Second Opinion: Older people need carers who are professionally trained

Gothenburg is a handsome city with imposing stone and brick buildings, simultaneously sober and ornamented, set among green hills falling to two archipelagos.

It was particularly striking during the fine weather that greeted the 22nd Nordic Gerontology Congress last week. This leading regional gerontology conference in Europe is held every two years, and is broad in perspective and meticulously organised.

More than 1,100 delegates, mostly from the Nordic countries, attended this showcase for the remarkable progress that these countries have made in fostering research and education into ageing, including sociology, psychology and the clinical sciences.

Active PhD programmes are allied with a level of inter-institutional co-operation that few other regions of Europe match. For example, 11 universities in Sweden have just developed a Swedish National Graduate School for ageing and health, a lead that Ireland could do well to follow.

From a health perspective, there was much food for thought. A session on managing complex care of older people in the Nordic countries showed interesting trends towards better targeting and provision of care in the community.

The trend is clearly towards increased hospital admissions with shorter stays, a reflection of both increasing need and more tailored responses.

Transportation and mobility

The depth, intensity and professionalism of the research programmes was clear in an excellent symposium teasing out the determinants of transportation and mobility in later life by a group from Jyväskylä in Finland.

It is clear that both personal autonomy and physical fitness have important links with transport and mobility in later life.

Ireland was ably represented by an excellent symposium on the subjective experience of dementia and service interventions from a group at Trinity College Dublin led by Suzanne Cahill.

The individual sessions covered even more ground, from forgiveness (which improves emotional wellbeing), pets, male engagement (involvement with home tasks, but not childcare, is associated with caring for parents) to a wonderful presentation about obesity and ageing.

A marker of the sophistication of Nordic care was a prominent focus on oral care for older people, a critically important but often neglected aspect of care, particularly in hospitals and nursing homes.

Perhaps the most important message from the conference was of a region of Europe where the complexity of ageing is embraced not only by academia but by civic society.

Older people, particularly when ill or disabled, are not just another group of adults: effective care needs to be informed by the science of gerontology.

This hit home for me, given my experience of investigating the first major nursing home scandal in Ireland in 2006. I could find no documentary evidence at the time of any sector in the Irish Department of Health, health services or professions (apart from the geriatricians iti.ms/1pmV6ve) of an awareness of the need to infuse care of older people in nursing homes with gerontological knowledge and training.

Nursing older people

Even three years later, the Irish Nursing and Midwifery Board released recommendations on nursing older people – iti.ms/1pmVd9W – without a single mention of gerontological or specialist nursing of older people.

This lapse was especially unhappy as the corresponding UK body had released a report two months earlier – iti.ms/1pmVrhl – which formally recognised that nursing older people is a specialism requiring highly skilled nurses who can deal with the complexity of healthcare and social-care needs with which older people can present.

One of the key recommendations of the Leas Cross Review was that staff in nursing homes should have gerontological expertise: in particular, a diploma in gerontological nursing or equivalent for directors of nursing in all long-term care facilities.

It is particularly distressing that the revised nursing home regulations from the Department of Health – iti.ms/1pmVBp5 – which are due to be implemented on July 1st, make no mention of any such requirement, or even of experience in a specialist unit.

Grave omissions

Despite much detail about other aspects, all that is stipulated is “at least three years’ experience of nursing older persons within the previous six years”. As older people form a majority of adult patients in many services, this is quite meaningless in terms of gerontological expertise.

The late residents and families of Leas Cross, as well as present and future cohorts of vulnerable older people, are let down by these grave omissions. Those concerned in Hawkin’s House, the HSE and the professions would benefit from some Nordic enlightenment.

A version of this column originally appeared as a British Medical Journal blog. Prof Des O'Neill is a consultant in geriatric and stroke medicine. His book, Ageing and Caring: A Guide for Later Life, is published by Orpen Press.