Nursing 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.
As it turned out both men were Korean War veterans, sent to war when conscripted as 18 year olds in the 1950s. It is a privilege to visit someone at home and spend time getting to know them and their families using the framework of a CGA, it takes time and fundamental to its success is relationship building. It draws upon core nursing skills of communication to assess, caring to be committed to focus on the whole person not an individual problem and it provides an opportunity for nurses to be courageous and develop competency in relation to new roles and approaches to care. A whole person approach to meeting our patient’s needs clearly demonstrates compassion in practice. It is therefore the 6 C’s in action.
Without CGA diagnosis, treatment and management of problems could be bypassed and simply attributed to old age which compromises the lives of our patients. Nurses are ideally placed to lead in CGA assessment and holistic care planning, making referrals to others, coordinating responses and case managing as necessary. With growing experience they can order and act upon diagnostic tests, make decisions about admitting and discharging, develop advanced practice clinical skills and become independent prescribers.
Nursing older people is a great place to showcase nursing. It remains however an unattractive career option for many and in an ageing population world, nursing as a body must change this. Only then will we move from seeing our ageing population as a burden, to seeing it is a once in a life time opportunity to really get it right. The NHSE New Care Models [Vanguard] programmes have improved the lives of older people living in care homes, and if we can get it right for these people, who have the most complex of needs, then we can get it right for older people everywhere.