Contributors xiii
Foreword xvi
Acknowledgements xvii
Unit 1 Principles of Caring for the Older Person 1
Chapter 1 Ageing and Ageing Populations 3
Elaine Francis
Introduction 3
What Is Ageing? 4
What Age Is 'Old Age'? 4
Trends in Population Ageing 4
Exploring Representations of Ageing and Older People 6
Interpersonal Ageism 7
Self- directed Ageism 8
Institutional Ageism 8
Ageing, Health and Society 9
Conclusion 10
References 10
Chapter 2 Healthy Ageing 13
Stuart Nicholson and Laura Graham
Introduction 13
Healthy Ageing and Ageing Well 14
Public Health Approaches 16
Psychological Well- being 17
Positive Relationship Support (Sexuality and Sexual Relationships) 19
Social Prescribing 21
Conclusion 22
References 22
Further Reading 24
Chapter 3 Person- Centred Care - Caring for Older People 25
Sue Tiplady, Jane Murray, and Isabel Quinn
Introduction 25
Person- Centred Care 26
Personhood 28
Person- Centred Communication 29
Cultural Considerations 32
Becoming More Person- Centred 33
Conclusion 33
References 34
Further Reading 35
Chapter 4 Legal and Professional Context of Care 37
James Mingham, Esther Clift, and Isabel Quinn
Introduction 37
Professional Regulation 38
Professional Codes of Conduct 40
Duty of Care 40
Information Governance 40
Confidentiality 40
Information Sharing 41
Consent 41
Mental Capacity Act 42
Lasting Power of Attorney 43
Best Interest Decision- Making 44
Deprivation of Liberty Safeguards 44
Health and Social Care Act (2012) 44
The Care Act (2014) 45
Safeguarding and Raising Concerns 45
Conclusion 46
References 46
Further Reading 47
Chapter 5 Communication 49
Eilaine White
Introduction 49
Communication, Ageing and Health 50
Cultural Considerations 52
Good Communication Practice When Assessing Older Adults 52
Shared Decision- Making 52
Health Literacy 53
Advocacy 54
Caring Conversations 55
Professional Communications Across Teams 56
Transitions of Care 57
Conclusion 57
References 58
Further Reading 58
Chapter 6 Approaches to Care for Working with Older People 59
Donna Massey, Hayley Bamber, Ursula Roberts, and Kirsty Marshall
Introduction 59
An Outline of the Approaches to Care of the Older Person 60
Co- production 60
Multidisciplinary 60
Interdisciplinary 61
Transdisciplinary 61
Integrated Care 61
Technology- Enhanced Care and Its Role in Models of Care 62
Caring for a Person Living with Dementia in the Community: Discussion 63
The Importance of Comprehensive Assessment: Discussion 65
Conclusion 67
References 67
Chapter 7 Settings of Care 69
Stacey Louise Finlay, Philip Hodgson, and Kevin Murphy
Introduction 69
Place and Importance of Place 70
Enablers of Ageing in Place 72
Adult Social Care 72
Alternative Housing 73
Community Support 73
Intermediate Care and Reablement 74
Emergency and Urgent Care for Older People 75
Urgent Community Response 75
Hospital at Home 75
Emergency Department 76
Same Day Emergency Care 76
Care Homes 76
Care of Older People in Prison 78
Conclusion 78
References 79
Further Reading 81
Chapter 8 Carer and Family Support 83
Elaine Francis and Judy Mattison
Introduction 83
Definition 84
What Matters to Carers? 85
Caring for Carers 87
Wider Health and Care Issues 89
Health Care Costs and Accessibility 89
Conclusion 91
References 91
Further Reading 92
Chapter 9 Multimorbidity 93
Jenny Allen and Esther Clift
Introduction 93
Definitions 93
Prevalence 94
Impact of Multimorbidity 94
Research and Impact on Care Guidelines 95
Conclusion 99
References 100
Further Reading 102
Chapter 10 Frailty and Comprehensive Geriatric Assessment 103
Stacey Louise Finlay and Claire Pryor
Frailty as a Syndrome 103
Risk Factors 104
Ageism 105
Biological Sex and Frailty 106
Identification and Assessment of Frailty 106
Assessing Frailty 108
The Domains of the CGA 109
The Problem List 111
Care and Support Planning 112
Conclusion 113
References 113
Further Reading 114
Unit 2 Anatomy and Physiology of Ageing 115
Chapter 11 The Anatomy and Physiology of the Brain and Nervous System 117
Barry Hill and Alison Young
Introduction 117
Structural Changes in the Ageing Brain 118
Functional Changes in the Ageing Brain 118
Clinical Implications 119
Delirium 120
Dysphasia 122
Altered Pathophysiology in the Older Person 122
Considerations of the Impact for People and Care 124
Caring for Carers 124
Epilepsy in Older People 125
Medicines Management 125
Stroke in Older People 126
Conclusion 128
References 128
Chapter 12 The Anatomy and Physiology of the Senses 131
Debbie Findlay
Introduction 131
Anatomy and Physiology of Ageing on Hearing 131
Anatomy and Physiology of Ageing on Taste 133
Anatomy and Physiology of Ageing on Smell (Olfaction) 134
Anatomy and Physiology of Ageing on Touch 135
Anatomy and Physiology of Ageing on Vision 135
Anatomy and Physiology of Ageing on Cranial Nerves which Impact the Senses 136
The Impact of Sensory Changes with Ageing 137
Considerations of the Impact on People and Care 138
Conclusion 139
References 139
Chapter 13 The Anatomy and Physiology of the Cardiovascular System 143
Stuart Barker
Introduction 143
The Heart 143
The Ageing Heart 144
The Conduction System of the Heart 145
The Ageing Conduction System 146
The Vascular System 147
Peripheral Vascular Disease 149
Coronary Artery Disease 149
Regulation of Blood Pressure 150
The Baroreceptor Reflex 150
Heart Failure 152
Conclusion 153
References 153
Chapter 14 The Anatomy and Physiology of the Respiratory System 155
Karen Corder and Elaina Henderson
Introduction 155
The Respiratory System 155
Gas Exchange 156
Changes in the Ageing Body that Affect the Respiratory System 159
Psychological Considerations for People with Respiratory Diseases 161
The Impact for People and Care 163
Conclusion 164
References 164
Chapter 15 The Anatomy and Physiology of the Gastrointestinal System 167
Claire Norman
Structures 168
The Small and Large Intestines 170
The Processing of Food 174
Circulation 175
Dysphagia 175
Bowel Care 176
Constipation 176
Conclusion 177
References 177
Chapter 16 The Anatomy and Physiology of the Renal and Genitourinary System 179
Barry Hill and Claire Pryor
Introduction 179
The Renal System 180
Age- Related Changes 180
Renal Blood Flow and Filtration Efficiency 181
Electrolyte Imbalances and Fluid Overload 181
Excretion and Waste Management in Ageing 182
Anatomy and Physiology of an Ageing Genitourinary System 183
Reproductive Health and Sexual Health in Ageing 184
Medicines Management 185
Discussion 187
Conclusion 187
References 188
Chapter 17 The Anatomy and Physiology of the Endocrine System 191
Barry Hill and Dominic Simpson
Introduction 191
Changes to the Endocrine System in Ageing 192
Understanding Hormonal Changes in Older People 193
Diabetes in Older People 196
Principle of Pharmacology 199
Conclusion 202
References 203
Chapter 18 The Anatomy and Physiology of the Immune and Haematological Systems 205
Helen Evans and Claire Pryor
Introduction 205
The Ageing Immune System 206
B- Cell and T- Cell Lymphocytes 206
Dendritic Cells 207
Macrophages 207
Natural Killer Cells 208
The Innate and Acquired Immune System 209
Vaccinations in Older People 209
The Ageing Haematological System 210
Conclusion 212
References 212
Chapter 19 The Anatomy and Physiology of the Musculoskeletal System 215
Alex Hemsley and Sue Tiplady
Introduction 215
The Musculoskeletal System and Age-Related Changes 215
Sarcopenia 216
Osteoporosis 220
Osteo-sarcopenia 223
Osteoarthtritis 224
Conclusion 226
References 227
Further Reading 228
Chapter 20 The Anatomy and Physiology of the Integumentary System 229
Sue Tiplady
Introduction 229
Effects of Ageing on the Skin 229
Skin Care 234
Skin Assessment 234
Skin Tears 237
Moisture- Associated Skin Damage 238
Personal Hygiene 238
Considerations for Personalised Care Planning for Personal Hygiene 239
Conclusion 240
References 240
Further Reading 241
Unit 3 Care Management 243
Chapter 21 Assessing and Managing Pain in Older People 245
Isabel Quinn
Introduction 245
Pain Classification 246
Pain Assessment in Older People 250
Pain Management 252
Conclusion 255
References 255
Chapter 22 Mental Health and Learning Disability in Ageing 257
Lynette Harper and Sarah Mackay
Introduction 257
Functional Mental Health 257
Substance Misuse 259
Pain Assessment 260
Neurodiversity in Older Adults 263
Capacity and Consent for All 264
Conclusion 265
References 266
Chapter 23 Dementia 269
Shibley Rahman and Claire Pryor
Introduction 269
Diagnosis 271
Prevention and Risk Reduction 273
Communication 274
Meaningful Activities and Independence 274
Living Well with Dementia 275
Carer Support 275
Distress and Communication 277
Medicines Management 277
Conclusion 279
References 279
Chapter 24 Nutrition and Hydration Care 281
Philip Hodgson, Sarah Docherty, and Glenda Cook
Introduction 281
Nutrition Care: Assessment 282
Nutrition Care: Practices 284
Hydration Care: Assessment 285
Hydration Care: Practices 286
Conclusion 288
References 288
Chapter 25 The Recognition and Assessment of the Acutely Ill Older Person 291
Tony Conner, Deborah Leetham, and Sue Tiplady
The Importance of Recognising Acute Illness in the Older Person 291
Atypical Presentation 292
The Influence of Comorbidities 293
The Importance of Social Support 293
The Assessment of the Acutely Unwell Older Person 293
Sepsis in the Older Person 297
Typical and Atypical Presentation of Sepsis in Older People 298
The Assessment of Sepsis 299
The Treatment of Sepsis 300
Prevention of Sepsis 302
Conclusion 303
References 303
Further Reading 305
Chapter 26 Pharmacology and Medicines Management 307
Joanne Dunn, Claire Pryor, Janet Wilkinson, and Patrick Dawodu
Introduction 307
Anticholinergic Burden 312
Deprescribing 312
Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) 313
Concordance Support 313
Social and Support Consideration for Medication and Medication Optimisation 314
Conclusion 315
References 315
Chapter 27 End- of- Life Care 317
Nicola Payne and Isabel Quinn
Introduction 317
Death and Dying in Older People 317
End- of- Life Care 318
The Relationship Between Supportive Care, Palliative Care and Terminal Care 318
When Is 'End of Life' 319
Advance Care Planning 321
Preferred Place of Death 322
Ethical Challenges 323
Emotional Support 323
End- of- Life Symptoms 324
Care in the Last Days and Hours of Life 324
Care After Death 326
Conclusion 326
References 326
Further Reading 327
Index 329
