1 Exploring the concept of older people nursing
Introduction
We begin this chapter by asking the following questions:
This is a good starting point for our explorations of what we mean when we speak of older people nursing. In this introductory section we invite you to consider your own perceptions and experiences to date of caring for older people. We also invite you to think about your own perceptions of older people more generally, perhaps in terms of your own assumptions and attitudes towards older people as, arguably, this will also inform your perspective when caring and working with older people in the context of health care. We also aim to unpack the complexity of care for this particular client group and to help you to consider alternative ways of thinking about older people and their care within the overarching context of the healthcare system.
Activity
Take a few moments to reflect on the above quote by Maggie Kuhn:
1. What do you think the author is trying to say about what it is like to be an older person?
2. What experiences might have shaped the background to this quote?
3. How does this perception of ageing contrast to your own perceptions of old age and experiences of caring for older people?
In order to investigate these questions, Ann Bowling and Paul Dieppe carried out a systematic review, which involved a review of research and academic papers that had incorporated the phrase ‘successful ageing’. Bowling and Dieppe examined a number of research papers that reported the findings of both quantitative and qualitative studies. Importantly, they also included lay definitions which are essentially the particular facets of components of health that older people themselves attributed to successful ageing.
Bowling and Dieppe also examined the theoretical models that had been used to explore the constituents of successful ageing in order to answer the above question. The main themes that emerged from the review reflected biomedical or psychosocial approaches or a combination of the two and the main constituents of successful ageing as identified by Bowling and Dieppe are presented in Box 1.1.
Box 1.1 Main constituents of successful ageing
Theoretical definitions
(Taken from Bowling A, Dieppe P 2005)
As Box 1.1 illustrates, many older people’s own definitions of successful ageing fell outside of the mainstream theoretical definitions. This is a very important observation, particularly within the particular context of healthcare delivery. For example, as Bowling and Dieppe further highlight, the achievement of successful ageing as defined by biomedical models is an unrealistic goal for many older people. However, many older people consider that they are healthy and well even in the presence of disease or disability.
Therefore, if we begin to think about the implications of these observations in terms of nursing care for older people, we can perhaps begin to identify the potential tensions of working with older people in a positive and inclusive way if the goals that are set are not attainable or realistic. Davies et al (2000), for example, emphasise a key distinction between ‘decisional autonomy’, that is the ability to make a decision, and ‘executional autonomy’, the ability to carry out those decisions. In developing their argument, Davies et al (2000) point to an important distinction in that older people who require nursing care may have limitations in terms of executional autonomy, however this does not automatically translate into an absence of decisional autonomy.
Activity
Before we move on, take a few minutes to consider the following poem by Jenny Joseph (1997), Warning: When I Am An Old Woman I Will Wear Purple. Jenny Joseph is an accomplished poet and this particular poem, which was written in the early 1960s, is still extremely popular. There is even a Red Hat Society!
