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AGEING AND CARING

‘A timely and refl ective publication. As an organi-sation which promotes the value of older people’s contribution in Irish society, we particularly wel come Professor O’Neill’s comments on combat-ing ageism and the value of social activity.’Mary Nally, founder of Third Age

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DISCLAIMER

This book is designed to increase knowledge, aware-ness and understanding of ageing issues. It is not intended to replace the advice that your own doctor can give you. If you are concerned by any of the issues raised in this book make sure you consult your GP, who is there to help you.

Whilst every effort has been made to ensure the accuracy of the information and material contained in this book, nevertheless it is possible that errors or omissions may occur in the content. The author and publishers assume no responsibility for and give no guarantees or warranties concerning the accuracy, completeness or up-to-date nature of the informa-tion provided in this book.

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AGEING AND CARING

A Guide for Later Life

Professor Des O’Neill

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FOREWORD

It comes as no surprise that Professor Des O’Neill has written this self-help guide to ageing.

As a geriatrician who has been a fearless advo-cate for older people in Ireland, Professor O’Neill has played a key role in helping to shape and improve policies for older people in Ireland. From his work in helping develop policy on elder abuse prevention, to his report on the Leas Cross nursing home scandal, he has played a very public role in the fi ght for the rights of older people. When you add to this his talent for writing and communication, he was always a likely candidate to produce an important book like this.

Writing a guide to ageing is a daunting task. No two of us will age the same way. So many factors impact on how each of us will age. But Professor O’Neill has captured the major issues in this broad-reaching publication.

It is so encouraging to read a book about ageing which views the ageing process in a positive light. The fact that we are all living longer is something to celebrate. The fact that ageing presents challenges for some older people is something to plan for, rather than something to scaremonger about. This book

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not only deals with ageing for those already facing age-related issues, but also addresses the need for younger people to plan for when they will be older.

My colleagues in Age Action work each day with older people and their families who are living life to the full, adapting their lives to meet the challenges of ageing, and sometimes struggling with age-related issues. We try to empower older people and their families. Information is a key factor in empower-ing people. It enables them to decide how they will address their issues and live their lives. Hopefully this book will help empower many people and their families.

Ageing and Caring is a publication that could act as a conversation starter about pending issues. It could help each of us focus on, and plan for, issues ahead of us. In a society where the numbers of over-65s are predicted to increase steadily in the coming decades, this guide to ageing is certainly welcome and timely.

Eamon TimminsHead of Advocacy and Communications,Age Action

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CONTENTS

Foreword ........................................................ viiPreface............................................................ xxvReader’s Guide ............................................... xxvii

Section I Ageing: What You Need to Know .................................. 1

1. What Is Ageing? ...................................... 3Growth and Loss............................................. 4Positive Aspects of Ageing ............................... 5What Are the Characteristics of Ageing in

Late Life? ..................................................... 6What Causes the Negative Aspects of Ageing? ..... 9Social Aspects of Ageing .................................. 12Embracing Dualism ........................................ 13Standing Up to Ageism.................................... 14

2. As You Age .............................................. 19Arbitrary Cut-Offs ........................................... 20A Balanced View on Ageing ............................. 22Boxing Clever.................................................. 22Work .............................................................. 24Recreation ...................................................... 25Social Behaviour ............................................. 27Spirituality ..................................................... 28

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Sexuality ........................................................ 29Sleep .............................................................. 32Your Environment .......................................... 34Thankfully We Are Not Old Dogs … and

Do Learn New Tricks! ................................... 35

3. Ageing in Ireland .................................... 37A Country of Young People? ............................ 37Ageing Specifi c Policies in Ireland ................... 38Are Older People Seen as Valued Members

of Irish Society? ............................................ 39Income and Finances ...................................... 39Advocacy ........................................................ 41Health Status of Older People in Ireland .......... 42Structure of the Health Services ...................... 42Access to Healthcare ....................................... 44Specifi c Healthcare Policies for

Older People ................................................. 45Geriatric Medicine........................................... 46Community Care Services ............................... 47Long-Stay Care ............................................... 49In Summary ................................................... 50

4. Active Ageing .......................................... 53Exercise .......................................................... 54

Health ....................................................... 56How Much and What Type of Exercise

Should I Do? ............................................ 56That’s All very Well, But I’m Too Sick for

All That! .................................................. 57Mental Activity ................................................ 58Social Activity ................................................. 59

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5. Healthy Ageing ....................................... 63The Good News ............................................... 63The Health Promotion Schedule ...................... 65

Weight Control and Diet .............................. 65Blood Pressure Control ............................... 71Infl uenza Vaccination – The Flu Jab ............ 73What about Cholesterol? ............................. 73What about Cancer Screening? ................... 75For Smokers ............................................... 78For Those with Diabetes ............................. 80

Are these Prevention Strategies just for Middle Age and Early Old Age? ..................... 82

6. Finances and Ageing .............................. 83Thanks for the Speech, But What About

Me Now? ...................................................... 84Managing Money ............................................. 85Pension Planning ............................................ 85Maximising Your Sources of Support .............. 86

Allowances ................................................ 87Benefi ts ..................................................... 88Payments and Benefi ts also Available for

Carers ..................................................... 88Tax and Tax Allowances Applicable in

Later Life ................................................. 88Relevant Tax Credits for You as an Older

Person and/or Carer ................................ 89Who Will Look after My Money if I Become

Incapacitated? .............................................. 89Enduring Power of Attorney ............................ 91Making a Will .................................................. 94Equity Release Schemes ................................. 96Signing over Property ...................................... 97

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7. Planning, Accessing and Coordinating Health and Social Care Services ............ 99

When You Need Health and Social Care .......... 99Who Is Responsible for My Care? .................... 100Who Coordinates My Care? ............................. 101What if I/We Cannot Access

Adequate Care? ............................................ 103Structure of Your Care .................................... 104

Your GP ..................................................... 106The Public Health Nurse ............................. 112Therapists and Primary Care Teams ........... 113

Planning Care in the Community .................... 120Diagnosis and Assessment ......................... 120Listing of Care Needs ................................. 121Matching Needs with Community-Based

Services .................................................. 124Filling in the Gaps ...................................... 131

Other Services ................................................ 132Meals on Wheels ........................................ 132Podiatry (formerly known as Chiropody) ...... 133Respite Care .............................................. 133Geriatric Medicine and Old Age

Psychiatry ............................................... 135And Back to Coordination ............................... 138

8. Developing into the Carer Role: Ageing and Families ............................... 139

Getting a Clear Perspective ............................. 140Not for the Thanks ...................................... 143

Prodigal Son Syndrome ................................... 145A Time of Growth Too ..................................... 145Dementia ........................................................ 146Strategies for Caring ...................................... 147

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Information ............................................... 147Share the Caring ........................................ 148Setting Limits ............................................. 150Look after Yourself as Well ......................... 151Channel Your Anger and Frustration into

More Useful and Constructive Pathways ...... 151Develop Personal Strategies for Dealing

with the Negative Emotions You Will Experience while Caring for Someone ........................ 152

Adapt to the Pace ....................................... 152Professional Help ............................................ 153Learning from Others ...................................... 153Becoming an Employer ................................... 155

Elder Abuse and Home Care Services ......... 157Aftercare ......................................................... 159

9. Transport and Driving ............................ 161Illness and Driving .......................................... 162Medications and Illness .................................. 164Making the Driving Task Easier ...................... 164When You Can No Longer Drive ...................... 165Public Transport ............................................. 167

Section II Common Health Problems ..... 169

10. Diabetes .................................................. 171What Is Diabetes? ........................................... 172Who Will Look After My Diabetes? ................... 173Education, Diet and Exercise .......................... 174How Often Should I Be Checked Up? .............. 175Medications and Diabetes ............................... 176Complications of Diabetes ............................... 177Driving and Holidays ...................................... 179In the Nursing Home ...................................... 180

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11. Mobility Problems and Falls ................... 183Mobility and Balance Problems ....................... 183

Arthritis ..................................................... 185Muscle Weakness ...................................... 188Problems with the Brain ............................. 189The Middle Ear .......................................... 192

The Action Plan .............................................. 194Prevention .................................................. 194Diagnosis ................................................... 194Treatment .................................................. 194

The Ultimate Balance and Mobility Problem – Falls ............................................. 195

Fractures .................................................. 196Ensure that You Know How to

Get Up After a Fall ................................... 199The Extra Emphasis ....................................... 199

Physiotherapy ............................................ 199Review of Your Environment ....................... 199Fear of Falling ............................................ 200

Review of Your Activity and Transport ............. 200Severe Gait and Balance Disturbance ............. 201

12. Sight Problems ....................................... 203What about Eye Diseases? .............................. 204

Cataracts ................................................... 204Age-Related Macular Degeneration ............. 205Glaucoma .................................................. 206Diabetic Eye Disease .................................. 207

Adapting to Poor Vision ................................... 207Increase the Brightness of Your Lighting ..... 208Nightlights ................................................. 208Remove Hazards ........................................ 208Avoid Patterns ........................................... 209

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Visual Aids ................................................ 209Registering as Blind ........................................ 209

13. Hearing Diffi culties ................................ 211Assessment .................................................... 212Hearing Aids ................................................... 213

Cost ........................................................... 214

14. Memory Problems and Dementia ........... 217Memory Problems which Do Not Affect Your Ability

to Carry Out Everyday Tasks ........................ 218Mild Cognitive Impairment ......................... 218

Memory Disorders which Do Affect Your Ability to Carry Out Everyday Tasks ............ 220

Delirium ..................................................... 220Dementia ................................................... 222

Getting Help ................................................... 223Removing Things which Make It Worse ........... 224Making a List .................................................. 225As the Memory Condition Progresses .............. 226Deterioration .................................................. 231What Is My Future? ........................................ 231Behavioural and Psychological Symptoms

of Dementia ................................................. 231In the Nursing Home ....................................... 232

15. Loneliness, Bereavement and Depression .............................................. 233

Loneliness ...................................................... 233Bereavement ................................................... 235Depression ..................................................... 237

Getting Help ............................................... 239Specialist Referral ...................................... 241

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16. Stroke, Heart Failure and Atrial Fibrillation .............................................. 245

Acute Stroke ................................................... 245Transient Ischaemic Attack ......................... 250

Chronic Stroke Disease ................................... 250Heart Failure .................................................. 251

Diagnosis ................................................... 252Management .............................................. 253Side Effects of Medications ......................... 254Change in Symptoms ................................. 254New Technologies ...................................... 255Communication, Communication,

Communication........................................ 255Atrial Fibrillation ............................................ 255

17. Sleep Problems ....................................... 259Sleep Hygiene ................................................. 259

Routines .................................................... 259Environment .............................................. 260

Sleeping Tablets .............................................. 262

18. Bladder and Bowel Incontinence and Constipation ........................................... 263

Bladder Incontinence ...................................... 263What Should I Do? ..................................... 266Management of Early Stages of

Incontinence ........................................... 267In Moderate to Later Stages ........................ 269Carrying Out And Adjusting Your Plan ........ 270Late Stages ................................................ 271

Bowel Incontinence ......................................... 272Constipation ................................................... 275

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19. Medications ............................................ 279Reducing Medications ..................................... 280Organising Your Medications .......................... 281Crushing Tablets ............................................ 282

Section III The Final Years ...................... 283

20. When Home Is No Longer Possible ......... 285Making the Choice ......................................... 288What Is Available? .......................................... 289

Private Nursing Homes ............................... 290Public Nursing Homes ................................ 290Voluntary Nursing Homes ........................... 291

Which Do I Go To? .......................................... 291How Is Extended Care Funded? ...................... 292The Process from Home .................................. 293Going to a Nursing Home from Hospital .......... 294The Choice: The Least Worst Compromise ....... 294Medical Care and Therapies in

Nursing Homes ............................................ 295What Should I Consider in a

Nursing Home? ............................................ 298Home-Like Atmosphere ............................... 299Caring Staff ............................................... 299A Clean and Tidy Environment ................... 299The Other Residents and Day-to-Day Life .... 300Medical Care and Therapy Cover ................ 300Type of Room ............................................. 300Food .......................................................... 301Your Own Possessions and Their Security ... 301Privacy and Belonging ................................ 301Special Care for Dementia .......................... 301

Preparing for the Move .................................... 302

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Settling In ....................................................... 302Visiting, Outings and Stimulation ................... 303Quality of Care ............................................... 304The Future ..................................................... 306

21. Advance Care Planning and Preferences ............................................. 307

Resuscitation .................................................. 309Transfer to a Hospital ..................................... 310Cancer Treatment ........................................... 311

22. End of Life .............................................. 315

23. Elder Abuse ............................................. 323

Appendix A The Nursing Homes Support Scheme ...................... 329

Appendix B Aids and Appliances ................ 343

Appendix C Advance Care Plan .................. 349Suggested Further Reading ............................. 357Useful Resources ............................................ 361Index .............................................................. 369

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Poem from a Three-Year OldBrendan Kennelly

And will the fl owers die?

And will the people die?

And every day do you grow old, do I grow old, no I’m not old, do fl owers grow old?

Old things – do you throw them out?

Do you throw old people out?

And how you know a fl ower that’s old?

The petals fall, the petals fall from fl owers, and do the petals fall from people too, every day more petals fall until the fl oor where I would like to play I want to play is covered with old fl owers and people all the same together lying there with petals fallen on the dirty fl oor I want to playthe fl oor you come and sweep with the huge broom.

The dirt you sweep, what happens that, what happens all the dirt you sweep from fl owers and people, what happens all the dirt? Is all the

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dirt what’s left of fl owers and people, all the dirt there in a heap under the huge broom that sweeps everything away?

Why you work so hard, why brush and sweep to make a heap of dirt? And who will bring new fl owers? And who will bring new people? Who will bring new fl owers to put in water where no petals fall on to the fl oor where I would like to play? Who will bring new fl owers that will not hang their heads like tired old people wanting sleep? Who will bring new fl owers that do not split and shrivel every day? And if we have new fl owers, will we have new people too to keep the fl owers alive and give them water?

And will the new young fl owers die?

And will the new young people die?

And why?

Reproduced with permission. © Brendan Kennelly, The Essential Brendan Kennelly, with audio CD (Bloodaxe Books, 2011).

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Legendary Figures, in Old Age Thomas Kinsella

I saw there a number of elders in intimate companionship, their old shapes without shame,

playing with one another – with all that remained of the barbed shafts of Love.

And I heard one of them saying to those around her: ‘We cannot renew the Gift

but we can drain it to the last drop.’

Reproduced with permission. ‘Legendary Figures, in Old Age’ by Thomas Kinsella, PN Review 165, Volume 32, Number 1, published by Carcanet Press, September–October 2005.

Click here to order…

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