Doctors diagnose and treat disease, nurses, nurse, physio and occupational therapists rehabilitate but what do the millions of people who support older people do?
Firstly it is important to emphasise that none of us, not even the wealthiest, is ‘independent’ but there is now general agreement on the use of the term dependency with three levels of dependency:
Low eg “needs help with moving heavy objects at home”
Medium eg “needs help with showering or bathing”
High eg “needs help with using the toilet or chairfast or bedfast”
Kingston A et al 2018 The Population Care And Simulation Study Lancet Public health 3e 447-455
So what word should we use to describe what people do when they are helping people cope with low, medium or high dependency? The usual word is ‘caring’ which has come to mean doing practical things for people, practical “assistance’’ in the words of the National Assistance Act of 1948 as distinct from feeling sympathy and compassion for them, the original meaning of the term. However, the Social Care Act of 2014 requires local authorities not only to provide support but also to be active in “Preventing needs for care and support (1)A local authority must provide or arrange for the provision of services, facilities or resources, or take other steps, which it considers will-- (a)contribute towards preventing or delaying the development by adults in its area of needs for care and support…. (c)reduce the needs for care and support of adults in its area”
This is a radical change from the principles of the National Assistance Act (1948) which assumed that although younger people with disabilities needed education to overcome their disabilities, people affected by “age” simply needed “care and attention”. The assumption was that older people just needed things done for them. The evidence base tells us that this is wrong. Rather than taking over, we should be giving older people the support that they need to achieve what they want.
One term for this could be “Coaching”. The International Coaching Federation (ICF) defines coaching as "a partnership between the coach and the client in a thought-provoking and creative process that inspires the client to maximise personal and professional potential". The ICF goes on to say that the process of coaching helps the client to depend their understanding of themselves to improve their quality of life, performance and self learning. This highlights the key aspect that differentiates coaching from care - it's a partnership where both parties are equal, not hierarchical. The power of coaching comes from this equal partnership between the coach and client. The coach challenges and supports the client allowing them to take meaningful action, change behaviour and increase self awareness.
The coaching process enables the client to create, develop and commit to a plan of action that comes from them and works for them in order to achieve their goals. The don't follow orders or a plan made for someone else. They are accountable for themselves.
Another term which is used is enablement, the process of supporting someone with the aim of helping them become less dependent by increasing their physical and mental capacity.
Learning outcomes for Enablers, both professionals and volunteers:
Understanding ageing - By the end of this module you will be able to:
Understand what is meant by the term ageing
Emphasise to other people the effects that many people assume are due to ageing are in fact due to three other factors – loss of fitness, disease and negative beliefs and attitudes
Be more positive about ageing and take action to reduce the loss of fitness or preventable disease
Improving physical ability and resilience - By the end of this module you will be able to:
Define what is meant by physical fitness and describe how it relates to ageing?
Describe the different dimensions of physical fitness and how they can be improved?
Understand the social barriers to increased activity and how people overcome these barriers.
Relate these concepts to the other two dimensions – cognitive fitness and emotional fitness
Preventing and coping with disease - By the end of this module you will be able to
Understand the relationship between disease, ageing and loss of fitness
Understand the importance of multimorbidity
Appreciate the importance of loss of fitness for people who have one or more than one long term condition, whatever their age
Take action to ensure that the treatments that are being offered are all those with a high probability of benefit and low probability of risk
Understanding and changing how people think about ageing -By the end of this module you will be able to
understand how negative beliefs and pessimistic attitudes can increase the rate at which ability is lost and disability develops
know about the importance of being positive
Understanding the changing brain and mind - by the end of the module you will
understand the relationship between the brain and the mind
know the difference between the effects of normal ageing and the effects of dementia
Know what can be done to optimise brain ability
Maintaining a sense of purpose and developing a positive plan
Learning Outcomes By the end of this module, you will be able to
Understand the importance of purpose
Know about the different types of purpose
Think of ways in which you can strengthen the sense of purpose
Have developed a plan based on what they want to achieve and want they want to achieve
Developing strength and power
Learning Outcomes By the end of this module you will be able to
describe the difference between strength and power
define the reasons why strength declines as you live longer
know what can be done to maintain and increase strength and power
Maintaining and improving skill & co-ordination
Learning outcomes By the end of this episode you will be able to
Define what is meant by a skill and why it is important to maintain and develop skills
Understand why ageing by itself is less important for losing skills than failing to use, and trying to improve them, thus proving the concept of "use it or lose it"
Decide to try a new activity
Learning outcomes By the end of this episode you will be able to
define what is meant by stamina as one aspect of physical fitness and
what is meant by moderate intensity exercise and how that can be achieved?
Know the type of activity that other people can be encouraged to take up or increase to increase stamina.
understand the importance of increasing stamina in people with heart or lung disease
Learning outcomes by the end of this module you will be able to
understand what is meant by suppleness and how it relates to stiffness
understand the relative contributions of ageing, loss of fitness and disease to the development of fitness