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?

A review of the study Attitudes of nurses to the care of the elderly in hospital written by Dorothy Baker 1978

Baker explains the study’s findings, which explored nurses’ perceptions of patients defined as geriatric, and the implication of this categorisation for the kind of care which was given.

Certificate of character for Alexandra Mcintyre Edmonton Workhouse 1912

The Edmonton Union workhouse opened in 1842, now on the site of North Middlesex University Hospital. An 1881 census of the workhouse records 2 nurses aged 60+ employed as servants and 7 nurses as inmates, the oldest being 87 years.

Elderly person dependency form 1970s

Kept by nurse Dorothy Baker, this form was used to record the state and needs of older patients, from continence to confusion.

Enamel bedpan and feeding cup c1914

On loan from the British Red Cross Museum and Archive. In the nineteenth century there was next to no focus on supporting older people to be independent. Bed pans and feeding cups were used widely for those considered ‘bed bound’.

Four specimens of sea skink late eighteenth century

On loan from the Royal Pharmaceutical Society. Believed to be an aphrodisiac, sea skink was reported to ‘restore warmth in old age [and] decays of nature’ and increase ‘the Semen Virile’.

How to start and equip a nursing home by Edith Holden RRC c1929

This booklet outlines practical advice for setting up a nursing home in the 1920s and 30s, from choosing a building and its staff to creating a ‘human atmosphere.’

Old people Report of a survey committee on the problems of ageing 1947

As well as a survey of pension schemes and living conditions, the report also lists popular past times for older people. Reading, going to the cinema, and gardening feature, as well as belonging to clubs, particularly for men who find themselves to be ‘a positive nuisance to his wife and to himself when he has nothing to do except potter around.’ - You can listen to an excerpt of this below.

Old peoples clubs A handbook for old and new clubs National Old Peoples Welfare Committee 1952

The handbook states ‘We [should] all be able to live in our own homes as long as possible. Oddly enough, one of the best ways of achieving this is to get those people who are physically able to do so out of their homes into clubs.’

Stearns tonic 1920s

On loan from the Royal Pharmaceutical Society. The tonic was advertised as an ideal remedy for elderly people, but also for ‘weak, pale and delicate children.’ It was particularly used for those recovering from illness.
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.

Workhouse jpeg

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

A code of good practice for residential and nursing home care 1984 and 1996

Central to these codes, published by the Centre for Policy on Ageing, was the aim to keep the rights of older people to be treated as individuals and with dignity and respect.

Case study collected by the RCN working party on violence towards the elderly 1979 1981

A working party was set up to ‘identify the constituents of abuse and to suggest guidelines to help members to become more aware of conditions which contribute to abuse of elderly people.’

Geriatric Nursing section of the syllabus for General Nursing 1980s

This booklet was owned by Dr Dawne Garrett. It acted as a checklist and record of experience in various areas of nursing. Each area was signed off by a clinical assessor, without which registered nurses were unable to progress in their training.

Hospital Hilton Workhouse stigma a thing of the past The Reporter 6 February 1987

The Nursing Development Unit at Tameside Hospital generated much media attention. Here, the new initiatives are described as ‘something close to a miracle’ for older people’s care.

News clipping in the Evening Standard and letter to the Editor from Pauline Blight 1986

News clipping in the Evening Standard, and letter to the Editor from Pauline Blight, 1986.

Plastic slipper bed pan c1960

On loan from the British Red Cross Museum and Archive. At this time, bedrest was still considered an important part of recovery. This meant the continued use of bed pans, particularly in patients’ own homes when supported by a district nurse.

Serenace Ampoules for Restlessness and agitation in the elderly 1996. 

On loan from the Royal Pharmaceutical Society. Containing haloperidol, Serenace is a brand of medicine used as an anti-psychotic. Whilst its main uses may include the treatment of schizophrenia, mania or mood disorders, it is widely used on older people, particularly those with dementia-related psychosis.

Tablet dispenser for use in a care home 1980

On loan from the Royal Pharmaceutical Society. This dispenser has 42 compartments with labels to record information about the patient, institution, and medicine dosage.

Tagamet tablets 2001

On loan from the Royal Pharmaceutical Society. These specially designed tablets (for the treatment of stomach conditions) are distinctly shaped with a nodule on one side to make it easier for older people to pick them up from flat surfaces.

The National Boards for England and Wales Nursing Elderly People course number 941 1990

This course aimed to teach nurses to think about the role of the elderly in society, how to contribute within a multi-disciplinary team, and carry out individualised programmes of care.
Aspects of age case 2
Photo credit: Justine Desmond

Doreen Norton began nursing at St Charles Hospital, North Kensington, a former Poor Law Infirmary, in 1942. She reflects on her visits to Dr Marjory Warren’s geriatrics unit at WestMiddlesex Hospital.

Pam Hibb worked with the design team on the new Homerton Hospital, previously the ‘German Hospital’, when it became part of the City and Hackney Health Authority in 1974.

Dawne Garrett, RCN Professional Lead for the care of older people and dementia, trained in the 1980s. Here she talks about her research into sexual intimacy among older people.

Lesley Williams was a ward sister and clinical nurse teacher at West Suffolk Hospital in the late 1970s. Here she talks about the changes she has seen in discharge procedures for older people.



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.

 

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.


Aspects of age case 3

Aspects of age case 3

Pockets of progress header 

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.

Did you know?

The term ‘geriatric’ comes from the Greek for ‘old age’ and ‘physician.’ (It technically means old physician!) So it makes sense that this term is not used anymore. Instead ‘care of older people’ is widely used in health care settings.

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Red text reading: future proof on a yellow / orange background

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?

Stylized wall clock with pendulum in black on a patterned yellow background.