One of the first things I learnt as a student in anatomy and physiology lectures was the need to understand what is normal in order to appreciate the changes that occur as a result of illness and disease.
This is crucial in old age, where the normal effects of ageing can be blurred and confused with signs of ill-health.
Nurses therefore need a good understanding of normal age-related changes in order to accurately assess and distinguish between an expected decline in bodily function and illness and disease. The classic example is cognitive function.
In the first part of a series on dementia published last year in Nursing Times, the authors noted that while our ability to process information naturally slows with age this is not directly linked to dementia and we should not conclude that dementia is an inevitable part of ageing.
Over the last six months we have published the first six parts of an 11-part series looking at how ageing affects the systems of the body. This provides a firm foundation for anyone caring for older people.
However, health in old age is also influenced by our life experiences and the first article in this archive selection looks at the role of health inequalities on the lives of people in old age. Understanding the role of inequality in our patients’ life experience is an important part of nursing assessment and ongoing care.
A few weeks ago Sir James Munby, a family judge, expressed concerns about separating older couples who could no longer look after themselves. He found it difficult to comprehend how a couple who had been together for 40 or 50 years could cope with separation, and spoke movingly about the effects on health and mortality. The second article in this archive selection looks at how we manage issues relating to sexuality and intimacy in care homes and how these essential needs often go unrecognised.
These issues were also highlighted in a research paper looking at staff attitudes to lesbian and gay residents in Irish nursing homes. It found that staff can brush aside residents’ needs to express their sexuality and this can inhibit holistic care.
The final article in our selection summarises a study that explored why admission to care homes happens following an acute hospital admission.
The researchers looked at what happened during their hospital stay, and what led to the decision to discharge them to a care home. What stands out is that only 37% of individuals were documented as having been involved in the decision-making process. The researchers also found that at the time of discharge, only 28% of patients were documented as being fully continent, compared with 62% on admission. They note that this dramatic increase may indicate an issue with hospital-related harm and I wonder if staff had the appropriate education to assess and manage bladder and bowel function effectively.
The articles in this selection demonstrate the depth of expert knowledge nurses require to provide safe and effective care to older people. This point was raised by Robert Francis in 2013 when he recommended the development of a specialist older people’s nurse role in his report on care failing at Mid Staffordshire Foundation Trust. He wanted to highlight the distinct set of skills required to nurse older people with complex needs, and to incentivise and spread good practice.
Although the then government rejected the proposal, roles have developed in the UK and nurses continue to argue for a recognised role for older people’s nurses and to develop specialist nurses in dementia care.