Aspects of age

Older age is changing.

In the twenty-first century, our later years can be as dynamic and productive as our younger years. Today, travel vaccinations  and sexual health advice for older people are common. For many, age really is just a number.

Yet some older people do have complex needs. A small but significant group of older people require 24 hour nursing with highly intensive and sometimes ethically challenging care. We are also seeing newly emerging diagnoses and cutting edge treatment plans delivered at home. Nursing older people demands a deep understanding of the physical, emotional and social worlds of individuals.

The history of caring for our older generations is not always an easy one. It is a story shaped by how we view older people in society, and how we value the role of those that care for them.

In an ageing population, how much have we learned from the attitudes of the past?

Aspects of age case 1

Aspects of age case 1
Photo credit: Justine Desmond

1. News clipping in the Evening Standard, and letter to the Editor from Pauline Blight, 1986. Read by Alan Chalkley and Dianne Yarwood.

2. RCN Working party on violence towards the elderly, 1979 – 1981. Case 2 - Account by the sister of a nursing home resident, who died aged 68. Read by Anna Shipway.

3. Hospital Hilton! Workhouse stigma a thing of the past. The Reporter, 6 February 1987. Read by Razwana Akram.

“Incapable, elderly and sick"

In the nineteenth century, the elderly and chronically sick were too often left to the mercy of the workhouse and the Poor Law system. Here, conditions were squalid and facilities scant. A form of nursing care did exist in the workhouse, but was often delivered by older female inmates. Treatment of the elderly was fast becoming a national scandal. Following a barrage of bad press revealing the crowding, death and disease of the workhouses,the Local Government Act in 1929 saw the Poor Law disbanded. The municipal hospital system was established and local authorities became responsible for those in need of health care.

In 1936, Matron Eva Huggins was working alongside Geriatrician Dr Marjory Warren, at Middlesex County Hospital.

They pioneered a change for both the elderly and chronically ill, providing proper diagnoses for those in their care and discharging people who did not need to be in hospital beds.

Yet this pace of change was not universal. Despite attempts to improve the care of older people,accommodation continued to be substandard and ward equipment poor. As a profession, older people’s nursing struggled to detach itself from the low status reputation it had gained over the past century. There was no encouragement for bright young doctors and nurses to pursue older adult care. It was simply not a popular place to be.


The time has gone when the care of the elderly can be comfortably regarded as a backwater of medicine; it is an area which requires a status in accordance with its proper social importance. Nursing of the elderly in particular needs to be recognised for its high value to the patients, and the distinct skill set required to lead its provision. One way such recognition could be provided, and good and effective nursing practice incentivised, would be the creation of a registered older persons nurse status.
Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013.


Aspects of age case 2

Aspects of age case 2
Photo credit: Justine Desmond

Single 70 and seeking love Growing old does not mean sensual pleasure diminishes. In fact, our older generations may be the most clued up of all. They have witnessed the introduction of the first lubricated condom in the late 1950s, the advent of the pill in the 1960s, not to mention today’s dating websites for love in later life. The number of brides and grooms over 65 – known as ‘Silver splicers’ – has risen in the last decade. 

Sex in your seventies may well be better than ever, yet sex and sexuality in older people is still taboo. For those in care homes, having the space for intimacy can be hard to find. Striving to promote and support healthy and safe romantic lives for residents is an essential.

"We work in their homes"

Separate care homes for paying patients have existed since the late nineteenth century, but not everyone could afford private care. When the Poor Law system was disbanded, many workhouses were converted into Public Assistance Institutions (PAI). Conditions were still poor and the institutions struggled to shake the workhouse reputation. By the start of the Second World War, the vast majority of residents in PAIs were older people. At the formation of the National Health Service in 1948, PAIs were converted into NHS hospitals or ‘old people’s homes’ run by the local council. Gone were the days of the Poor Law Board of Governors. Yet, the care received by older people continued to be a concern.

As well as local innovations in hospital settings in the 1980s, new legislation also determined that a registered medical practitioner, or a registered nurse should be in charge of a care home. But even today in England, there is no safe staffing law to ensure that enough nursing staff are in place. This goes for older people’s wards in hospital as well as private care homes. The view that people move to a care home and never leave is no longer a reality. Staying in a care home may involve a period of short stay respite care, or rehabilitation following an illness. The average length of stay for a patient today is 11 months, but can be as little as a week.


Image source: RCN Archive


1. The RCN 'Caring for an ageing population' conference key note speech, by Reverend Doctor Michael Wilson, April 1973. Read by Nate Evuarherhe.

2. Extract from ‘Old people. Report of a survey committee on the problems of ageing and the care of old people, Published for the trustees of the Nuffield Foundation. 1947. Read by Kat Black.

3. Letter to the editor, The Oldie, Issue One, from Michael Reilly of Yelverton, Devon. Read by Alan Chalkley.


Pockets of progress

Important progress began to happen in hospital settings across the UK by the latter decades of the twentieth century. At the forefront of this progress was the Nursing Development Unit at Tameside Hospital’s Department of Care for the Elderly, established in 1985. Within this, nurses could take part in an international exchange programme, attend ‘survival skills’ courses and use a new on-site staff library. The aim? To enhance the development and the status of nursing older people.

What these units could not temper however, was the increasing numbers of the very old. A hospital setting was not right for many of these patients. Additionally, people with dementia needed professional support, either at home or in a facility, with the right nursing care.Lightbox panel

Future proof

Living beyond 100 may well become normal for children born within the next generation. Life as a centenarian is hard to imagine for many of us living today.Longer life expectancies change how we view work, retirement, relationships and our health. In these later years, some of us will need more support than others, whether from friends and family or nurses and social care workers.

The nursing role brings with it a difficult history and a challenging present. But also space for hope and creativity. How do we ensure that society can look forward to the rewards of ageing? And how can nurses pioneer the best support, whether for those who need 24-hour care, or others who simply wish to grow old (dis)gracefully?