Caring for Older People in the Community

Angela Hudson, MSC (Gerontology), PG Dip HE, BA (Hons) Open, RN, Senior Lecturer, Faculty of Health and Life Sciences, University of the West of England, Bristol. Angela’s background is in working with older people in rehabilitation settings. Her interests lie with long-term conditions and their impact on the older person's health and well-being.She is currently Project Lead for a Blended Learning Project within the university focusing on the provision of  education for long-term conditions. Angela has been involved in a number of projects including the facilitation of Action Learning Sets with four groups of community matrons. She is currently working with two local primary care trusts to deliver case management workshops. Lesley Moore, MA, RN, Diploma of Nursing (Wales), Cert Ed (FE), RNT, Florence Nightingale Scholar, Fellow of the Higher Education Academy, Churchill Fellow, National Teaching Fellow, FRSA, Senior Lecturer Faculty of Health and Life Sciences, University of the West of England, Bristol.Lesley's background was in intensive care and recovery nursing for both the NHS and military sectors before becoming a clinical teacher and a nurse teacher. After majoring in social ethics, Lesley’s research interests have focused on ethics and work-based learning. As an informal carer, she supported a close relative at home having renal haemodialysis. As a result of this experience, she is aware of the vulnerability of the older person with a long-term condition being cared for in the community during the transition of change in the NHS.

• Contributors ixForeword xiiiPreface xvIntroduction xviiSection 1 – Past and current infl uences on practice 11 Historical perspectives from past to present 3Robin MeansIntroduction 3Family, kinship and older people 3The welfare state, older people and the changing role of institutions 8Towards Care in the Community 14Modernisation muddles. 20Conclusion 22References 232 Older people's experiences: social context and contemporary social policy 27Tina Fear and Grace BoddyIntroduction 27Social context 27Policy as a response to needs of older people 40Health and social care provision 47Conclusion 54References 553 Ethical tensions for the older person and carers 61Lesley MooreIntroduction 61Paradigm shifts in health and social care 61Factors influencing moral reasoning and behaviour 65Values and beliefs 65Signifi cant ethical theories 67Power versus professional perspectives 74End of life and decision-making 78The diversities and tensions of caring 81Conclusion 87References 88Section 2 – Contemporary challenges 934 Healthy ageing, active ageing: the challenges 95Angela Hudson, Jane Buswell and Natalie GodfreyIntroduction 95The context 96Active ageing. 99Healthy ageing 100Barriers 100Policy frameworks. 103Health promotion versus health education 104Targeted health education for older people 107Challenges 109Complementary therapies 110Controversy and cultural shifts 111Conclusion 130References 131Useful websites 1385 Older people with learning disabilities 139Kim ScarboroughIntroduction 139Defining learning disability 139Recent policy and people with learning disabilities 141Impact of having a learning disability 141Communicating with older people with learning disabilities 142Vulnerability 145Principles underpinning services for people with learning disabilities 146Community services and support systems for older people with learning disabilities 146Impact of ageing on where an older person with learning disabilities lives 149Health services and older people with learning disabilities 150Primary care 150Specialist community learning disability teams 151Mental health services. 151Health of older people with learning disabilities 151Specifi c health issues for people with learning disabilities 153Partnership working and consent 158Advocacy and empowerment 159Person-centeredness. 159Health assessment 160Health action plans 160End of life care 160Conclusion 161References 162Useful websites 1666 Working with older people with dementia in the community 167Mary MarshallIntroduction 167What is dementia? 167Policy context 168Roles for nurses in the community 169The medical view of dementia 170Conditions often confused with dementia: delirium and depression 174The social view of dementia 175The citizenship view 176Stages of dementia 176Philosophical and ethical concerns 176Communication. 180Assessment 184Working with carers 187Working with other agencies and professionals 188Technology 189Challenges and rewards 190Conclusion 199Acknowledgements 199References 199Useful websites 204Section 3 – Future challenges 2057 Future trends. 207Lesley Moore and Angela HudsonIntroduction 207Signifi cant trends leading to the 60th year of the NHS 208The empowerment of patients through the Expert Patients Programme 211Community hospitals 213Cancer care – bringing diagnostic technology and chemotherapy treatment closer to patients 215The National Programme for IT 216Telecare, telehealth, telenursing and telemedicine 218Whole System Demonstrators 224Moving towards seamless care 225Partnership for Older People Projects 230Conclusion 232References 233Useful websites 235Index 237