Fundamentals of Caring for the Older Person

Claire Pryor is a Professor of Adult Social Care Nursing at the University of Salford. A registered nurse and independent and supplementary prescriber, she holds a PhD, an MSc in Advancing Healthcare Practice, and a BSc in Nursing Science. With extensive experience in both clinical practice and education, she supports both student nurses and nurses in their professional development, and works to enhance care for older adults through research and teaching. Sue Tiplady has had an extensive nursing career leading and managing the care of older people. Within her senior management roles in the NHS, she commissioned and designed services to improve care delivery for older people and their carers. As an Assistant Professor at Northumbria University, she contributed to a range of research focussed on Gerontology and Dementia Care, embedding the care of older people into the pre-registration nursing curriculum and designing specialist programmes for post-registration education delivery.

• Contributors xiiiForeword xviAcknowledgements xviiUnit 1 Principles of Caring for the Older Person 1Chapter 1 Ageing and Ageing Populations 3Elaine FrancisIntroduction 3What Is Ageing? 4What Age Is ‘Old Age’? 4Trends in Population Ageing 4Exploring Representations of Ageing and Older People 6Interpersonal Ageism 7Self- directed Ageism 8Institutional Ageism 8Ageing, Health and Society 9Conclusion 10References 10Chapter 2 Healthy Ageing 13Stuart Nicholson and Laura GrahamIntroduction 13Healthy Ageing and Ageing Well 14Public Health Approaches 16Psychological Well- being 17Positive Relationship Support (Sexuality and Sexual Relationships) 19Social Prescribing 21Conclusion 22References 22Further Reading 24Chapter 3 Person- Centred Care – Caring for Older People 25Sue Tiplady, Jane Murray, and Isabel QuinnIntroduction 25Person- Centred Care 26Personhood 28Person- Centred Communication 29Cultural Considerations 32Becoming More Person- Centred 33Conclusion 33References 34Further Reading 35Chapter 4 Legal and Professional Context of Care 37James Mingham, Esther Clift, and Isabel QuinnIntroduction 37Professional Regulation 38Professional Codes of Conduct 40Duty of Care 40Information Governance 40Confidentiality 40Information Sharing 41Consent 41Mental Capacity Act 42Lasting Power of Attorney 43Best Interest Decision- Making 44Deprivation of Liberty Safeguards 44Health and Social Care Act (2012) 44The Care Act (2014) 45Safeguarding and Raising Concerns 45Conclusion 46References 46Further Reading 47Chapter 5 Communication 49Eilaine WhiteIntroduction 49Communication, Ageing and Health 50Cultural Considerations 52Good Communication Practice When Assessing Older Adults 52Shared Decision- Making 52Health Literacy 53Advocacy 54Caring Conversations 55Professional Communications Across Teams 56Transitions of Care 57Conclusion 57References 58Further Reading 58Chapter 6 Approaches to Care for Working with Older People 59Donna Massey, Hayley Bamber, Ursula Roberts, and Kirsty MarshallIntroduction 59An Outline of the Approaches to Care of the Older Person 60Co- production 60Multidisciplinary 60Interdisciplinary 61Transdisciplinary 61Integrated Care 61Technology- Enhanced Care and Its Role in Models of Care 62Caring for a Person Living with Dementia in the Community: Discussion 63The Importance of Comprehensive Assessment: Discussion 65Conclusion 67References 67Chapter 7 Settings of Care 69Stacey Louise Finlay, Philip Hodgson, and Kevin MurphyIntroduction 69Place and Importance of Place 70Enablers of Ageing in Place 72Adult Social Care 72Alternative Housing 73Community Support 73Intermediate Care and Reablement 74Emergency and Urgent Care for Older People 75Urgent Community Response 75Hospital at Home 75Emergency Department 76Same Day Emergency Care 76Care Homes 76Care of Older People in Prison 78Conclusion 78References 79Further Reading 81Chapter 8 Carer and Family Support 83Elaine Francis and Judy MattisonIntroduction 83Definition 84What Matters to Carers? 85Caring for Carers 87Wider Health and Care Issues 89Health Care Costs and Accessibility 89Conclusion 91References 91Further Reading 92Chapter 9 Multimorbidity 93Jenny Allen and Esther CliftIntroduction 93Definitions 93Prevalence 94Impact of Multimorbidity 94Research and Impact on Care Guidelines 95Conclusion 99References 100Further Reading 102Chapter 10 Frailty and Comprehensive Geriatric Assessment 103Stacey Louise Finlay and Claire PryorFrailty as a Syndrome 103Risk Factors 104Ageism 105Biological Sex and Frailty 106Identification and Assessment of Frailty 106Assessing Frailty 108The Domains of the CGA 109The Problem List 111Care and Support Planning 112Conclusion 113References 113Further Reading 114Unit 2 Anatomy and Physiology of Ageing 115Chapter 11 The Anatomy and Physiology of the Brain and Nervous System 117Barry Hill and Alison YoungIntroduction 117Structural Changes in the Ageing Brain 118Functional Changes in the Ageing Brain 118Clinical Implications 119Delirium 120Dysphasia 122Altered Pathophysiology in the Older Person 122Considerations of the Impact for People and Care 124Caring for Carers 124Epilepsy in Older People 125Medicines Management 125Stroke in Older People 126Conclusion 128References 128Chapter 12 The Anatomy and Physiology of the Senses 131Debbie FindlayIntroduction 131Anatomy and Physiology of Ageing on Hearing 131Anatomy and Physiology of Ageing on Taste 133Anatomy and Physiology of Ageing on Smell (Olfaction) 134Anatomy and Physiology of Ageing on Touch 135Anatomy and Physiology of Ageing on Vision 135Anatomy and Physiology of Ageing on Cranial Nerves which Impact the Senses 136The Impact of Sensory Changes with Ageing 137Considerations of the Impact on People and Care 138Conclusion 139References 139Chapter 13 The Anatomy and Physiology of the Cardiovascular System 143Stuart BarkerIntroduction 143The Heart 143The Ageing Heart 144The Conduction System of the Heart 145The Ageing Conduction System 146The Vascular System 147Peripheral Vascular Disease 149Coronary Artery Disease 149Regulation of Blood Pressure 150The Baroreceptor Reflex 150Heart Failure 152Conclusion 153References 153Chapter 14 The Anatomy and Physiology of the Respiratory System 155Karen Corder and Elaina HendersonIntroduction 155The Respiratory System 155Gas Exchange 156Changes in the Ageing Body that Affect the Respiratory System 159Psychological Considerations for People with Respiratory Diseases 161The Impact for People and Care 163Conclusion 164References 164Chapter 15 The Anatomy and Physiology of the Gastrointestinal System 167Claire NormanStructures 168The Small and Large Intestines 170The Processing of Food 174Circulation 175Dysphagia 175Bowel Care 176Constipation 176Conclusion 177References 177Chapter 16 The Anatomy and Physiology of the Renal and Genitourinary System 179Barry Hill and Claire PryorIntroduction 179The Renal System 180Age- Related Changes 180Renal Blood Flow and Filtration Efficiency 181Electrolyte Imbalances and Fluid Overload 181Excretion and Waste Management in Ageing 182Anatomy and Physiology of an Ageing Genitourinary System 183Reproductive Health and Sexual Health in Ageing 184Medicines Management 185Discussion 187Conclusion 187References 188Chapter 17 The Anatomy and Physiology of the Endocrine System 191Barry Hill and Dominic SimpsonIntroduction 191Changes to the Endocrine System in Ageing 192Understanding Hormonal Changes in Older People 193Diabetes in Older People 196Principle of Pharmacology 199Conclusion 202References 203Chapter 18 The Anatomy and Physiology of the Immune and Haematological Systems 205Helen Evans and Claire PryorIntroduction 205The Ageing Immune System 206B- Cell and T- Cell Lymphocytes 206Dendritic Cells 207Macrophages 207Natural Killer Cells 208The Innate and Acquired Immune System 209Vaccinations in Older People 209The Ageing Haematological System 210Conclusion 212References 212Chapter 19 The Anatomy and Physiology of the Musculoskeletal System 215Alex Hemsley and Sue TipladyIntroduction 215The Musculoskeletal System and Age-Related Changes 215Sarcopenia 216Osteoporosis 220Osteo-sarcopenia 223Osteoarthtritis 224Conclusion 226References 227Further Reading 228Chapter 20 The Anatomy and Physiology of the Integumentary System 229Sue TipladyIntroduction 229Effects of Ageing on the Skin 229Skin Care 234Skin Assessment 234Skin Tears 237Moisture- Associated Skin Damage 238Personal Hygiene 238Considerations for Personalised Care Planning for Personal Hygiene 239Conclusion 240References 240Further Reading 241Unit 3 Care Management 243Chapter 21 Assessing and Managing Pain in Older People 245Isabel QuinnIntroduction 245Pain Classification 246Pain Assessment in Older People 250Pain Management 252Conclusion 255References 255Chapter 22 Mental Health and Learning Disability in Ageing 257Lynette Harper and Sarah MackayIntroduction 257Functional Mental Health 257Substance Misuse 259Pain Assessment 260Neurodiversity in Older Adults 263Capacity and Consent for All 264Conclusion 265References 266Chapter 23 Dementia 269Shibley Rahman and Claire PryorIntroduction 269Diagnosis 271Prevention and Risk Reduction 273Communication 274Meaningful Activities and Independence 274Living Well with Dementia 275Carer Support 275Distress and Communication 277Medicines Management 277Conclusion 279References 279Chapter 24 Nutrition and Hydration Care 281Philip Hodgson, Sarah Docherty, and Glenda CookIntroduction 281Nutrition Care: Assessment 282Nutrition Care: Practices 284Hydration Care: Assessment 285Hydration Care: Practices 286Conclusion 288References 288Chapter 25 The Recognition and Assessment of the Acutely Ill Older Person 291Tony Conner, Deborah Leetham, and Sue TipladyThe Importance of Recognising Acute Illness in the Older Person 291Atypical Presentation 292The Influence of Comorbidities 293The Importance of Social Support 293The Assessment of the Acutely Unwell Older Person 293Sepsis in the Older Person 297Typical and Atypical Presentation of Sepsis in Older People 298The Assessment of Sepsis 299The Treatment of Sepsis 300Prevention of Sepsis 302Conclusion 303References 303Further Reading 305Chapter 26 Pharmacology and Medicines Management 307Joanne Dunn, Claire Pryor, Janet Wilkinson, and Patrick DawoduIntroduction 307Anticholinergic Burden 312Deprescribing 312Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) 313Concordance Support 313Social and Support Consideration for Medication and Medication Optimisation 314Conclusion 315References 315Chapter 27 End- of- Life Care 317Nicola Payne and Isabel QuinnIntroduction 317Death and Dying in Older People 317End- of- Life Care 318The Relationship Between Supportive Care, Palliative Care and Terminal Care 318When Is ‘End of Life’ 319Advance Care Planning 321Preferred Place of Death 322Ethical Challenges 323Emotional Support 323End- of- Life Symptoms 324Care in the Last Days and Hours of Life 324Care After Death 326Conclusion 326References 326Further Reading 327Index 329