Three decades of older people's nursing reflected in our pages

The story of our journal seen through a dip into the archives, along with the recollections of two former occupants of the editor’s chair

The story of our journal seen through a dip into the archives, along with the recollections of two former occupants of the editors chair

You will not all agree, but it had to be done.

With those words the editor at the time, Linda Thomas, kick-started a new era for this journal, which until then, in June 1989, had gone by the name of Geriatric Nursing and Home Care.

The title of the magazine had to change to remove a term which genuinely offends so many of you, she wrote in an editorial.

And so Nursing the Elderly was born. Later the journal would change its name again, finally becoming Nursing Older People in 2000.

Positive and exciting era

In 1989,


The story of our journal seen through a dip into the archives, along with the recollections of two former occupants of the editor’s chair

Veteran members of Bill Haley’s Original Comets were interviewed by then editor Hazel Heath.
Picture: Phil Carpenter

‘You will not all agree, but it had to be done.’

With those words the editor at the time, Linda Thomas, kick-started a new era for this journal, which until then, in June 1989, had gone by the name of Geriatric Nursing and Home Care.

‘The title of the magazine had to change to remove a term which genuinely offends so many of you,’ she wrote in an editorial.

And so Nursing the Elderly was born. Later the journal would change its name again, finally becoming Nursing Older People in 2000.

Positive and exciting era

In 1989, Linda Thomas argued that the change in title marked a move away from the grey ‘geriatric’, a word tainted by the ‘dingy aura of the workhouse’, towards a more positive and exciting era for the specialty.

The first issue featured a range of clinical topics alongside book reviews, opinion pieces and products – a piece about an innovative, sit-down ironing machine, for example, headlined ‘Taking the sweat out of ironing’.

And Roger Watson, then a charge nurse, later a widely respected academic, reflected on what he had seen at the recent RCN Research Society annual conference.

He was struck by a poster examining the reasons behind the low status of older people’s care and its perceived position as related but not integral to nursing: ‘The poster was titled “All dressed up and nowhere to go”, which sums up the unfortunate attitude of some nurses working in care of the elderly,’ he wrote.

Ideas and innovations

Later that year the findings of a survey of local authority residential homes revealed wide variation in care standards. The government promised that planned community care reforms would herald tighter inspections. But shadow health minister Harriet Harman called the plans a ‘blueprint for privatisation’.

While topics such as care standards have been a running theme throughout the journal’s history, other ideas and innovations have come and rapidly gone.

A ‘mobile day-care unit’, for example, hit the road in rural Hampshire in 1990. It featured a minibus towing a trailer equipped with ‘bathing and toilet facilities, together with hairdressing and footcare services’.

With the trailer hooked up to mains utilities, the minibus would zip round local villages collecting the ‘frail or housebound’ so they could enjoy a bath in the trailer. An idea ahead of its time, perhaps.

As the journal developed its international reach grew. But in the early 1990s, analysis of how other countries supported older people featured less often in the journal’s pages.

An exception was a 1990 article based on the author’s visit to Denmark. Care homes there were notable for their excellent design and absence of staff uniforms, giving rise to a more homely feel, he wrote. But the standout feature of the visit was the positive approach of managers and carers, the impression of a ‘tangible philosophy in action’.

By 1993, Nursing the Elderly had become Elderly Care, and legal reforms were under way that carried huge implications, with implementation in April that year of the community aspects of the NHS and Community Care Act 1990.

Rising demand

A constant backdrop to the journal’s reporting of this and other events over the past three decades has been rising demand for services. A news item from 1994, for example, highlighted prescient calls for urgent action to address the complexities posed by dementia. The Alzheimer’s Society – then called the Alzheimer’s Disease Society – was quoted as saying 3.5 million people across Europe were affected by dementia, with the total set to rise to 4 million by 2000. Latest estimates suggest there are now 10 million people with the disease in the World Health Organization’s European region.

Another subject often discussed in the 1990s, and which continues to resonate today, is staffing levels. A 1997 RCN report found that the effect of staffing levels and skill mix on the quality of nursing was rarely evaluated. The college’s then lead on management issues, Jean Bailey, said research included in the report showed ‘a rich skill mix invariably led to improved patient outcomes’.

In the 1990s, RCN congress was as much a fixture of the nursing calendar as it is today, and at the 1999 event the RCN Forum for Nurses Working with Older People proposed a resolution on valuing older nurses.

It called on the college’s governing council to develop guidelines for nurses wishing to work beyond retirement age and for managers wanting to employ them. A rise in the state pension age and the requirement, rather than the choice, to work longer were still years away.

Choice and control

Into a new millennium, and in 2000 the journal included two students’ perspectives on placements in nursing homes. The transfer of the continuing care of older people from hospital to the community was meant to offer an opportunity to establish care environments with greater choice and individual control.

But the students were unconvinced. Care home staff seemed to assume that residents had lost their capacity to make choices, they wrote. ‘Residents’ activities were seen as needing to be confined within predetermined schedules. The time they got up in the morning to when they went to bed at night was dictated by staff routines.’

In September 2000, Elderly Care became Nursing Older People. Although the journal’s name had changed, many of the issues it covered remained the same.

In 2002, Japanese-born nurse Yumie Aoki, who had undertaken further study in England, described what she saw as the discrimination facing older people in the UK.

A woman with dementia and in terrible pain from necrotic ulcers on her toes and feet, had been denied surgery because of her age.

‘I could not understand why she had been refused amputation simply because of her age,’ Ms Aoki wrote. ‘One wonders just how much the patient’s disempowerment had been considered and understood.’

Failing too many

Living well for longer has become less of a challenge in the 21st century, not least for people with learning disabilities, many of whom would in previous eras not have been expected to reach older age.

A 2004 article considered the role of health and care services in helping people with a learning disability to live healthy, fulfilling lives as they aged. ‘The voices of people with learning disabilities have been silent for too long,’ the authors wrote. ‘We must not let them go silent again in old age.’

The announcement in 2007 of plans for a first government dementia strategy was warmly welcomed. Health minister Ivan Lewis said the system was failing too many people. ‘I am determined that this disease is brought out of the shadows,’ he said. But campaign groups highlighted the need for investment in dementia research. Help the Aged pointed out that in the US the equivalent of 66p per citizen was invested into researching dementia. In the UK the figure was just 15p.

Elsewhere, the journal reported that lifestyle magazine FHM was taking on four centenarians to act as ‘agony uncles’ for its young-buck readership. One of them, Buster Martin, offered this brisk response to a reader in a dilemma about marrying the girlfriend he claimed not to love: ‘If you don’t love her, then why the hell are you with her?’

Reader survey

Ten years ago, RCN Publishing Company, forerunner of RCNi and publisher of this and several other specialist journals, ran a reader survey to capture a snapshot of the profession and the differences between nurses in various specialties.

It found that older people’s nursing had a disproportionate number of older staff, especially in comparison with emergency care and mental health. June Clark of Swansea University said many nurses might only become aware of the importance of helping older people in later life, although Professor Clark conceded that young people might find the work ‘unattractive and boring’.

Also in 2009, the National Confidential Enquiry into Patient Outcome and Death shone a light on end of life care for older people in acute hospitals. Its conclusions were bleak. The enquiry found that many patients who were expected to die after admission to an acute hospital did not receive end of life care.

Dementia expert June Andrews, then director of the Dementia Services Development Centre, said it was ‘bizarre’ that in 17% of cases nurses had not even spoken to family members about the imminent death of a relative.

Greater potential to interact

In recent years, and in common with other nursing journals, Nursing Older People has developed a much stronger online presence, and social media has brought greater potential to interact with readers and promote content.

Older people, too, have benefited from advances in digital technology. Better management of long-term conditions and improved safety at home were cited in a 2017 article as two ways in which technology was helping people to lead more independent lives.

And the future? Evidence from the past 30 years suggests some challenges will recur: the fight for adequate resources, the continued need for determined and tireless advocacy among older people’s nurses on behalf of their patients, staffing issues, the perception among outsiders that nursing older people is insufficiently dynamic or interesting to attract them, and the certainty among insiders that it is both those things and much more.

Two former editors mull memories and highlights

Linda Thomas: ‘The problems of 30 years ago are still with us’

‘Nursing Older People was launched by an independent publisher in the early 1980s as the British Journal of Geriatric Nursing and Home Care. Alison Dunn, then head of the RCN’s publishing company, bought it and I became editor.

‘There seem to have been two significant developments since then – people are living much longer, so the dedicated wards for older people vanished as virtually every ward found itself a ward for older people, as predicted by the specialist nurses of the day.

‘However, lately I've heard radio discussions about the creation of “frail care” wards for older people, which sound much like the assessment wards on which I worked in the 1970s and 1980s.

‘Also in vogue is the need to stop “pyjama paralysis” and get patients up and dressed – another innovation of the 1970s.

‘My observation? That lessons the specialist nurses of the 1970s and 1980s learned are being learned again and put into practice by the current generation of nurses looking after older people, not necessarily as specialists.

Marvellous but confusing

‘The other significant development is in community care and quite complex packages of care on offer to keep people at home. Marvellous in principle but it can be confusing for those on the receiving end as different professionals, volunteers and carers come and go.

‘So I think the problems of 30 years ago are still with us and that demand for services is increasing without the concomitant increase in resources. When I decided to specialise in the care of older people in the 1970s I was funded to attend a six-month course in the specialty. Unthinkable now.’

Hazel Heath interviews members of Bill Haley’s Original Comets. Picture: Phil Carpenter

Hazel Heath: ‘The boundaries between social care and healthcare remain controversial’

‘I remember being at a conference in Newcastle in November 1988 talking about ageism – my first national presentation. An RCN press officer was listening and invited me for a chat. Linda Thomas was there and she had just acquired the magazine.

‘I went on to work with Linda for some years during which she taught me masses about how to be a good journal editor.

‘A major issue from the mid-1990s was the value of nursing with older people. The government of the day decided only “specialist nursing” would be deemed healthcare and therefore NHS-funded. “General nursing” – that is, all nursing not deemed specialist nursing, particularly in care homes – would come under social care.

‘This was a huge boundary shift and highly significant, as social care was means-tested. The boundaries between social care and healthcare remain controversial.

Older people's nurse consultants

‘Nursing’s most significant accomplishments during the journal’s 30 years? The achievements of older people’s nurse consultants – demonstrating clinical expertise and clinical leadership at its best.

‘Now, joined with allied health professionals as the Nurses and AHP Council, they are significant in the work of the British Geriatrics Society – some achievement.

‘The RCN Older People’s Forum, under the professional leadership of the wonderful Dawne Garrett and with Vicki Leah as chair, also continues to contribute significantly to the work of the RCN and more broadly.

‘My favourite article from my time as editor was on the veterans of the first world war. There were about 300 still alive at the time.

‘Second favourite was an interview with the musicians who were Bill Haley’s Original Comets, who recorded Rock Around the Clock in 1954. At the time they were all in their eighties and nineties, and most are sadly now gone. Wonderful fun and wonderful photos from photographer Phil Carpenter.’

Daniel Allen is a health writer

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