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
