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Contents

Contributors ix Foreword xiii Preface xv Introduction xvii Section 1 - Past and current infl uences on practice 1 1 Historical perspectives from past to present 3 Robin Means Introduction 3 Family, kinship and older people 3 The welfare state, older people and the changing role of institutions 8 Towards Care in the Community 14 Modernisation muddles. 20 Conclusion 22 References 23 2 Older people's experiences: social context and contemporary social policy 27 Tina Fear and Grace Boddy Introduction 27 Social context 27 Policy as a response to needs of older people 40 Health and social care provision 47 Conclusion 54 References 55 3 Ethical tensions for the older person and carers 61 Lesley Moore Introduction 61 Paradigm shifts in health and social care 61 Factors influencing moral reasoning and behaviour 65 Values and beliefs 65 Signifi cant ethical theories 67 Power versus professional perspectives 74 End of life and decision-making 78 The diversities and tensions of caring 81 Conclusion 87 References 88 Section 2 - Contemporary challenges 93 4 Healthy ageing, active ageing: the challenges 95 Angela Hudson, Jane Buswell and Natalie Godfrey Introduction 95 The context 96 Active ageing. 99 Healthy ageing 100 Barriers 100 Policy frameworks. 103 Health promotion versus health education 104 Targeted health education for older people 107 Challenges 109 Complementary therapies 110 Controversy and cultural shifts 111 Conclusion 130 References 131 Useful websites 138 5 Older people with learning disabilities 139 Kim Scarborough Introduction 139 Defining learning disability 139 Recent policy and people with learning disabilities 141 Impact of having a learning disability 141 Communicating with older people with learning disabilities 142 Vulnerability 145 Principles underpinning services for people with learning disabilities 146 Community services and support systems for older people with learning disabilities 146 Impact of ageing on where an older person with learning disabilities lives 149 Health services and older people with learning disabilities 150 Primary care 150 Specialist community learning disability teams 151 Mental health services. 151 Health of older people with learning disabilities 151 Specifi c health issues for people with learning disabilities 153 Partnership working and consent 158 Advocacy and empowerment 159 Person-centeredness. 159 Health assessment 160 Health action plans 160 End of life care 160 Conclusion 161 References 162 Useful websites 166 6 Working with older people with dementia in the community 167 Mary Marshall Introduction 167 What is dementia? 167 Policy context 168 Roles for nurses in the community 169 The medical view of dementia 170 Conditions often confused with dementia: delirium and depression 174 The social view of dementia 175 The citizenship view 176 Stages of dementia 176 Philosophical and ethical concerns 176 Communication. 180 Assessment 184 Working with carers 187 Working with other agencies and professionals 188 Technology 189 Challenges and rewards 190 Conclusion 199 Acknowledgements 199 References 199 Useful websites 204 Section 3 - Future challenges 205 7 Future trends. 207 Lesley Moore and Angela Hudson Introduction 207 Signifi cant trends leading to the 60th year of the NHS 208 The empowerment of patients through the Expert Patients Programme 211 Community hospitals 213 Cancer care - bringing diagnostic technology and chemotherapy treatment closer to patients 215 The National Programme for IT 216 Telecare, telehealth, telenursing and telemedicine 218 Whole System Demonstrators 224 Moving towards seamless care 225 Partnership for Older People Projects 230 Conclusion 232 References 233 Useful websites 235 Index 237

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