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AGEING AND CARING

A timely and reflective publication. As an organisation which promotes the value of older peoples
contribution in Irish society, we particularly
welcome Professor ONeills comments on combating 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, awareness 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 information provided in this book.

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AGEING AND CARING

A Guide for Later Life

Professor Des ONeill

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FOREWORD

It comes as no surprise that Professor Des ONeill

has written this self-help guide to ageing.
As a geriatrician who has been a fearless advocate for older people in Ireland, Professor ONeill 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 fight 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
ONeill has captured the major issues in this broadreaching 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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Foreword

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 empowering 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 over65s are predicted to increase steadily in the coming
decades, this guide to ageing is certainly welcome
and timely.
Eamon Timmins
Head of Advocacy and Communications,
Age Action

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CONTENTS

Foreword ........................................................
vii
Preface............................................................ xxv
Readers Guide ............................................... xxvii
Section I

Ageing: What You Need

to Know..................................

1. What Is Ageing? ......................................

Growth and Loss.............................................
Positive Aspects of Ageing ...............................
What Are the Characteristics of Ageing in
Late Life? .....................................................
What Causes the Negative Aspects of Ageing? .....
Social Aspects of Ageing ..................................
Embracing Dualism ........................................
Standing Up to Ageism....................................

3
4
5
6
9
12
13
14

2. As You Age ..............................................

Arbitrary Cut-Offs ...........................................
A Balanced View on Ageing .............................
Boxing Clever..................................................
Work ..............................................................
Recreation ......................................................
Social Behaviour .............................................
Spirituality .....................................................

19
20
22
22
24
25
27
28

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Sexuality ........................................................
Sleep ..............................................................
Your Environment ..........................................
Thankfully We Are Not Old Dogs and
Do Learn New Tricks! ...................................

29
32
34

3. Ageing in Ireland ....................................

A Country of Young People? ............................
Ageing Specific Policies in Ireland ...................
Are Older People Seen as Valued Members
of Irish Society?............................................
Income and Finances ......................................
Advocacy ........................................................
Health Status of Older People in Ireland..........
Structure of the Health Services......................
Access to Healthcare .......................................
Specific Healthcare Policies for
Older People .................................................
Geriatric Medicine...........................................
Community Care Services ...............................
Long-Stay Care ...............................................
In Summary ...................................................

37
37
38

4. Active Ageing ..........................................

Exercise ..........................................................
Health .......................................................
How Much and What Type of Exercise
Should I Do? ............................................
Thats All very Well, But Im Too Sick for
All That! ..................................................
Mental Activity ................................................
Social Activity .................................................

35

39
39
41
42
42
44
45
46
47
49
50
53
54
56
56
57
58
59

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5. Healthy Ageing .......................................

The Good News ...............................................
The Health Promotion Schedule ......................
Weight Control and Diet..............................
Blood Pressure Control ...............................
Influenza Vaccination The Flu Jab ............
What about Cholesterol?.............................
What about Cancer Screening? ...................
For Smokers...............................................
For Those with Diabetes .............................
Are these Prevention Strategies just for
Middle Age and Early Old Age? .....................

63
63
65
65
71
73
73
75
78
80

6. Finances and Ageing ..............................

Thanks for the Speech, But What About
Me Now? ......................................................
Managing Money.............................................
Pension Planning ............................................
Maximising Your Sources of Support ..............
Allowances ................................................
Benefits .....................................................
Payments and Benefits also Available for
Carers .....................................................
Tax and Tax Allowances Applicable in
Later Life.................................................
Relevant Tax Credits for You as an Older
Person and/or Carer ................................
Who Will Look after My Money if I Become
Incapacitated?..............................................
Enduring Power of Attorney ............................
Making a Will..................................................
Equity Release Schemes .................................
Signing over Property ......................................

83

82

84
85
85
86
87
88
88
88
89
89
91
94
96
97

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7.

Planning, Accessing and Coordinating

Health and Social Care Services ............
When You Need Health and Social Care ..........
Who Is Responsible for My Care? ....................
Who Coordinates My Care? .............................
What if I/We Cannot Access
Adequate Care? ............................................
Structure of Your Care ....................................
Your GP .....................................................
The Public Health Nurse .............................
Therapists and Primary Care Teams ...........
Planning Care in the Community ....................
Diagnosis and Assessment .........................
Listing of Care Needs .................................
Matching Needs with Community-Based
Services ..................................................
Filling in the Gaps ......................................
Other Services ................................................
Meals on Wheels ........................................
Podiatry (formerly known as Chiropody)......
Respite Care ..............................................
Geriatric Medicine and Old Age
Psychiatry ...............................................
And Back to Coordination ...............................
Developing into the Carer Role:
Ageing and Families ...............................
Getting a Clear Perspective .............................
Not for the Thanks......................................
Prodigal Son Syndrome ...................................
A Time of Growth Too .....................................
Dementia ........................................................
Strategies for Caring ......................................

99
99
100
101
103
104
106
112
113
120
120
121
124
131
132
132
133
133
135
138

8.

139
140
143
145
145
146
147

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Information ............................................... 147

Share the Caring ........................................ 148
Setting Limits ............................................. 150
Look after Yourself as Well ......................... 151
Channel Your Anger and Frustration into
More Useful and Constructive Pathways ...... 151
Develop Personal Strategies for Dealing
with the Negative Emotions You Will Experience
while Caring for Someone ........................ 152
Adapt to the Pace ....................................... 152
Professional Help ............................................ 153
Learning from Others ...................................... 153
Becoming an Employer ................................... 155
Elder Abuse and Home Care Services ......... 157
Aftercare ......................................................... 159
9. Transport and Driving ............................
Illness and Driving ..........................................
Medications and Illness ..................................
Making the Driving Task Easier ......................
When You Can No Longer Drive ......................
Public Transport .............................................
Section II

161
162
164
164
165
167

Common Health Problems..... 169

10. Diabetes ..................................................

What Is Diabetes? ...........................................
Who Will Look After My Diabetes? ...................
Education, Diet and Exercise ..........................
How Often Should I Be Checked Up? ..............
Medications and Diabetes ...............................
Complications of Diabetes ...............................
Driving and Holidays ......................................
In the Nursing Home ......................................

171
172
173
174
175
176
177
179
180

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11. Mobility Problems and Falls ...................

Mobility and Balance Problems .......................
Arthritis .....................................................
Muscle Weakness ......................................
Problems with the Brain .............................
The Middle Ear ..........................................
The Action Plan ..............................................
Prevention..................................................
Diagnosis...................................................
Treatment ..................................................
The Ultimate Balance and Mobility
Problem Falls.............................................
Fractures ..................................................
Ensure that You Know How to
Get Up After a Fall ...................................
The Extra Emphasis .......................................
Physiotherapy ............................................
Review of Your Environment .......................
Fear of Falling ............................................
Review of Your Activity and Transport .............
Severe Gait and Balance Disturbance .............

183
183
185
188
189
192
194
194
194
194

199
199
199
199
200
200
201

12. Sight Problems .......................................

What about Eye Diseases? ..............................
Cataracts ...................................................
Age-Related Macular Degeneration .............
Glaucoma ..................................................
Diabetic Eye Disease ..................................
Adapting to Poor Vision...................................
Increase the Brightness of Your Lighting .....
Nightlights .................................................
Remove Hazards ........................................
Avoid Patterns ...........................................

203
204
204
205
206
207
207
208
208
208
209

195
196

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Visual Aids ................................................ 209

Registering as Blind ........................................ 209
13. Hearing Difficulties ................................
Assessment ....................................................
Hearing Aids ...................................................
Cost ...........................................................

211
212
213
214

14. Memory Problems and Dementia ........... 217

Memory Problems which Do Not Affect Your Ability
to Carry Out Everyday Tasks ........................ 218
Mild Cognitive Impairment ......................... 218
Memory Disorders which Do Affect Your
Ability to Carry Out Everyday Tasks ............ 220
Delirium ..................................................... 220
Dementia ................................................... 222
Getting Help ................................................... 223
Removing Things which Make It Worse ........... 224
Making a List .................................................. 225
As the Memory Condition Progresses .............. 226
Deterioration .................................................. 231
What Is My Future? ........................................ 231
Behavioural and Psychological Symptoms
of Dementia ................................................. 231
In the Nursing Home....................................... 232
15. Loneliness, Bereavement and
Depression ..............................................
Loneliness ......................................................
Bereavement ...................................................
Depression .....................................................
Getting Help ...............................................
Specialist Referral ......................................

233
233
235
237
239
241

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16. Stroke, Heart Failure and Atrial

Fibrillation ..............................................
Acute Stroke ...................................................
Transient Ischaemic Attack .........................
Chronic Stroke Disease ...................................
Heart Failure ..................................................
Diagnosis...................................................
Management ..............................................
Side Effects of Medications .........................
Change in Symptoms .................................
New Technologies ......................................
Communication, Communication,
Communication........................................
Atrial Fibrillation ............................................
17. Sleep Problems .......................................
Sleep Hygiene .................................................
Routines ....................................................
Environment ..............................................
Sleeping Tablets..............................................
18. Bladder and Bowel Incontinence and
Constipation ...........................................
Bladder Incontinence ......................................
What Should I Do? .....................................
Management of Early Stages of
Incontinence ...........................................
In Moderate to Later Stages ........................
Carrying Out And Adjusting Your Plan ........
Late Stages ................................................
Bowel Incontinence .........................................
Constipation ...................................................

245
245
250
250
251
252
253
254
254
255
255
255
259
259
259
260
262
263
263
266
267
269
270
271
272
275

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19. Medications ............................................

Reducing Medications .....................................
Organising Your Medications ..........................
Crushing Tablets ............................................
Section III

279
280
281
282

The Final Years ...................... 283

20. When Home Is No Longer Possible .........

Making the Choice .........................................
What Is Available? ..........................................
Private Nursing Homes ...............................
Public Nursing Homes ................................
Voluntary Nursing Homes ...........................
Which Do I Go To? ..........................................
How Is Extended Care Funded? ......................
The Process from Home ..................................
Going to a Nursing Home from Hospital ..........
The Choice: The Least Worst Compromise .......
Medical Care and Therapies in
Nursing Homes ............................................
What Should I Consider in a
Nursing Home? ............................................
Home-Like Atmosphere ...............................
Caring Staff ...............................................
A Clean and Tidy Environment ...................
The Other Residents and Day-to-Day Life ....
Medical Care and Therapy Cover ................
Type of Room .............................................
Food ..........................................................
Your Own Possessions and Their Security ...
Privacy and Belonging ................................
Special Care for Dementia ..........................
Preparing for the Move ....................................

285
288
289
290
290
291
291
292
293
294
294
295
298
299
299
299
300
300
300
301
301
301
301
302

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Settling In .......................................................
Visiting, Outings and Stimulation ...................
Quality of Care ...............................................
The Future .....................................................

302
303
304
306

21. Advance Care Planning and

Preferences .............................................
Resuscitation ..................................................
Transfer to a Hospital .....................................
Cancer Treatment ...........................................

307
309
310
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 .................. 349

Suggested Further Reading ............................. 357

Useful Resources ............................................ 361
Index .............................................................. 369

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Poem from a Three-Year Old

Brendan Kennelly
And will the flowers die?
And will the people die?
And every day do you grow old, do I
grow old, no Im not old, do
flowers grow old?
Old things do you throw them out?
Do you throw old people out?
And how you know a flower thats old?
The petals fall, the petals fall from flowers,
and do the petals fall from people too,
every day more petals fall until the
floor where I would like to play I
want to play is covered with old
flowers and people all the same
together lying there with petals fallen
on the dirty floor I want to play
the floor you come and sweep
with the huge broom.
The dirt you sweep, what happens that,
what happens all the dirt you sweep
from flowers and people, what
happens all the dirt? Is all the
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Poem from a Three-Year Old

dirt whats left of flowers 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 flowers?
And who will bring new people? Who will
bring new flowers to put in water
where no petals fall on to the
floor where I would like to
play? Who will bring new flowers
that will not hang their heads
like tired old people wanting sleep?
Who will bring new flowers that
do not split and shrivel every
day? And if we have new flowers,
will we have new people too to
keep the flowers alive and give
them water?
And will the new young flowers 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, SeptemberOctober 2005.

Click here to order

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