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“Nursing homes must be innovators”

Ageless Voice interviews Dr Carol Long who is a principal at Capstone Healthcare and co-director, Palliative Care for Advanced Dementia, Beatitudes Campus on her thoughts on end-of-life care or palliative care. She is also an adjunct faculty, Arizona State University College of Nursing and Healthcare Innovation, Phoenix, Arizona, US:


With the growing population ageing and the importance here for end-of-life care or palliative care at home/nursing home, can you share some innovative approaches that you have seen that help support dying elderly as well as their families?

The demographics of ageing worldwide dictates that healthcare professionals pay more attention to the care of older adults who live their final days in nursing homes or other residential settings. By the year 2030 in the US, as baby boomers reach the age of 65, there will be 70 million older adults and by 2050, 20 percent of the total US population will be age 65 and older. In addition, 70 percent of deaths in America are in those age 65 years of age and older. For many, their healthcare needs are complex; with many suffering multiple-disabling medical conditions in their final years. Of interest is data that 33 percent of residents in nursing homes are most likely to die there and as one ages, there is an increased likelihood that nursing homes will become their final, permanent residence (National Center for Health Statistics, 2011). Many die in hospitals or nursing homes where palliative care may not be available. Nursing home staff require training in end-of-life care principles.

The End-of-Life Nursing Education Consortium (ELNEC) has been on the forefront of change with training in palliative care principles across all healthcare settings. Specifically, the ELNEC-Geriatric Train-the-Trainer provides education and training for nursing staff who work in nursing home settings. Focused education includes assessing and addressing pain and non-pain symptoms; identifying goals of care; incorporating ethical principles; culture and spiritual considerations in the care plan; developing communication skills; understanding loss, grief and bereavement; and preparation and care at the time of death. Nurses who complete ELNEC can provide training in their own employment settings and create change by improving care practices in their facility. (ELNEC-Geriatric Training and ELNEC-Geriatric Train-the-Trainer was provided at Hua Mei Training Academy.) For example, at Beatitudes Campus, a “Campaign against Pain” was initiated to help nurses provide pain relief for people residing in the Health Care Center, which is a skilled nursing facility.

A second effort is the Palliative Care for Advanced Dementia programme at Beatitudes Campus which makes comfort-care the No 1 goal in all care that is provided for persons with dementia. Since dementia is a terminal illness, caregiving staff direct all of their attention to comfort practices, ranging from full liberalisation of diets to aggressive pain management to integrative approaches that include pet therapy, massages and intergenerational activities with children. There are no physical restraints and caregiving staff abandon the usual nursing home task schedule to one that is based on a person’s own individual needs. For example, there are no shower schedules and dining is ‘on demand’.

Thus, nursing homes must be innovators in supporting the older adult and their families who are approaching the final years and days of their lives to assure a ‘good death’. Finally, nursing homes need to be person-directed and comfort-focused in all aspects of care.


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When the old spark has gone

Couples find it impossible to live with each other during retirement, according to a study done by Skipton Building Society in the UK. The study of 660 retired people still in relationships also showed many find their old spark has gone after giving up work.

Instead of celebrating their newfound freedom together, a massive 80 percent of respondents found they don’t share any of the same hobbies and interests, while one in five bickered about the lack of money.

Four in 10 of the older people polled also admitted they needed to learn how to live with each other again now that the children have left the nest and they are no longer committed to work.

The study also indicated one-third of retirees spend much of their time arguing about silly things with the other half, and a surprisingly 13 percent admitted they “irritate each other beyond belief”.

A further 29 percent were surprised to find they didn’t have the same expectations for their ‘golden years’.

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Over 55s in the UK still working

Over half of over 55s in the UK are still working – because they don’t feel sufficiently secure to think about early retirement, research done by UK’s Skipton Building Society has revealed. The study found that despite the approach of their golden years, an alarmingly large percentage cannot yet see the light at the end of the tunnel.

The report revealed that although two-thirds stopped working full-time in their long-term career by the age of 55, most have merely reduced their hours or taken on part-time work. It also emerged the most common ‘late career’ choices are cleaning, stacking shelves in a supermarket, cashier work or doing the accounts for local businesses.

Unfortunately, seven out of 10 of those polled said they were worried they would struggle to get by during retirement without working. As well as the financial implications of giving up work altogether, 55 percent of adults with parents aged 55+ believe they work to stave off boredom.

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UK survey reveals families feel burdened by older relatives

British families admit they feel burdened by older relatives including at Christmas, research conducted by Friends of the Elderly (FotE), has revealed. Despite 87 percent of people feeling it is the responsibility of family to look after older relatives, worries about the financial burden (19 percent), being too busy (45 percent) and living too far away (36 percent) mean that families can’t take the strain.

In fact, almost half of those surveyed (47 percent) are dreading the day their grandparents or parents need to be cared for.

A reluctance to spend time with older relatives was shown to be particularly poignant at Christmas, with 23 percent of people saying they have older relatives who are likely to spend Christmas alone.

However, only 32 percent of people plan to invite them over for Christmas, with the greatest reason for not inviting older relatives due to concerns about frailty (18 percent).

A problem not confined to Christmas, the survey of 2,000 adults, conducted by FotE, found that while 31 percent would be happy to check in on ageing family members and visit regularly, they wouldn’t want them to move in with them.

Richard Furze, chief executive of FotE, said: ‘‘We can all make a special effort at Christmas and it will make such a difference, not just with our relatives but with older people in our communities.”

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Living in isolation

There are one million people over 65 living lonely and isolated lives in the UK. Over half a million older people will spend Christmas day alone, according to Friends of the Elderly (FotE), a charity dedicated to supporting older people. The group aspires to a society where all older people are treated with respect and have the opportunity to live fulfilled lives.

Richard Furze, chief executive of FotE, said “The effects of isolation on older people – including loneliness, depression, feelings of low self-worth, poor health and diet – can be devastating, with isolated individuals being less likely to obtain the services they need or seek help. We understand that people are incredibly busy today, and especially at Christmas, but we urge people to get more involved with the older people around them – and not just at Christmas.

Small things such as simply checking in on an older neighbour regularly, popping a card through their door or having a chat with an older person at the shops is enjoyable for both young and older people, only takes a moment and can make a real difference. Rather than leave it to the few, if we all do a little bit then a lot will get done!”

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