger people.
Although individuals vary, older people’s health needs are often age-related. As we age we undergo physical and cognitive changes that can lead to interacting and complex needs.
The following scenario on an orthopaedic ward illustrates this. In one bed, an 18-year-old has had a motorbike accident and fractured his hip. In the next bed, an 80-year-old has also come off his motorbike and broken his hip. The impact of age, on top of the injury, means the older patient is at greater risk of multiple factors affecting his recovery – including delirium and malnutrition – than the 18-year-old. He is also more likely to need rehabilitation, intermediate care or social support.
Our experience is that, on occasions, nurses may not see this clear difference. According to the National Service Framework for Older People, almost two-thirds of acute hospital beds are used by people aged over 65. A high proportion will probably have complex age-related needs.
Hospitals are under increasing pressure to reduce length of stay and prevent avoidable readmissions. It is vital therefore that all nurses have the skills needed to care for older people.
Nurses can no longer argue that they do not need to know about older people’s care. With the exception of paediatric and maternity care, older people access most services. We must all be able to offer them high-quality care.
This highlights the need to ensure that current and future nurses have the skills to care for older people and are able to access specialist support. There have been two major consultations on the future of nurse training and careers recently. In neither report is there a specific focus on the needs of older people. This could be seen to reflect the success of anti-age discrimination and as a welcome move away from seeing old age as a disease or problem. However, unless we keep the needs of older people in the spotlight, there is a risk that services will regress and specialist practice in the care of older people will become marginalised.
While nurses recognise the importance of communication when caring for older people, they must not lose touch with the technical and interpretive skills required.
It is not just about being the ‘right kind of person’.
Nursing older people can be intensive due to complexity of need. Policy and best practice guidance have given us a clear focus for older people’s services and practice development. It is time to build on this.
So, do older people need specialist or generalist care? In truth, they need both. They may have complex needs requiring a high level of skilled nursing. But general nurses must also be able to manage as much of this as possible, with access to specialist expertise and support for the most complex cases.
If older people have no access to expert support, there is a real risk that their complex needs will not be met. We don’t want to go back to the days of a Cinderella service now that we have modern services that respect diversity and offer access regardless of age. It’s time to put care for older people in the ‘world class’ category.
Jonathan Webster is consultant nurse, older people, University College London Hospitals NHS Foundation Trust
Nicky Hayes is consultant nurse, older people, King’s College NHS Foundation Trust