Evidence and Practice
How to support the inclusion in research of older people who lack capacity to consent
COVID-19: the experiences of a frailty specialist community rapid response team
Learning and leadership in advanced dementia care
Clinical
How to support the inclusion in research of older people who lack capacity to consent
Support for nurses to ensure that older people who lack capacity can participate in research
COVID-19: the experiences of a frailty specialist community rapid response team
Changes made to service delivery by a team caring for older people living with frailty
Learning and leadership in advanced dementia care
Evidence about leadership skills and competencies needed in advanced dementia care is scant
A survey of nurses involved in assessing the eligibility of older people for NHS...
Why you should read this article: • To gain insight into the complexity of NHS continuing healthcare (CHC) assessments • To reflect on what skills and knowledge are required for the optimal assessment of an older person’s eligibility for CHC • To understand the training and development needs of nurses involved in CHC-associated work Background Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs. Aim An online survey was conducted to identify the educational status and development needs of nurses involved in CHC assessments. Method The survey was informed by a literature review and focus group discussions, and distributed via email to the members of the Royal College of Nursing older people’s forum. Descriptive data analysis was undertaken. Results Overall, respondents were confident about their ability to undertake CHC-associated work and manage each aspect of the CHC process. However, respondents were less confident about how to determine whether a primary health need exists based on the four main criteria – nature, complexity, intensity and unpredictability – of a person’s health and social care needs. This was one of the respondents’ priorities for training and development. Conclusion The survey demonstrates the importance of face-to-face and multidisciplinary CHC training delivered locally. It also confirms the need for a standardised approach and more consistency in the CHC assessment process. A CHC competency framework would contribute to standardise the process and benefit all involved.
Dignity, well-being and identity: a qualitative study of older people’s interpretations...
Why you should read this article: • To understand how the way nurses speak to older people can negatively affect older people’s well-being • To learn about older people’s preferences for forms of address during healthcare encounters • To identify assumptions nurses might make when choosing how to address older people Background The initial interaction between an older person and a nurse, and how the older person interprets this interaction, is important and sometimes overlooked. Evidence suggests that the way healthcare workers speak to older people can negatively affect older people’s well-being. Aim To interview community-dwelling older people aged ≥65 years who had recently held a conversation with a healthcare worker and to understand the meanings older people attributed to these conversations. Method Ten community-dwelling older people were recruited and interviewed. Interviews were recorded and transcribed verbatim. Qualitative analysis was informed by narrative methods. Findings Participants freely and readily interpreted their conversations with healthcare workers in terms of the values and attitudes conveyed. Their preferences for forms of address ranged from formal to informal. They were sensitive to a range of contextual factors shaping the use of language. While they were generally tolerant of forms of address that did not match their personal preferences, some inferred disrespect from the unthinking use of first names and some resented assumptions being made based on age. Conclusion Nurses are encouraged to be skilful and sensitive when speaking to older people. It is advisable to follow older people’s preferences regarding forms of address, as these are important markers of dignity and respect.
Meaningful activity in advanced dementia
Why you should read this article: • To acknowledge that the research base for meaningful activity in advanced dementia is limited but increasing • To recognise that people living with advanced dementia should have the opportunity to participate in personalised meaningful activities that may enhance their quality of life and well-being • To be aware that carers and practitioners will require support and training to implement personalised meaningful activities with people living with advanced dementia This article is part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia. When someone with advanced dementia can no longer communicate verbally and has limited movement, activities they once enjoyed may no longer be possible. This limits opportunities for self-realisation and can lead to a preoccupation in advanced dementia care about the routines associated with the maintenance of comfort and nourishment, at the expense of contentment and moments of fulfilment. Such a narrow focus can lead to changes in behaviour, indicating boredom, frustration and distress. Yet there are opportunities for a more creative approach to activity that can be adapted to the person’s changing needs and the human desire to feel connected and engaged. Examples of these evidence-informed, creative interventions for people living with advanced dementia care include music, doll-focused activity, animal-assisted interventions, multisensory experiences such as Namaste Care and complementary therapies. These activities can engage the person with advanced dementia in a close connection with another human being through individualised and sensory-based care.
CPD articles
Type 2 diabetes in older people: pathophysiology, identification and management
Exploring the implications of increased longevity and how this is linked to type 2 diabetes
Sexual health and well-being in later life
This article defines sexual health and explores the changes people experience in later life
How therapeutic communication can reduce distress in people with dementia
Newcastle Model’s biopsychosocial framework is revisited to understand the caregiving context
Osteoporosis and fragility fractures: risk assessment, management and prevention
Nurses need to be aware of the risk factors and identify at-risk patients
Understanding and managing depression in older people
Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.
Helping people live with chronic obstructive pulmonary disease
How nurses can have a positive effect on the lives of people with COPD
How to
How to address the communication needs of older patients with hearing loss
Hearing loss is a common problem in older people and may have a negative effect on their care while in hospital, as well as resulting in significant cost to the NHS. This article outlines the findings of a two-year project in an NHS trust to improve the care of older people with hearing loss. An important outcome of the project was the development of a hearing loss toolkit containing good practice recommendations and tools to help staff in all NHS trusts, and other care settings, implement practical and cost-effective improvements.
How to use advance care planning in a care home
Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.
Practice question
How do I encourage older people to become physically active?
Types of physical activity that can benefit older adults and some suggested resources
How can I ensure dementia care is based on the best available evidence?
Critically appraised topic (CAT) process helps ensure clinical practice is evidence-based
How do I manage the care of an older person with delirium?
Guidelines recommend prompt detection by screening older people on admission to hospital
Why is medicines optimisation important for older people living with frailty?
Medicines optimisation can help ensure appropriate polypharmacy
How should I discuss not attempting CPR with people who have dementia?
Discuss the wishes of people with dementia proactively due to its progression
Surprise questions that can improve end of life care
Older people approaching the end of life can be helped by asking the right questions