Analysis

How nurses can promote healthy ageing and prevention

Prevention of health problems among older people is and should be the cornerstone of geriatric medicine, and nurses have an important role 
Picture shows a group of older people doing stretch exercises. Prevention of health problems among older people should be a cornerstone of geriatric medicine, and nurses have an important role to play.

Prevention of health problems among older people is and should be the cornerstone of geriatric medicine, and nurses have an important role

  • Nurses are pivotal in supporting people to make choices for healthier ageing
  • Even older people who are already ill or frail can benefit
  • Collaborate with older people to give them the best chance of recovery and independence

Prevention is as relevant to older people as it is to their younger counterparts, says a British Geriatrics Society report, Healthier for longer how healthcare professionals can support older people , which argues that while gains in longevity may be modest, quality of life can be improved significantly.

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Prevention of health problems among older people is and should be the cornerstone of geriatric medicine, and nurses have an important role 

  • Nurses are pivotal in supporting people to make choices for healthier ageing
  • Even older people who are already ill or frail can benefit
  • Collaborate with older people to give them the best chance of recovery and independence
Picture shows a group of older people doing stretch exercises. Prevention of health problems among older people should be a cornerstone of geriatric medicine, and nurses have an important role to play.
Sit-to-stand exercises are simple ways to reduce sedentary behaviour. Picture: iStock

Prevention is as relevant to older people as it is to their younger counterparts, says a British Geriatrics Society report, Healthier for longer – how healthcare professionals can support older people, which argues that while gains in longevity may be modest, quality of life can be improved significantly.

‘When we talk about prevention, we tend to think about middle-aged or younger people and children, but this is focusing on the benefits for older people too. It’s giving equality,’ says Lucy Lewis, who chairs the society’s nurses and allied health professionals’ council.

59%

of nurses say promoting mobility for patients in hospital is neglected due to lack of time 
Source: RCN

‘Nurses have an opportunity to put a lot of what’s in this report into their practice. But we need the ability in the workforce to have these conversations, including the time they take,’ she adds.

Lifestyle factors, basics of daily living and medical interventions

Citing prevention as a cornerstone of geriatric medicine, the report states: ‘Prevention is as important at 70 years old as it is at age seven.’

Prevention has also been identified as a government priority, with a green paper published last July, following a vision document the previous autumn.

Centred on three themes, the society's report looks at lifestyle factors such as alcohol, smoking and physical activity; the basics of daily living, including sleep, eye and dental health; and medical interventions.

4 in 10

people living in nursing homes in England have depression
Source: Age and Ageing

‘While the benefits of prevention in younger populations may take many years to come to fruition, prevention measures in older people, even those who are already ill and/or frail, can have very quick and almost instant results,’ says the report.

RCN professional lead for care of older people and dementia Dawne Garrett says: ‘What’s especially helpful is the timely reminder that it’s never too late to start or keep going. It’s easy to fall into a spiral of ill-health.’

A different cohort of older people is emerging

For healthcare professionals it is important to recognise that a different cohort of older people is emerging, says Dr Garrett.

Five steps to promote healthy ageing

The British Geriatrics Society report, Healthier for longer: how healthcare professionals can support older people, identifies five steps all healthcare professionals can take to promote healthy ageing:

  1. Care at every contact – see every touchpoint as a potential opportunity to help people to engage in their own health and work with others to improve it
  2. Cover the basics – ensure older people can see, hear, eat, drink and sleep well, even if other more complex health issues are being addressed
  3. Consider the whole person – remember healthcare issues may not be the only or even the most pressing concern for a patient. Ask what matters to them and how they can be supported
  4. Communicate clearly – tell older people what is going on and how they can help with improving their health
  5. Collaborate with others – work with colleagues, nursing and therapy teams, families and the older person themselves to give the best chance of recovery and independence

‘There’s some legacy from the post-war years, where people had relatively healthy lifestyles, but the generation coming through now has had much more availability of food, alcohol and drug misuse. We’re seeing cocaine users in their late sixties and early seventies.’ 

Discovering activities that someone once enjoyed, such as gardening, can be a good way to encourage people to take the first steps, suggests Dr Garrett, who advises that nurses find out what is available locally, so they can direct people.

20%

of UK residents in long-term care are dehydrated
Source: Journals of Gerontology

‘Remind people they can make healthier choices’

‘But it’s not enough to say: “Here’s the address of a great bowls club.” You may also need to say: “They can collect you and I can ask someone to call and have a chat, if you’d like that.” All of us feel uncomfortable about going into new environments with people we don’t know,’ she says.

Dr Garrett believes nurses are pivotal because of the high number of patient interactions: ‘There is always an opportunity to remind people they can make healthier choices.

‘We can also explain and reinforce the other benefits of being active. For example, if you’re more mobile and engaging in mentally stimulating activities you’re less likely to experience loneliness, with friends and supporters on hand to help when things go wrong.’

Using volunteers to support patients to be more active

A study designed to encourage older patients in hospital to move more has been welcomed by everyone involved.

‘Patients absolutely loved it,’ says Southampton Mobility Volunteer’s principal investigator Stephen Lim, a clinical lecturer in geriatric medicine at the University of Southampton. ‘There are lots of positives.’

Involving 50 patients at Southampton General Hospital with an average age of 86-87, the initiative looked at whether it was possible to train volunteers to support nursing staff and therapists to improve mobility for older hospital patients.

‘We realised they were not as active as they should be,’ says Dr Lim. ‘There are consequences of being inactive, including muscle wasting and a decline in physical functions.’

Volunteers from the hospital’s pool of almost 1,000 volunteers were trained to work with patients, including assisting those who were able to walk around the corridors or beyond, after assessment by a therapist. Those less able were helped to do resistance exercises on a chair or at the bedside.

Vital role of volunteers

‘It’s a big step forward to see if volunteers can work directly with patients,’ says Dr Lim. ‘We monitored any adverse incidents, such as falls, and there weren’t any.’

One nurse taking part in the study spoke positively about the role of the volunteers, saying: ‘I consider them as part of the team. They’re an asset… Anyone who comes in and provides that extra bit of service, it’s a good thing... we should have time, but we haven’t, and that’s the role they’ve been playing, which is a vital support to us.’

For patients, having regular social interaction was a big plus. ‘It wasn’t a professional telling them what they needed to do, but someone who was less pushed for time, who could chat to them,’ says Dr Lim. ‘This social aspect is brilliant.’

Encouraged to have a go

One patient commented: ‘Would I have done it if he had not have come in? I might not have done. It is having the volunteers. They encourage you to have a go.’

Although it was a feasibility study rather than a randomised controlled trial, researchers still measured outcomes. Initial findings show that patients who had the intervention had an improved daily step count of 45%, rising from 630 steps a day beforehand to 930. There was also a half-day reduction in length of hospital stay.

With the aim of eventually rolling it out nationwide, researchers are planning a larger multi-centre study, involving several hospitals, alongside looking at how it might also work in the community.

‘We want to do a bigger trial to show its impact on patient outcomes, including length of stay, physical function and activity levels,’ says Dr Lim. ‘This will make it easier for other trusts to write a business case.’


Lynne Pearce is a health journalist

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