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Book Details
Abstract
Now in its fourth edition trusted textbook Older People: Issues and Innovations in Care provides a unique collection of conversations and commentaries by leading international and local experts on a range of contemporary issues around the care of older people.
Featuring six new chapters, current research and policy changes, the esteemed author team continue to highlight the importance of interdisciplinary healthcare in providing a comprehensive, person-centred approach to care.
This edition encourages readers to explore care issues, innovations and change, and to utilise evidence-based practice to improve the care of older people and their families.
This text reflects new thinking in care; include the ideas and experiences of policy analysts, nurses, doctors, allied health professionals and the consumer experience mainly from Australia but with international contributions and be based on contemporary research. It will also point readers to ‘the evidence’ where it exists, and include vignettes of practice and ‘video’ clips where appropriate.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Evolve splash page | IFC1 | ||
| Half title page | i | ||
| Dedication | ii | ||
| Older People | iii | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| About the authors | vii | ||
| Acknowledgments | ix | ||
| Foreword | xi | ||
| Preface | xiii | ||
| Organisation of the volume | xiv | ||
| Section 1: Contextual issues and innovations | xiv | ||
| Section 2: Practice issues and innovations | xv | ||
| Section 3: Innovations in action | xvi | ||
| Contributors | xvii | ||
| Reviewers | xxiii | ||
| 1 Contextual issues and innovations | 1 | ||
| 1 Caring for older people: | 3 | ||
| Introduction | 3 | ||
| The consumer view in Australia | 4 | ||
| The economic view | 5 | ||
| The consumer view | 6 | ||
| Choice | 6 | ||
| Community care | 8 | ||
| Quality of care | 9 | ||
| Evidence-based practice | 11 | ||
| Dementia services across health and aged care | 11 | ||
| Conclusion | 12 | ||
| References | 13 | ||
| 2 Public health for an ageing society | 15 | ||
| Introduction | 15 | ||
| Public health and the changing pattern of life expectancy | 16 | ||
| Public health’s shift towards chronic disease | 20 | ||
| Population ageing and society | 21 | ||
| The impact of ageing on demand for health and aged care | 23 | ||
| Role of public health in an ageing society | 26 | ||
| Reorienting health and aged care | 28 | ||
| Conclusion | 31 | ||
| References | 31 | ||
| 3 Redefining ‘old age’: | 35 | ||
| Introduction | 35 | ||
| How many Australian centenarians are there? | 37 | ||
| Marital status and living arrangements | 41 | ||
| Birthplace | 42 | ||
| Semi-supercentenarians and supercentenarians in Australia | 43 | ||
| Health of centenarians | 45 | ||
| Quality of life | 49 | ||
| Theoretical perspectives and defining centenarian quality of life | 49 | ||
| Quality of life survey findings | 50 | ||
| Conclusion | 55 | ||
| References | 56 | ||
| 4 Ageing in rural areas | 59 | ||
| Introduction | 59 | ||
| Rural demography | 61 | ||
| Access to health services | 64 | ||
| Tyranny of distance and cost | 64 | ||
| Transport issues | 65 | ||
| Economic forces | 65 | ||
| Rural stoicism | 65 | ||
| Access issues in remote Australia | 66 | ||
| Professional practice in the rural context | 66 | ||
| Rural health workforce shortages impacting on interdisciplinary care of older people | 68 | ||
| Nursing | 68 | ||
| Medical | 69 | ||
| Allied health | 70 | ||
| Aboriginal health workers | 70 | ||
| Educating the rural health workforce | 71 | ||
| Initiatives supporting interdisciplinary care for older people in rural areas | 73 | ||
| Telehealth and telemedicine | 73 | ||
| National registration and accreditation for health professionals | 75 | ||
| Extended scope of practice initiatives | 75 | ||
| Living longer and living better in the bush | 78 | ||
| Conclusion | 80 | ||
| References | 81 | ||
| 5 Younger people in residential aged care facilities | 87 | ||
| Introduction | 87 | ||
| The current situation | 88 | ||
| Admission to an RACF | 90 | ||
| Funding | 91 | ||
| Rehabilitation | 92 | ||
| Building design | 92 | ||
| Freedom of choice | 93 | ||
| Risk taking | 93 | ||
| Leisure and lifestyle | 94 | ||
| Understanding behaviour | 94 | ||
| Pain management | 95 | ||
| Intimacy and sexual expression | 95 | ||
| Younger onset dementia diagnosis and care | 96 | ||
| Developing a therapeutic approach to care | 97 | ||
| The Eden Alternative | 97 | ||
| Progressively lowered stress threshold (PLST) | 98 | ||
| Enhanced lifestyle through optimal stimulus (ELTOS) | 98 | ||
| Montessori methods | 98 | ||
| Conclusion | 100 | ||
| References | 101 | ||
| 6 Community support for older Australians: | 103 | ||
| Introduction | 103 | ||
| The Australian community service system | 104 | ||
| Aged Care Assessment Program | 104 | ||
| Home and Community Care | 105 | ||
| Packaged care | 106 | ||
| Respite | 108 | ||
| Other community care services | 108 | ||
| Carers and the interface between formal and informal care | 109 | ||
| Tensions and pressures in the aged care system | 110 | ||
| Population | 110 | ||
| Future availability of carers | 112 | ||
| Community expectations | 112 | ||
| Key concepts in community aged care | 113 | ||
| Successful ageing | 113 | ||
| Restorative care and promotion of wellness | 115 | ||
| Person-centred care | 120 | ||
| Consumer-directed care | 120 | ||
| Targeting | 122 | ||
| The role of assessment | 124 | ||
| The Productivity Commission review and Australian government response | 126 | ||
| Conclusion | 127 | ||
| References | 128 | ||
| 2 Practice issues and innovations | 135 | ||
| 7 Person-centred care | 137 | ||
| Introduction | 137 | ||
| So what is person-centred care? | 138 | ||
| Person-centred care | 139 | ||
| Person-centred care: measuring success in residential aged care | 142 | ||
| A whole-of-organisation approach | 143 | ||
| Practical approaches to foster person-centred care at a local unit level | 144 | ||
| Conclusion | 144 | ||
| References | 145 | ||
| 8 Upholding rights and managing risk while improving quality of care | 147 | ||
| Introduction | 147 | ||
| Research evidence: hip protectors | 149 | ||
| Quality, risk, rights and evidence-based practice | 150 | ||
| Quality | 150 | ||
| Quality of healthcare and quality of life | 150 | ||
| Risk | 151 | ||
| Risk perception | 151 | ||
| Risks to different stakeholders | 152 | ||
| Rights | 152 | ||
| The right to autonomy and ‘dignity of risk’ | 152 | ||
| Autonomy and decision-making capacity | 153 | ||
| Rights of the collective | 153 | ||
| Rights and professional duty of care | 154 | ||
| Evidence-based practice | 154 | ||
| Putting it all together | 154 | ||
| The broader context: improving quality of care | 155 | ||
| A systems approach | 155 | ||
| Systems of care | 156 | ||
| Governance | 157 | ||
| Measurement of care | 158 | ||
| Responding to improve care | 159 | ||
| Balancing rights and risk at the systems level | 160 | ||
| Systems of care and aged care | 160 | ||
| Measuring care in aged care | 161 | ||
| Governance in aged care | 162 | ||
| The broader context | 163 | ||
| Conclusion | 163 | ||
| References | 165 | ||
| 9 Health and care of older Aboriginal and Torres Strait Islander peoples | 169 | ||
| Introduction | 170 | ||
| Background | 170 | ||
| Chronic disease and risk factors | 173 | ||
| Disability | 174 | ||
| Geriatric syndromes in older Aboriginal Australians | 175 | ||
| Dementia | 176 | ||
| Depression | 180 | ||
| Falls | 182 | ||
| Urinary incontinence | 183 | ||
| Chronic pain | 184 | ||
| Community and residential care | 185 | ||
| Approach to care | 186 | ||
| Awareness, recognition and referral | 187 | ||
| Initial assessment and diagnosis and post-diagnosis support | 187 | ||
| Management, care, support and review | 189 | ||
| Conclusion | 189 | ||
| References | 192 | ||
| 10 Working with families: | 197 | ||
| Introduction | 197 | ||
| A brief history of our work | 200 | ||
| Systematic review of the research evidence | 201 | ||
| Communication | 202 | ||
| Information | 202 | ||
| Education | 202 | ||
| Administrative support | 202 | ||
| Familiarity, trust, respect and empathy | 202 | ||
| Implementing research evidence into practice | 203 | ||
| Measuring staff–family relationships | 205 | ||
| Conclusion | 206 | ||
| References | 208 | ||
| 11 Older people and acute care | 211 | ||
| Introduction | 211 | ||
| Should older people be in acute care? | 211 | ||
| The nurse’s experience: | 217 | ||
| Emmy’s son’s response | 217 | ||
| Acute hospital inpatient care | 218 | ||
| Discharge planning | 220 | ||
| Conclusion | 220 | ||
| References | 221 | ||
| 12 Person-centred comprehensive geriatric assessment | 223 | ||
| Introduction | 223 | ||
| The importance of an interdisciplinary approach to comprehensive geriatric assessment | 224 | ||
| What is the value of comprehensive geriatric assessment? | 226 | ||
| The structure of a comprehensive assessment | 227 | ||
| Medical health | 227 | ||
| Physical function | 227 | ||
| Psychological function | 228 | ||
| Social function | 228 | ||
| Sources of assessment information | 229 | ||
| How to conduct a comprehensive assessment | 230 | ||
| Selecting the right tools for assessment | 231 | ||
| Use of data from assessments | 236 | ||
| Ethical responsibilities | 237 | ||
| Record keeping | 237 | ||
| Use of technology | 238 | ||
| Practical considerations when conducting a person-centred comprehensive assessment | 238 | ||
| Facilitating person-centredness | 238 | ||
| Medical considerations | 239 | ||
| Communication considerations | 239 | ||
| Cultural considerations | 240 | ||
| Conclusion | 242 | ||
| References | 243 | ||
| 13 Alzheimer’s dementia: | 247 | ||
| Introduction | 247 | ||
| Dementia incidence | 248 | ||
| What is dementia? | 249 | ||
| Cortical dementia | 250 | ||
| Alzheimer’s dementia | 250 | ||
| Other dementias | 252 | ||
| Diagnosing dementia: the importance of neuropsychological assessment for early diagnosis and differential diagnosis | 253 | ||
| Non-pharmacological treatments for dementia | 255 | ||
| The Tasmanian Healthy Brain Project | 256 | ||
| The ACTIVE study | 258 | ||
| The ACE study | 258 | ||
| Cognitive training in mild cognitive impairment | 259 | ||
| The importance of early diagnosis of dementia | 260 | ||
| Treatment options | 260 | ||
| Quality-of-life issues | 261 | ||
| Conclusion | 261 | ||
| References | 262 | ||
| 14 Depression and suicide in older people | 267 | ||
| Introduction | 267 | ||
| Depression | 267 | ||
| Epidemiology | 267 | ||
| Risk factors | 268 | ||
| Clinical features | 269 | ||
| Comorbidity | 270 | ||
| Differential diagnosis | 270 | ||
| Other assessment issues | 271 | ||
| Psychological treatments | 271 | ||
| Drug treatments | 272 | ||
| Older antidepressants | 273 | ||
| Newer antidepressants | 273 | ||
| Other treatments | 274 | ||
| Prevention | 276 | ||
| Prognosis | 276 | ||
| Suicide | 276 | ||
| The spectrum of suicidal behaviours | 277 | ||
| Epidemiology | 277 | ||
| Risk factors | 277 | ||
| Methods | 278 | ||
| Management | 278 | ||
| Treating suicidal behaviour | 279 | ||
| Suicide prevention in older people | 280 | ||
| Assisted suicide | 280 | ||
| Conclusion | 281 | ||
| References | 282 | ||
| 15 Persistent pain in older people | 285 | ||
| Introduction | 285 | ||
| Epidemiology of pain in older people | 286 | ||
| Pain prevalence in people with dementia | 286 | ||
| Comprehensive assessment and measurement of pain in older people | 287 | ||
| Psychometric approaches to a comprehensive assessment of pain | 289 | ||
| Measurement of pain | 294 | ||
| Pain assessment in people with dementia | 294 | ||
| Measurement of psychosocial impacts of pain | 295 | ||
| Measurement of activity, disability and pain-related interference with daily activities | 296 | ||
| A comprehensive approach to treating chronic pain in older people | 297 | ||
| Medical management of chronic pain in older people | 299 | ||
| Medical management of pain in people with dementia | 306 | ||
| Psychological approaches to pain management | 307 | ||
| Physical therapies | 311 | ||
| Physical modalities | 312 | ||
| Superficial heat | 312 | ||
| Superficial cold | 312 | ||
| Vibration | 313 | ||
| Transcutaneous electrical nerve stimulation | 313 | ||
| Multidisciplinary approaches to pain management | 314 | ||
| Conclusion | 315 | ||
| References | 316 | ||
| 16 Sexuality, ageing and health professionals | 323 | ||
| Introduction | 323 | ||
| Grappling with the last frontier: some challenges | 324 | ||
| Sexuality: more than sex | 327 | ||
| Sexuality and healthcare | 327 | ||
| Representations of sexuality: images and stereotypes | 328 | ||
| Sexuality and older people: an emerging issue | 329 | ||
| Older people and sexual practices | 330 | ||
| Ageing and illness: effects on interest and opportunity | 335 | ||
| Ageing and sexual health | 336 | ||
| Sexuality and dementia | 337 | ||
| Sexuality, health professionals and person-centred care: the need for change | 338 | ||
| Conclusion | 340 | ||
| References | 341 | ||
| 17 Intervention in a situation of elder abuse and neglect | 347 | ||
| Introduction | 347 | ||
| Definition and overview of elder abuse | 347 | ||
| Identifying elder abuse | 348 | ||
| Vulnerability to abuse | 349 | ||
| Prevalence of elder abuse | 349 | ||
| Reasons for the emergence of elder abuse as a contemporary social issue | 349 | ||
| General principles for assessment | 350 | ||
| Options for intervention | 351 | ||
| Decision making in relation to elder abuse | 352 | ||
| A situation for analysis | 352 | ||
| Discussion | 355 | ||
| Conclusion | 356 | ||
| References | 356 | ||
| 18 End-of-life decision making for older people | 359 | ||
| Introduction | 359 | ||
| End-of-life trajectories for older people | 360 | ||
| Decision making | 362 | ||
| Competence | 363 | ||
| Determining competence | 365 | ||
| Advance care planning | 366 | ||
| Types of advance care planning | 367 | ||
| Some issues to consider … | 369 | ||
| Conclusion | 370 | ||
| References | 371 | ||
| 3 Innovations in action | 375 | ||
| 19 Self-esteem, dignity and finding meaning in dementia | 377 | ||
| Introduction | 377 | ||
| The concept of self | 378 | ||
| Autonomy | 383 | ||
| Hope | 385 | ||
| Boredom | 387 | ||
| Creativity | 388 | ||
| Conclusion | 390 | ||
| References | 390 | ||
| 20 Accreditation: | 393 | ||
| Introduction | 393 | ||
| Accreditation | 394 | ||
| Accreditation, of itself, will not stop bad things happening | 394 | ||
| Standards | 396 | ||
| Residents | 397 | ||
| Compliance with regulations or the pursuit of excellence? | 398 | ||
| Regulation | 398 | ||
| Quality | 399 | ||
| Excellence | 402 | ||
| To bring this together | 404 | ||
| My experience 2003–2012 | 404 | ||
| Conclusion | 405 | ||
| References | 408 | ||
| 21 Environments that enhance dementia care: | 411 | ||
| Introduction | 411 | ||
| The scope of the problem | 411 | ||
| The evidence base | 412 | ||
| Assessing the physical environment | 413 | ||
| The principles of design | 415 | ||
| Unobtrusively reduce risks | 415 | ||
| Provide a human scale | 416 | ||
| Allow people to see and be seen | 416 | ||
| Reduce unhelpful stimulation | 417 | ||
| Optimise helpful stimulation | 418 | ||
| Support movement and engagement | 418 | ||
| Create a familiar space | 419 | ||
| Provide opportunities to be alone or with others | 419 | ||
| Provide links to the community | 420 | ||
| Respond to a vision for a way of life | 420 | ||
| The philosophy of care | 421 | ||
| The obstacles to implementing our knowledge | 423 | ||
| Conclusion | 424 | ||
| References | 427 | ||
| Other resources | 431 | ||
| 22 Assistive technology: | 433 | ||
| Introduction | 433 | ||
| What is assistive technology? | 434 | ||
| Work and financial independence | 435 | ||
| Understanding the role of assistive technology | 435 | ||
| Selection of assistive technologies | 437 | ||
| Steps for selecting assistive technologies | 438 | ||
| Understanding and acceptance | 438 | ||
| For the individual | 438 | ||
| Examples of the application of assistive technology | 440 | ||
| Tracking movement | 440 | ||
| The Alzheimer’s Australia Western Australia Safe2Walk Service | 441 | ||
| Telecare | 441 | ||
| Smart toilet | 442 | ||
| Robots | 442 | ||
| Smart homes | 442 | ||
| Assistive technology for service providers or practitioners | 443 | ||
| Telehealth | 444 | ||
| Mobile device applications | 445 | ||
| Knowledge management | 445 | ||
| Cloud computing | 445 | ||
| Intelligent agent software | 446 | ||
| Green computing | 446 | ||
| Call centres and monitoring | 446 | ||
| Standards | 447 | ||
| Some possible applications of assistive technology | 447 | ||
| Tracking people and objects | 447 | ||
| Sensor technologies, personal healthcare devices | 448 | ||
| Mobility and falls monitoring | 448 | ||
| Behaviour patterns and monitoring | 448 | ||
| Barriers to using assistive technology | 449 | ||
| Attitudes to technology | 450 | ||
| Ethical concerns | 450 | ||
| Confidentiality and privacy | 450 | ||
| Evaluation of assistive technology | 451 | ||
| Conclusion | 452 | ||
| Future directions | 453 | ||
| References | 454 | ||
| 23 Innovative responses to a changing healthcare environment | 457 | ||
| Introduction | 457 | ||
| Changes in demand | 457 | ||
| Changes in supply | 459 | ||
| Innovation in the care of older people | 460 | ||
| Delirium | 465 | ||
| Conclusion | 467 | ||
| References | 467 | ||
| 24 My journey of heartbreak: | 471 | ||
| Introduction | 471 | ||
| My father Ted’s story | 472 | ||
| October 2005 | 472 | ||
| Early 2007 | 474 | ||
| October 2007 | 475 | ||
| May 2008 | 475 | ||
| January 2009 | 475 | ||
| March 2009 | 476 | ||
| April 2009 | 476 | ||
| June 2009 | 476 | ||
| A Friday incident | 477 | ||
| Carers’ meetings | 477 | ||
| April 2010: a beach holiday | 478 | ||
| Private hospital | 478 | ||
| September 2010 | 479 | ||
| My mother Ruth’s story | 482 | ||
| References | 487 | ||
| Further reading | 488 | ||
| 25 Visionary leadership for a ‘greying’ healthcare system | 489 | ||
| Introduction | 489 | ||
| What do we know about leadership in the healthcare context? | 490 | ||
| How does the current and future healthcare context affect leadership? | 491 | ||
| Who can be a leader? | 495 | ||
| Being and growing leaders | 495 | ||
| Conclusion | 499 | ||
| References | 500 | ||
| Index | 503 | ||
| A | 503 | ||
| B | 505 | ||
| C | 505 | ||
| D | 507 | ||
| E | 508 | ||
| F | 509 | ||
| G | 509 | ||
| H | 509 | ||
| I | 510 | ||
| J | 511 | ||
| K | 511 | ||
| L | 511 | ||
| M | 511 | ||
| N | 512 | ||
| O | 513 | ||
| P | 513 | ||
| Q | 515 | ||
| R | 515 | ||
| S | 516 | ||
| T | 517 | ||
| U | 518 | ||
| V | 518 | ||
| W | 518 | ||
| Y | 519 | ||
| Z | 519 |