Book review: Aging gracefully!?

Sara Hawkins is a community matron working with patients who have long term conditions. Her role includes hospital admission avoidance and comprehensive geriatric/ frailty assessments, and the holistic management of her patient group. She tweets @sara_hawkins

This is a review of the book Developing a Relational Model of Care for Older People which aims to clear away the misconceptions surrounding the care of the older people and persuasively argues for a new approach based on interpersonal relationships. It brings together a vast array of evidence and incisive theory to generate a new understanding of how we can tackle some of the most pressing questions in our society.

We are an aging population with people living significantly longer than 20 years ago. So, what does this mean for society? Developing a relational model of care for older people involves looking at the changes in the concept of retirement and the need to re-define “old age”. It focuses on issues and challenges that people face when ‘growing old’.

As individuals we spend most of our working life counting down the years left until we retire. The time we will spend traveling, fulfilling our dreams and enjoying those golden years. Although, in reality, should we be thinking about both the blessings and burdens of old age?

Age is just a number!

Defining “old age” needs to be re-addressed throughout the years. What once was considered old is now not seen that way and in fifty years from now the boundaries will change again.

The term dependency is also altering - over a million people that are over the age of 65 are still in paid work, and many older people report their health as good. This makes us re-define the concept of dependency in old age.  Many people classed in the older population are not financially dependent either, and they are often the ones supporting younger family members. A valuable part of the book raises an excellent point, of how we shouldn’t confuse old age with poverty. People who are poor are rarely poor because they are old, they are poor now as they were poor when they were younger by not having any assets or pension in place.

The main body of the book concentrates on creating environments for shared living. Is social isolation the reason we are aging sooner? Can shared living in either a residential setting or living with a family member improve well-being and make people thrive?

Would it be too idealistic to imagine a world where, when we can no longer manage independently, we are taken into the safety and security of our children’s or other relative’s homes? In reality, many people are faced with the decision between social care or alternative living. With this comes cost, which isn’t always achievable in some financial situations. The ‘best’ homes in any area generally offer expensive price tags with top-up from social care still making them beyond many people’s price range.  The Dilnot report looks in depth at the current care bills and how the government could cap costs to make it fair game for everyone, and hopefully enabling people to plan ahead.

So, if we did achieve the ‘5 star’ living within nursing home care, how achievable would it be to maintain family bonds within this environment? This book demonstrates how older people living in this environment can be given a new lease of life, improved mental state and an improvement to physical health. Nursing home care is about achieving supportive relationships to achieve this and altering our mindset about the care of older people.

By producing an integrated model of care within these environments, homes for older people living together will be a HUB for a delivery of services, day care, support groups and creative therapies to name a few. There will be a shared commitment to function, where people in the community can build a network of relationships, delivering person-centred/relationship-centred care.

An excellent read that tells us it is impossible to generalise about older people and the diversity they bring, it puts person-centred care back into our mind-set. It tells us that, wherever we live in older age, our environment should be one that maintains health, independence and an active life.

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