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Aspects of age

Older age is changing.

In the twenty-first century, our later years can be as dynamic and productive as our younger years. Today, travel vaccinations  and sexual health advice for older people are common. For many, age really is just a number.

Yet some older people do have complex needs. A small but significant group of older people require 24 hour nursing with highly intensive and sometimes ethically challenging care. We are also seeing newly emerging diagnoses and cutting edge treatment plans delivered at home. Nursing older people demands a deep understanding of the physical, emotional and social worlds of individuals.

The history of caring for our older generations is not always an easy one. It is a story shaped by how we view older people in society, and how we value the role of those that care for them.

In an ageing population, how much have we learned from the attitudes of the past?

A blue yoga mat next to a pair of red slippers.

Title saying: 'Incapable, elderly and sick'

 

In the nineteenth century, the elderly and chronically sick were too often left to the mercy of the workhouse and the Poor Law system. Here, conditions were squalid and facilities scant. A form of nursing care did exist in the workhouse, but was often delivered by older female inmates. Treatment of the elderly was fast becoming a national scandal. Following a barrage of bad press revealing the crowding, death and disease of the workhouses,the Local Government Act in 1929 saw the Poor Law disbanded. The municipal hospital system was established and local authorities became responsible for those in need of health care.

In 1936, Matron Eva Huggins was working alongside Dr Marjory Warren, the geriatrician at Middlesex County Hospital. They pioneered a change for both the elderly and chronically ill, providing proper diagnoses for those in their care and discharging people who did not need to be in hospital beds. Yet this pace of change was not universal. Despite attempts to improve the care of older people, accommodation continued to be substandard and ward equipment poor. As a profession, older people’s nursing struggled to detach itself from the low status reputation it had gained over the past century. There was no encouragement for bright young doctors and nurses to pursue older adult care. It was simply not a popular place to be. 

Did you know?

The term ‘geriatric’ comes from the Greek for ‘old age’ and ‘physician.’ (It technically means old physician!) So it makes sense that this term is not used anymore. Instead ‘care of older people’ is widely used in health care settings.

 

Image of a building with a high ceiling supported by pillars, filled with people who appear in groups, some sitting and some standing.

Image: Workhouse, Poland Street Soho, 1809. Wellcome Collection.
Four specimens of sea skink, late eighteenth century. On loan from the Royal Pharmaceutical Society. Believed to be an aphrodisiac, sea skink was reported to ‘restore warmth in old age [and] decays of nature’ and increase ‘the Semen Virile’. A white ceramic feeding cup c.1914 - 1918 with a spout like a teapot and a handle to the side. Enamel bedpan cup, c.1914. In the nineteenth century there was next to no focus on supporting older people to be independent. Bed pans were used widely for those considered ‘bed bound’. Loaned from the British Red Cross Museum and Archive. Nursing the older patient, a book by Steve Wright.

Royal College of Nursing · Excerpts from the RCN Archive

1. Extract from ‘Old people'. Report of a survey committee on the problems of ageing and the care of old people, Published for the trustees of the Nuffield Foundation. 1947. Read by Kat Black.

2. News clipping in the Evening Standard, and letter to the Editor from Pauline Blight, 1986. Read by Alan Chalkley and Dianne Yarwood.

3. Hospital Hilton! Workhouse stigma a thing of the past. The Reporter, 6 February 1987. Read by Razwana Akram.

 

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Important progress began to happen in hospital settings across the UK by the latter decades of the twentieth century. At the forefront of this progress was the Nursing Development Unit at Tameside Hospital’s Department of Care for the Elderly, established in 1985. Within this, nurses could take part in an international exchange programme, attend ‘survival skills’ courses and use a new on-site staff library. The aim? To enhance the development and the status of nursing older people.

What these units could not temper however, was the increasing numbers of the very old. A hospital setting was not right for many of these patients. Additionally, people with dementia needed professional support, either at home or in a facility, with the right nursing care.

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“The time has gone when the care of the elderly can be comfortably regarded as a backwater of medicine.

It is an area which requires a status in accordance with its proper social importance.

Nursing of the elderly in particular needs to be recognised for its high value to the patients, and the distinct skill set required to lead its provision. One way such recognition could be provided, and good and effective nursing practice incentivised, would be the creation of a registered older persons nurse status"


-Quote from Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013.

 

 

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Serenace Ampoules for restlessness and agitation in the elderly, 1996. Nurse and an older adult patient on a hospital ward, c.1980. RCN Archive. Two district nurses move and prepare a bed-bound older patient for bathing, c.1955-1965. RCN Archive. District nurses on a home visit to an older patient, c.1950. RCN Archive. Plastic slipper bed pan, c.1960. At this time, bedrest was still considered an important part of recovery. This meant the continued use of bed pans, particularly in patients’ own homes when supported by a district nurse. Loaned from the British Red Cross Museum and Archive.

Royal College of Nursing · Oral history clips from the RCN Archive

Doreen Norton began nursing at St Charles Hospital, North Kensington, a former Poor Law Infirmary, in 1942. She reflects on her visits to Dr Marjory Warren’s geriatrics unit at West Middlesex Hospital.

Pam Hibb worked with the design team on the new Homerton Hospital, previously the ‘German Hospital’, when it became part of the City and Hackney Health Authority in 1974.

Dawne Garrett, RCN Professional Lead for the care of older people and dementia, trained in the 1980s. Here she talks about her research into sexual intimacy among older people.

Lesley Williams was a ward sister and clinical nurse teacher at West Suffolk Hospital in the late 1970s. Here she talks about the changes she has seen in discharge procedures for older people.

Single 70 and seeking love

Growing old does not mean sensual pleasure diminishes. In fact, our older generations may be the most clued up of all. They have witnessed the introduction of the first lubricated condom in the late 1950s, the advent of the pill in the 1960s, not to mention today’s dating websites for love in later life. The number of brides and grooms over 65 – known as ‘Silver splicers’ – has risen in the last decade. 

Sex in your seventies may well be better than ever, yet sex and sexuality in older people is still taboo. For those in care homes, having the space for intimacy can be hard to find. Striving to promote and support healthy and safe romantic lives for residents is an essential part of nursing care.


Stylised zimmer frame with a black bra hanging off it and a pair of shoes in the corner

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Do you know the difference between a care home and a nursing home?

Care homes are staffed 24-hours a day, with qualified care assistants. Residents can get help with washing, dressing, eating, using the toilet and general mobility. District nurses are often called in to help when residents need injections or complex dressings.

Nursing homes are now known as care homes with nursing. Here a resident will receive everything offered in a care home, but with additional 24-hour support from a registered nurse. This is often a better option for those that need ongoing clinical or medical care, or for those with advanced dementia.

 

 

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Separate care homes for paying patients have existed since the late nineteenth century, but not everyone could afford private care. When the Poor Law system was disbanded, many workhouses were converted into Public Assistance Institutions (PAI). Conditions were still poor and the institutions struggled to shake the workhouse reputation. By the start of the Second World War, the vast majority of residents in PAIs were older people. At the formation of the National Health Service in 1948, PAIs were converted into NHS hospitals or ‘old people’s homes’ run by the local council. Gone were the days of the Poor Law Board of Governors. Yet, the care received by older people continued to be a concern.

As well as local innovations in hospital settings in the 1980s, new legislation also determined that a registered medical practitioner, or a registered nurse should be in charge of a care home. But even today in England, there is no safe staffing law to ensure that enough nursing staff are in place. This goes for older people’s wards in hospital as well as private care homes. The view that people move to a care home and never leave is no longer a reality. Staying in a care home may involve a period of short stay respite care, or rehabilitation following an illness. The average length of stay for a patient today is 11 months, but can be as little as a week.

Black and white postcard with a district nurse attending an elderly person in their home.  
 Image: District nurse on a home visit with an older patient. RCN Archives.
The Oldie, Issue 1, 1992. The Oldie aimed to create a ‘free-thinking, funny magazine, a light-hearted alternative to a press obsessed with youth and celebrity.’ Still in print today, The Oldie is also a podcast. Fidget tools by Alzheimer’s UK, 2019. These tools were developed to keep hands busy and relaxed. Activity like this can be calming and can help support repetitive actions. Shewee, 2019. Whilst portable urinals are best known for avoiding dirty seats in busy festival loos, they are also recommended for older women who find it difficult to squat over a public toilet or bend to sit on their toilet at home. Viagra, 1997. On loan from the Royal Pharmaceutical Society. Sildenafil citrate’ was approved for use for erectile dysfunction in 1998. Originally made to treat hypertension, men involved in early studies began to notice its other useful side effect. Yet it may be younger men under pressure to perform that explains the rise in its use, rather than older men who are more likely to find alternative ways to be sexual.

Title saying: Staying connected

Increased life expectancy is certainly a positive development. Older
people are more connected, active for longer, and find support in
technologies from Skype to stair lifts and digital companions. Yet age
discrimination still exists and society continues to view older age as a problem.

Around the UK, nursing initiatives are taking place to address how we
care for older people. These can be small interventions like anti-spill mugs
and easy grip cutlery, to wearable ‘smart’ glasses which enable care
workers to live stream to other professionals for advice and diagnoses.

But innovation isn’t just about new technologies. It’s about ensuring
better communication and having skilled practitioners in place at the
right time. In 2016, Burton Hospitals NHS Foundation Trust introduced
a dedicated service of health care assistants specially recruited to work
with older people. Assistants gave one to one support to the same
patient for as long as care was needed, enabling them to build trust and
a relationship with that person. It meant fewer doctor call-outs and next
to no patient falls.

It is members of the nursing family who are best placed to ensure their
patients, whether in their own home or a care home, achieve a sense of
security, belonging and purpose.

Image: Pimp my zimmer has been adopted in care homes across the UK. Decorating zimmer frames has helped to reduce falls, simply by encouraging residents to use them.

 

 

Red text reading: future proof on a yellow / orange background

Living beyond 100 may well become normal for children born within the next generation. Life as a centenarian is hard to imagine for many of us living today. Longer life expectancies change how we view work, retirement, relationships and our health. In these later years, some of us will need more support than others, whether from friends and family or nurses and social care workers.

The nursing role brings with it a difficult history and a challenging present. But also space for hope and creativity. How do we ensure that society can look forward to the rewards of ageing? And how can nurses pioneer the best support, whether for those who need 24-hour care, or others who simply wish to grow old (dis)gracefully?

A stylised cocktail and glass of red wine on a table next to a potted plant.