Improving care for older people is a priority, but we can help people live longer, healthier lives by teaching them to look after themselves when they are still young, says Linda Nazarko
A century ago the average woman had a life expectancy of 50 years and the average man 46. Now those figures are 81 and 77 respectively. Many people live much longer and, while most people want to live a long time, few wish to be old.
Unfortunately many people find their final years are marred by ill health and increasing disability. An important element to successful ageing is to prevent or delay the onset of long term conditions so that people enjoy a healthy life for as long as possible.
Those of us who care for older people need to do two things to provide quality care for them. We need to deal with the here and now and help people to recover from acute episodes of illness and to live as well as possible with long term conditions. We also need to work hard to educate and enable adults so that we can prevent or delay the onset of problems that can mar their lives in middle and old age.
The Department of Health’s (2009) prevention package for older people deals with the here and now. This is a suite of downloadable resources designed to support commissioners in prioritising services for this group. The package consists of information on services that older people have identified as important to them such as: falls and fractures; foot care; hearing; telecare; intermediate care; and accident prevention. This package is welcome because some of these services have attracted less attention and funding than others.
The package aims to show commissioners what a good service looks like and what they should consider when commissioning. Nurses working in acute and community settings who are setting up or reviewing services can also use elements from the package when putting together service specifications.
Some of the resources, such as the one on developing a local joint strategic needs assessment for falls and fractures, are excellent and should help to ensure older people receive more appropriate services.
However, the resource on effective interventions for falls and fractures is disappointing. Prescribed medication, including hypnotics, sedatives and certain analgesics, increases the risk of falls significantly but, although the issue of medication review is mentioned, there is little detail on it in the resource.
Researchers have also found that many people who fall have visual problems that can be easily treated. While the resource does refer to the issue of reducing visual disability, there is no detail on simple and effective interventions to do this.
In addition, continence and visual services are not covered in the package, which is surprising as the incidence of problems in these areas increases with age.
The package will help us to manage the here and now and, hopefully, over time there will be additions it. But in the near future I hope the DH will also develop resources to enable those who are commissioning and delivering services to promote health.
There are fears that our generation and our children’s generation will age less successfully than the current older one – no surprise given that, although rates of cigarette smoking are falling, more people are drinking heavily, only a minority of adults exercise often enough to maintain good health and obesity rates have greatly increased over the last 20 years.
The onset of many conditions such as diabetes, high cholesterol, hypertension, joint pain, stroke and vascular dementia can be prevented or delayed by lifestyle measures. A health promotion package would enable adults of all ages to lead happier and healthier lives.
LINDA NAZARKO is consultant nurse for older people, Ealing and Harrow Community Services
Department of Health (2009) Prevention Package for Older People Resources. London: DH.