The success of modern medicine has resulted in many people surviving strokes, heart attacks and cancer when previously they would have died prematurely. This has resulted in an ageing population. With this changing demographic comes the challenge of how to achieve healthy ageing. Sadly many older people are not achieving this, and the numbers of older people living with frailty are rising. People living with frailty often have multiple chronic illnesses, weak muscles, poor mobility, exhaustion and are dependent on others for their care (Clegg, 2013). They are the main users of heath and social care and have high mortality (Shamliyan, 2013). Decisions around care choices are often complex, particularly where patients have dementia or are coming to the end of life. Choices must take into account patient preferences as well as what is achievable and sensible to maintain a good quality of life.
Sue Lillyman, IAH Trustee
Although there is evidence of good care and some equality for older people we still hear accounts in the media about how they continue to experience social exclusion, marginalisation and oppression at an international level. These are often, (according to Duffy et al 2012), due to the negative stereotypical views of older people that are prevalent in society. Dabove in 2013 called for an international convention on human rights for older people. Whilst she questions whether older people should have different rights she suggests that there is a need for a convention with more consistence to the tools and institutions, principles, rules laws and judicial practices that are accessed and available to the older person. She highlights the issues of capacity, empowerment, freedom, civil rights, integrity and health, abuse, property rights, legal issues, social rights and security and access to justice. In October this year the All Parliamentary Group for Ageing and Older People in the UK launched a major new inquiry into human rights of older people. This aims to improve the protection of rights of older people with an international legally binding agreement addressing the issues raised above. These changes have already been achieved for people with disabilities through the Convention on the Rights of People with Disabilities and for children with a further Convention on the Rights of the Child, it is now timely for there to be an additional one for older people.
Lesley Bainbridge, Lead Nurse Care Home Vanguard Programme, Newcastle Gateshead Clinical Commissioning Group,
Watching the Invictus Games last week prompted me to draw parallels between sudden onset disability and that associated with old age. While watching I was reminded of two patients I’d cared for over a decade ago whose problems in old age were attributed to the trauma of war. Working as a nurse specialist for older people in a community intermediate care team both men were referred by their GPs for further assessment.
What led to the ‘diagnosis’ of war trauma was comprehensive geriatric assessment [CGA] and the fact that I worked in a multidisciplinary [MDT] team that meant my patients were speedily referred to others when necessary. CGA is the best evidence base we have for providing care for older people with complex needs and it is well accepted that those that have access to MDTs do best.
CGA considers the whole person, covering 5 domains of their life including medical, social, mental health, environmental and functional. It allows us to gather information about usual and present state to identify problems and draw up a care plan to address each issue in turn in order to optimise overall health and wellbeing.