There are many types of care available for older adults depending on their specific needs, and complex care is one that you may need to know more about if you are caring for an older loved one with additional needs.
Complex care is a form of person-centred care for anyone living with a chronic or long-term health condition who requires more help in order to manage their day-to-day symptoms and continue with daily activities. According to the National Institute for Health and Care Excellence, complex care needs may be a result of an illness, a disability, wider life circumstances or a combination of several of these elements, and these can be present from birth or develop later in a person’s life. Any condition that requires a combination of treatments and support could qualify as complex care, and these needs may also fluctuate over time or develop as a person gets older.
Complex care needs could be something like:
For some people this kind of intense care requires moving into a care home or nursing home, however you can receive this type of care at home if you wish to.
Severe mental illness, disabilities and intellectual disabilities are all linked with earlier onset of conditions associated with getting older, an increased risk of preventable secondary conditions, and premature mortality – for these reasons, it is important to ensure those with complex care needs receive the support they need to manage any conditions they have, keep them comfortable, and maintain their independence as much as possible.
Complex care is different from other types of home care as it often involves some elements of medical or nursing care in order to keep the person healthy and comfortable.
Some examples of complex needs include:
These are only a few of the complex care needs someone might experience, but ultimately the aim of complex care (for any condition) is to help anyone dealing with symptoms and additional needs to find the best quality of life possible for them through personalised nursing and medical care.
For anyone receiving care at home, a Care Plan is required to lay out the details of what a person needs, how care will be administered, and who will administer this care. In the case of a complex care plan, this focuses on those with complex care needs and presents a specific, detailed breakdown of every health condition that the person has and what needs to happen in order to care for them.
Research finds that those with complex care needs often find interactional issues with their care, where different elements of care that involve their loved ones, caregivers, healthcare professionals and more may lack consistency, clarification and appropriate support. For this reason, a clear and extensive complex care plan is needed to keep everyone involved on the same page.
According to the NHS, a care and support plan should include the below elements, and a complex care plan will be similar while being personalised to the individual’s complex needs:
The complex care plan should indicate the amount of care that will be needed, which should determine whether an individual will require care workers to visit on a regular basis or whether live-in care will be needed to ensure the person’s safety and comfort at all times.
Developing a complex Care Plan requires input from a number of people, so it may be slightly more difficult to create than other Care Plans. As with all care needs, the first step is often a Care Needs Assessment. This is to evaluate the person in their home and find out exactly what they need to feel safe and comfortable in their own space, and have all of their needs met effectively. When complex needs are involved, the regional medical professionals (GPs or nurses) in charge of the person’s care may provide input at this stage to ensure the assessment takes note of certain elements of their condition(s).
From there, a complex Care Plan will be developed with further input from everyone who might be involved in care. As well as observing the person at home, the Care Needs Assessment will take into account things like their daily activities, health conditions, mobility needs, personal preferences and more. They will also speak to family members or caregivers, clarify what the medical recommendations are, and provide a rough overview of the next steps.
The complex Care Plan will then be sent to the person and their caregivers or family members for their feedback. In the UK, the NHS and local councils prioritise person-centred care, so you and your loved one can be highly involved in the creation of their Care Plan. When you receive the Care Plan, there are usually contact details for the best person to get in touch with if you have questions or concerns about the Care Plan or care. If you do have any questions or feel changes need to be made, don’t be afraid to reach out to them to discuss this.
Complex care can last for as long as it is needed, because the care will be bespoke to the person’s individual situation. For some, they may be returning home from hospital and need complex care while they heal from a surgery or injury, which could present a clearer pathway for recovery. For others, they could be battling a difficult chronic illness that does not have an exact end date. Also, some may have been living with a condition since birth, and therefore will require ongoing support. Whether a person needs a few weeks of home care visits to help with specific tasks, or they need 24/7 live-in care to help them manage their additional needs, there are options for everyone.
If you are paying for complex care yourself, you may be keen to understand exactly how long this will last so you can budget for the future, however it can be difficult to gauge this.
Some elements of complex care will need to be administered by a trained nurse or a medical professional, but not all. Complex care is typically provided by a combination of specialist carers who can cover all of the individual needs of the person, alongside full-time carers who will assist with more general care, while coordinating other professionals visiting the home.
Any care workers involved in complex care will need specialist training in the person’s specific health needs in order to effectively help them. For example, at Home Instead, our Care Professionals undergo specialist training to ensure they are equipped to help with the needs of the person they are caring for. We keep our team up to date on the latest care training, with workshops covering everything from general guidance on medication and manual handling, to safeguarding and basic life support, to specialist training in things like Parkinson’s, diabetes, catheter care, dementia care, and end-of-life care. Our matching service ensures all our clients are paired with the perfect Care Professional for them, who has undergone the specialist training needed to effectively look after the person in their care.
Complex care can be carried out effectively in a number of locations, however many people and their loved ones prefer to organise this type of care at home due to the benefits this setting provides.
For some people with serious health issues, care requires moving into a nursing home or a hospital setting, and the location of care will depend on the intensity of the needs of the person, as well as the length of time they are likely to require this for. While a nursing home or hospital may be more appropriate for some, it is possible to receive complex care at home if you would prefer to stay there, and this is likely to be arranged if you require complex care on a long-term or ongoing basis.
Below, you will find the benefits and downsides of each of these complex care locations so you can make an informed decision about where is the right place for your needs, or the needs of your loved one.
When people receive complex care in hospital, the aim is usually to eventually move them from hospital into either another facility like a nursing home, or ideally to their own home.
You may find more useful information in our guide to the benefits of home care vs a care home.
Organising complex care for a loved one at home is possible, and in fact, could be preferable for your loved one. One study found that, in a group of over 45-year-olds, more than 67% said they would happily receive care in their own home, while in a group of over 75-year-olds, 80% said the same.
Some elements of complex care will need to be administered by a trained nurse or a medical professional, but not all, so complex care can usually be arranged at home by bringing in a part-time or full-time carer who can help with more general daily care needs, while coordinating other specialists and professionals visiting the home who can cover all other medical needs.
If you are looking to start this process soon, you can arrange a Care Needs Assessment to begin, and the professionals who provide this through your local council can talk you through what your loved one may need and how this can be arranged – either funded through your local council or as a private option. From there, a comprehensive care plan will be drawn up.
This process can provide further advice on everything you need to know, such as how to coordinate home healthcare professionals visiting, how to arrange respite, adaptations to the home environment for safety, and further assistance.
Remember, any care workers involved in care for someone with complex needs will require specialist training in the specifics of the person’s health condition in order to effectively provide support. At Home Instead, our Care Professionals undergo specialist training to ensure they are equipped to help the person they are caring for, and our team are kept up to date on the latest care training with workshops covering everything from general guidance on medication, manual handling, safeguarding, basic life support, and much more.
As well as the aforementioned benefits of receiving complex care at home, there could also be further health benefits, including:
Another study found home-based care seemed to have a positive impact on the person’s adherence to their medication schedule, their patient satisfaction scores, and their health-related quality of life, so depending on the condition the person has, there could be multiple health benefits to choosing home care over other settings.
Research carried out for a 2022 report found that only 20% of people aged over 45 believed they would be happy to go into a residential care home later in life, so it appears to be widely understood that receiving care at home is better.
Studies find home healthcare interventions are likely to be just as effective – but less expensive – than hospital care interventions, so for many people receiving complex care in the comfort of their own home is the preferred choice. In addition, local councils tend to align with the view of the World Health Organization, which recommends older adults (who are arguably more likely to require complex care) be cared for in their own homes for as long as possible in order to maintain their wellbeing and independence.
While the health benefits and other positives of complex care at home are undoubtedly important, it seems many people simply prefer the idea of remaining in the environment that is familiar to them, and that they are comfortable in. Staying in their own home may enable them to, for example:
Complex care requires careful management and forward planning in order for carers and family members to remain proactive with a person’s health and care needs. Whether or not you or your loved one have already had a Care Plan put in place, organising care for a person with complex needs often means further care planning is required.
A Care Plan is a written document created for anyone who is eligible for care. This document details information about the type of support needed to meet the care needs of the person, and allows everyone involved – from local authority staff, to private carers, to family – access to information about the person’s needs. According to the NHS, a Care Plan should include:
As well as the above, every Care Plan is personalised to the person’s own needs, so some additional inclusions might be information on things like:
All Care Plans are unique to the person, but the National Institute for Health and Care Excellence states that all plans should include extensive information on how a person’s needs will be met. The point of any Care Plan is to clarify the roles and responsibilities of each person involved in care.
Complex care plans are similar to other care plans, but often include slightly more information on the medical care side as typically there will be an element of medical care involved to address the multiple needs of the individual. A complex care plan will integrate medical, social, psychological and environmental factors to create a coordinated, holistic approach, and encourage collaboration between various healthcare professionals, caregivers and community resources.
Research finds that complex care can sometimes lack consistency and clarification, so a Care Plan is incredibly important for those with complex care as it includes information about every health and social care professional involved, a summary of the person’s health status, plans for their future care, any care coordination efforts made to improve quality of care, the patient’s own responsibilities during care, and more.
The complex care plan should be reviewed and updated regularly as needed, written in simple language so non-medical staff can understand it, and displayed prominently in the person’s home so they can find the information they need at any time.
A complex care plan gives people the opportunity to be part of the planning process, decide any goals they would like to aim for, help them feel better about any long-term conditions they live with, and learn how to manage these more effectively. Complex care plans can help people feel more confident and in control of their own health by ensuring they understand the care required – this is the essence of person-centred care.
A Care Needs Assessment is an assessment carried out to discover what an individual needs for their health-related care and social support. Assessments are undertaken by an independent assessor who will consider a person’s physical, mental and emotional needs, as well as what care could be implemented to manage these. A Care Needs Assessment may take into account things like a person’s mobility needs, their communication needs, their personal care needs, and any medical conditions they have.
In the case of a person with complex needs, a Care Needs Assessment will take a more tailored, comprehensive look at their needs and goals to evaluate the individual’s medical, social, psychological and environmental requirements for care. This is usually done by gathering detailed information about any health conditions present, disabilities, the person’s functional abilities, and the support network available to help.
A Care Needs Assessment for complex care would typically involve steps such as:
The Care Needs Assessment is a similar process for everyone, however for those with complex needs, usually this will require an assessor with experience in the particular challenges associated with the condition(s) involved, and a more comprehensive approach to collecting information to ensure all needs are effectively managed.
Home adaptationsare changes that must be made to a person’s house in order to make living there safer and more comfortable. Whether this means installing grab rails to help with mobility challenges, equipment to make life easier for those with dexterity issues, or reminders and instructions added around the home to help those with cognitive struggles, home adaptations can be made to help with a number of complex needs.
Home adaptations can enable people to continue living independently with an enhanced quality of life. Examples of helpful home adaptations could be changes such as:
These are only a few of the many home adaptations that can be made to help those with complex needs, and a Care Needs Assessment can provide more information about specific adaptations that could help in the case of you or your loved one.
Often those with complex needs will spend time in hospital to manage difficult symptoms of their condition. As an example, a person with breathing difficulties may need to be admitted to hospital if their breathing becomes particularly laboured.
The transition from hospital to home (and vice versa) can be stressful for all involved. Studies on parents of children with complex needs report feeling exhausted and stressed during this process, and similar experiences are reported in adults with complex needs.
According to NHS Improvement, hospital discharge should be included as part of a patient’s treatment plan, and medical teams should organise this as early as possible alongside an advocate for the patient. A complex carer could be the ideal person to do this, and should take a person-centred care approach to transferring a person with complex needs from hospital to home. Studies show the importance of this for older adults, as many who return to hospital have not been taking the recommended medications due to a lack of understanding at the time of discharge. Having a complex carer be part of this process could ensure better adherence to medical instructions, and therefore a reduced chance of readmission.
For anyone with complex needs, the Care Plan should include a detailed record of what care is taking place so that this can be easily transferable between hospital and home settings.
The logistics of transferring someone with complex needs to and from hospital can be tricky, so including this in the Care Plan is important. Studies have identified multiple risks in the process of transitioning a patient from hospital to home, including communication issues, organisational issues, medication provisions, and poor quality of handover instructions.
It is recommended that during a hospital stay, the complex carer should remain in touch with hospital staff, share relevant information from the Care Plan, and begin making arrangements as soon as possible with the hospital discharge coordinator for bringing the patient home. They could also collect contact numbers in case of further issues or readmission, and arrange follow-ups with relevant hospital staff.
The Care Plan should be updated with any additional information gained from the hospital admission, new medications or treatments, and ongoing care needs. In addition, any new necessary medical equipment and supplies should be delivered to the home before the patient is discharged, if possible.
Carers are integral to complex care management and care planning for those with complex needs, and will be required to work together with medical staff to create a holistic approach to care. This should encompass all of the person’s physical, psychological and social needs.
Studies show that home care for older adults is often arranged too late after hospital admission, a rapid health decline, or when family caregivers are already hitting the stage of carer burnout. For this reason, being proactive when it comes to support from a carer is crucial to ensure a smooth transition for the person with complex needs.
Carers can help by facilitating communication with healthcare professionals, coordinating appointments with other carers, ensuring adherence to medication schedules, and more. In addition, complex carers are typically still involved with daily activities like personal care, meal preparation, mobility support and more, depending on the specific needs of the person and what is included in their Care Plan.
Carers are essential to the smooth-running care process as they will observe and report changes in the person’s health status, enabling early intervention which can be life-preserving in some cases. Carers also provide vital emotional support, companionship and advocacy, which can empower an individual with complex needs to navigate their healthcare journey with dignity and confidence.
At Home Instead, our Care Professionals are specially trained to ensure they can effectively help the person they are caring for and address all of their needs. With the latest care training, workshops, safeguarding and more, we can ensure you are paired with the best Care Professional to suit your exact needs.
If you are currently looking to put home complex care in place for a loved one in order to manage care planning, our award-winning home care team can help by offering the bespoke, person-centred care you need. Reach out to the Home Instead team to discuss your needs and allow us to create a personalised package to support you.
Older adults often face a mounting number of healthcare challenges as they age, and time spent in hospital can be a worrying prospect. Thankfully, healthcare can also be carried out at home, providing a preferred alternative for many older people, and offering a new way for healthcare professionals to respond to the growing needs of the ageing population. Without disrupting their lives, healthcare professionals can provide hospital-level care to older adults in the comfort of their own home.
Older people tend to have more health issues than younger age groups due to the natural physiological decline that comes with ageing. According to research from the National Council On Aging, almost 95% of adults aged 60+ live with at least one chronic health condition, and almost 80% have two or more conditions.
The common health challenges older adults face vary depending on factors such as where they live, their lifestyle and their genetic predispositions, but some of the most prevalent conditions include:
These are just a few examples of common health issues faced by older adults, but individual experiences can vary widely. It is essential for older people to maintain regular check-ups with healthcare providers to effectively manage these conditions.
Healthcare at home in the UK refers to medical services provided to individuals in the comfort of their own house, or the home of a loved one if they are staying elsewhere. This approach aims to deliver a wide range of services – including nursing care, medication management, wound care, physiotherapy, palliative care and more – without the person needing to attend hospital or another facility to manage ongoing health conditions.
Healthcare at home offers a more convenient and personalised alternative to traditional hospital treatment or clinic-based care, and is particularly beneficial for older people who usually require more care than younger age groups. Those with chronic conditions will find this to be the most useful.
Not only can healthcare at home enhance a person’s comfort and independence, it also has wider positive impacts on hospitals and NHS facilities that are already under increasing strain, with hospital at home initiatives helping to reduce emergency bed use and improve flow within the healthcare system. This is significant, as the World Health Organization suggests between 2015 and 2050 the global population of people aged 60+ is expected to rise from 12% to 22%.
Healthcare at home services could include things like:
Healthcare at home involves bringing medical and nursing staff into the home, as well as appropriately trained carers, and this can have a number of benefits for older adults. Many older people prefer not to continuously visit a hospital for care, so bringing care to their own home instead can enhance their overall wellbeing and quality of life by promoting a sense of security and independence.
Mental health outcomes can be improved by avoiding frequent hospital visits, as research shows these visits can increase feelings of depression and anxiety. Older adults can continue to enjoy activities they love, see family and friends any time, and be around their own belongings rather than spending long periods of time in a hospital or care facility.
Healthcare at home may also provide more personalised medical care and enable those with mobility issues to access treatment without the upheaval of being transferred to and from hospital. There is also the benefit of a reduced risk of infection and complications associated with hospital visits, which is significant for older adults with weakened immune systems.
In addition, by having doctors, nursing staff or carers visit the person’s home, they are able to view the home environment and the person’s routine, make recommendations for home adaptations or lifestyle modifications to improve safety and health, and recognise if current caregivers are suffering from carer’s burnout and may require respite care to be put in place.
For those in need of end-of-life care, healthcare at home could be the ideal option as many people going through this would prefer to die with dignity at home – research suggests around 71% of people with a terminal diagnosis prefer to receive care at home rather than in a hospice.
The term ‘ageing in place’ refers to adults growing older and remaining in their own homes instead of being transferred to a care home, nursing home or another facility to manage their health conditions. The World Health Organization recommends older individuals be cared for in their own homes for as long as possible to maintain a strong sense of wellbeing, and this can involve a home help organisation to reduce pressure on family caregivers.
Ageing in place will not be the best option for every older adult, but for many it could provide additional benefits. For those who do not require major healthcare procedures or treatments, this can be an ideal option, and is often the preferred choice due to a natural desire to stay in familiar and comfortable surroundings.
When an older adult has a sudden health scare, a typical knee-jerk reaction is to decide on a move to a care home or nursing home, however taking time to evaluate what the best option might be for the person can have more long-term benefits.
For example, ageing in place enables older adults to stay in the comfort and familiarity of their own homes, which can promote emotional wellbeing and independence. This continuity of environment fosters a sense of security; research done on hospital care at home found patient satisfaction was higher than in those admitted to hospital for care, and one study found patients who received home care experienced the same positive health outcomes six months later as those who had been admitted to hospital.
This care model is especially helpful for those with dementia, as ageing in place allows them to remain in familiar surroundings so they are less likely to become confused, anxious or lost. One study found those with dementia living at home experienced higher activity levels, quality of life, and felt more socially connected than those living in a care home.
Staying in their own homes can also help older adults to feel less isolated and lonely, as they can continue to stay involved in their community and receive visits from family and friends. With the appropriate support services in place, such as healthcare at home and home adaptations for safety, older adults can enjoy a higher quality of life while continuing to age in their preferred environment.
Home care can provide invaluable support for older adults who are choosing to age in place. While healthcare professionals can visit the person’s home to administer any treatments or medications necessary, home carers can assist with daily tasks such as bathing, dressing and meal preparation to ensure older adults remain comfortable and safe at home, have someone to talk to for emotional support, and can adhere to the routines and medication schedules doctors have recommended.
‘Virtual wards’ are another recent addition to the hospital at home model, whereby older adults can have their health remotely monitored in their house using advanced digital technology. This means timely interventions can be made if a patient’s condition changes, which can ultimately prevent hospital admissions. While this method works remotely, home carers play a vital role in this care model by providing on-site support and monitoring to ensure all equipment is being used correctly and continues to work efficiently.
Carers can also assist with medication management, vital sign monitoring, daily living activities and more, as well as providing much-needed companionship – this is crucial when older adults are living alone and receiving remote monitoring, as they may go long periods of time without speaking to another person.
By integrating home carers and virtual wards, older adults can benefit from highly personalised and timely medical attention, reduced hospital visits and improved overall health outcomes, empowering them to age in place.
When selecting a home care provider, older adults must consider several important factors such as whether or not they will hire an individual carer, use an introductory agency to find a carer, or use a managed live-in care provider.
In any case, it is important to research the home carer or agency’s reputation, their credentials, the costs, the range of services offered, and more. Ultimately, you must find out whether or not the carer has the training and experience to help with the specific health conditions you need to manage. You may also want to check if it is possible to do a trial run of the services you need, as this can help you both decide whether or not the arrangement could be a good fit.
Remember, you can try more than one carer or care agency before deciding which is right for you, so do not be afraid to move on to the next option if you do not feel you have found the ideal fit yet.
Ageing brings with it a number of changes, both physiologically and mentally, and learning to manage and effectively cope with these health changes can be a challenge for older adults. Maintaining open communication with healthcare providers is key in order to let them know about changes and symptoms that signal potential health problems. You should seek regular health check-ups to be proactive about your health management.
Also, as much as is possible for you, try to engage in regular physical activity, eat a balanced, nutritious diet, and get sufficient rest in order to maintain your wellbeing and promote resilience. In addition, it can help to join support groups for any health conditions you have, and regularly seek companionship and emotional support from friends, family or a hired carer to maintain your mental health.
As you age, your body and mind will inevitably begin to change, however this does not always result in a reduced quality of life. Remaining flexible and adaptable in your routines is crucial, and understanding the best ways to not only manage any advancing health conditions, but maintain the best quality of life possible while living with them in order to make the most of your older years and maintain a positive attitude.
Complex care can be carried out effectively at home for a number of health conditions, but it does have limitations. If you are looking into care options for a loved one with complex needs, you may be wondering if home care is suitable for your particular situation. Here, we are looking at which complex needs can be managed at home and which cannot, as well as how a home carer can provide support at home, and the questions you may wish to ask a potential carer to determine if they have the training and experience for the role.
A number of complex needs can be well managed at home. While occasionally certain conditions will require treatment in hospital depending on the specific needs and length of time assistance will be required, most situations can be dealt with just as well in the person’s house as they can be elsewhere, enabling them to live well for longer in the comfort of their own home.
Also, with complex care available at home and respite care services available for family caregivers, this type of care could be provided long-term if required. Some of the benefits of this include:
Home care services can be life-changing for those with complex needs who require long-term or ongoing care, as it avoids them receiving this care in a hospital or nursing home. Some of the complex needs thought to be suitable for home care include:
While home care is thought to be suitable for many different types of complex needs, in certain situations home care will not be the best option. For example, medical emergencies will require immediate hospital intervention, and these include things like heart attacks or a severe head trauma. This is because much of the equipment and expertise needed for the life-saving procedures required can only be found in a hospital setting.
Similarly, those requiring round-the-clock medical monitoring or intensive care may require specialist resources from a hospital or nursing home facility, so home care will not be possible for them. Additionally, those who require complex care for more specialised surgeries such as an organ transplant or an emergency surgery may be required to remain in a healthcare facility that will be better equipped to intervene on any unexpected complications, and can offer the best chance of a speedy recovery.
Understanding which complex needs are best managed in hospital as opposed to at home can make a big difference to a person’s health, so having in-depth discussions about the pros and cons of each option for your particular situation can be hugely beneficial.
Home carers play an important role in supporting those with complex needs by providing personalised assistance that can be tailored to the individual’s requirements and preferences. Home carers can offer help with daily personal care tasks such as bathing, getting dressed in the morning and preparing meals. If trained to do so, they can also carry out more specialist health care tasks such as administering medications, monitoring health conditions, and assisting with medical equipment as needed.
Some of the most important benefits home carers bring to a complex care situation are emotional support and companionship, as these foster a sense of wellbeing for those who are in need of complex care and who may experience feelings of loneliness as a result.
Home carers can also liaise with healthcare professionals, coordinate appointments and advocate for the person to ensure all complex needs are catered to.
Truly effective complex care at home requires a trained, experienced and highly dedicated home carer who can take on the role and manage the person’s complex needs efficiently, and always with safety in mind. Assessing a carer’s training and experience in managing complex needs is incredibly important when enlisting the help of a complex carer.
Some of the steps you may wish to carry out include:
If you are looking to hire a home carer to assist with complex care needs for you or a loved one, you may wish to start by arranging a Care Needs Assessment, as this will give you more information about the type of care you might need and how to organise this through your local council. If you require a private carer for complex care, this is also an option.
Vital signs are named so for good reason; they are some of the most important factors medical professionals take into account when predicting the health of anyone based on their bodily functions, and especially so for older adults. Here, we are taking a look at what these are, what vital sign monitoring does, how it is done, why vital signs are so important for older people, what the ‘normal’ ranges are and how to know if there is a problem, how vital signs change over time, and how a home carer can support you in monitoring vital signs and alerting medical professionals of any potential issues.
Vital signsare important measurements taken of key physiological functions within the body that indicate a person’s overall health status. Five main vital signs are taken into account:
All five of the above vital signs are crucial to a person’s health, and offer valuable insights into how their body is functioning. In many cases, the first thing a healthcare professional will do is assess a person’s vital signs and continue to monitor any changes.
Usually vital sign monitoring involves tasks like recording blood pressure, oxygen saturation levels, pulse rate, respiration rate, temperature and more. This will be done by a healthcare assistant if a person is situated in a nursing home or hospital, but can also be done by a family caregiver at home, or by a visiting home carer.
If a person is in hospital, their vital signs will often be monitored continuously for real-time data so interventions can be made immediately if needed. In non-urgent cases, vital signs may be taken on a semi-regular basis and any changes recorded over time to give an overall picture of whether someone’s health is declining or they are getting better.
In older adults,vital signsmay be monitored more frequently as age-related changes and comorbidities often create more fluctuations. Nowadays, this is often done usingelectronic equipment, virtual ward systems, or non-invasive methods such as wireless sensors.
For each vital sign, there will be a different method of data collection. For example:
Temperature varies from person to person. This is usually measured using a tympanic thermometer inside of the ear, but it can also be measured with other types of thermometer orally (under the tongue) or in the armpit. This should be checked regularly in order to spot any problems early; if it is too high, the person may have an infection or another issue, or if it is too low, the person may have a health condition such as hypothermia.
Pulse rate can be taken using the wrist in some cases, but medical professionals typically assess this at the artery in the neck. You may hear it referred to as heart rate instead of pulse rate, but in any case, this can be checked by pressing two fingers against the side of the neck just under the jawline.
You can set a timer for 30 seconds, and monitor both the rate of the pulse and the rhythm, which is especially important in older adults as this could indicate any heart issues such as atrial fibrillation. It is important to know that pulse rate can be influenced by a number of elements, such as how the person is feeling, any physical activity they have recently undertaken, the medication they take, and more.
Blood pressure monitoring is important for detecting conditions like hypertension and more. Using a reliable blood pressure monitor cuff – which looks like a strap that sits around the upper arm and is inflated by a qualified healthcare professional – you can tell what the person’s blood pressure is and any fluctuations that could be cause for concern.
Respiratory rate is likely the simplest vital sign to check, as most people can see this visually; if the person’s chest or abdomen is rising up and sinking down again, they are breathing. Look out for chest or abdomen movement, feel the person’s chest, and count how many breaths the person takes within one minute. Like other vital signs, this too can be affected by things like illness, stress and more.
Regular monitoring in older adults can help with the early detection of health issues. Have the appropriate equipment handy for the above checks, create a regular routine, take care and time to measure accurate readings of each vital sign, and ensure the person’s environment is stress-free and calming so it does not impact results.
While some of these can be monitored by family caregivers at home, and other care organisations or individuals may offer these services, remember that vital sign monitoring is an important element of healthcare for someone with particular needs, such as an older adult. This should always be done with the permission of the doctor in charge of the person’s care, in accordance with the Care Plan they have put together, to make sure it is done regularly and accurately. If you have any concerns, don’t be afraid to ask your care provider questions about how they plan to do this.
Vital signs are important for anyone, but older adults more so. This is because early detection of vital sign fluctuations usually corresponds with quicker detection of changes in health status, and can help to pick up early signs of things like infections and other health issues in older adults who are more susceptible to things like this, and may recover less easily.
Vital sign monitoring can also help to prevent misdiagnosis, detect medical issues with no obvious symptoms, and see if lifestyle modifications are helping. Plus, studies have found changes in vital signs impacted the prognosis of older patients more than other age groups.
Older people with ongoing health conditions – like hypertension, heart disease, chronic obstructive pulmonary disease (COPD), and more – can benefit from regular vital sign checks. Conditions like these can result in the need for certain medications which could alter a person’s vital signs. This is why it is so important to let your GP or hospital doctor know if you are on any medication that they may not know about.
Normal ranges for vital signs in older adults can vary slightly from younger people, so knowing both the typical ranges for health and thevital sign abnormalities that can predict any underlying issues are so important.
For temperature, the range forpeople older than 65typically falls between 96.4°F (35.8°C) to 98.5°F (36.9°C). Anything lower than this could indicate hypothermia, and anything higher could be a sign of an infection or inflammation of some sort. Remember that each person is different, so these are approximate figures – if you have any concerns about the temperature of someone you are caring for, speak to their GP.
A normal resting heart rate for an adult could be anywhere from 60 to 100 beats per minute (BPM), however older adults are likely to be on the higher end of this spectrum. A pulse rate that is lower than 60 BPM or higher than 100 BPM could be a sign that something is wrong, and you should seek medical assistance. Keep in mind that pulse rates will vary from person to person, and could be different due to emotions, exercise, medications they are taking, or if someone is ill or injured.
Blood pressure is measured in millimetres of mercury (mm Hg), and according to the NHS, adults should have an approximate blood pressure reading of over 90/60 mm Hg and under 120/80 mm Hg.
For context, high blood pressure (hypertension) is thought to be any reading higher than 135/85 mm Hg if your reading was taken at home, and 140/90 mm Hg if your reading was taken in a pharmacy, GP surgery or clinical setting. Low blood pressure (hypotension) is any reading of 89/59 mm Hg or lower, regardless of where this is taken. It is important to remember that certain factors can influence blood pressure readings, such as stress, smoking, temperature, exercise, and more.
Generally, respiratory ratesin healthy adults range from 12 to 18 breaths per minute, which indicates the level of oxygen in a person’s blood, however this could be higher for older people. Doctors will look for breathing to be within this range, and may also listen for things like wheezing or other atypical sounds, as well as check for muscle tightening or pain while breathing.
As people age and life is lived, bodily changes can influencevital signranges, which is why older adults usually require more vital sign monitoring than younger people in order to pick up on subtle alterations. For example, core body temperature is lower, and pulse rate may slightly increase due to decreased cardiac efficiency and loss of elasticity in blood vessels, leading to higher blood pressure readings. Also, respiratory rates tend to stay relatively stable but can decrease slightly as lung elasticity and function changes with age.
Studies have found several physiological changes may occur with age which can adapt vital signs, and make older people less able to adapt to physiological stressors. Regular monitoring will help to detect any deviations from typical ranges as they occur, providing adequate time for appropriate interventions.
Home carers are usually necessary for supporting older adults with vital sign monitoring and alerting at home if their familial caregivers are not able to provide adequate checks each day. They can assist in regular monitoring of temperature, pulse rate, blood pressure and respiratory rate using appropriate devices, ensure these measurements are taken at the right time each day or week, and even encourage older people to become proactive in their own healthcare by involving them in the process so they understand the signs to look out for.
If a client requires this service, home carers will be trained to identify what normal ranges should be and detect any deviations from these or concerning trends that need to be checked, in accordance with the Care Plan provided by the person’s GP or the healthcare professional in charge of their care. This should include upper and lower limits, and details of who to call if they have any concerns or questions. Through maintaining records of vital signs over time and noting any changes or patterns, early intervention can help with a number of medical issues and underlying conditions. Carers should quickly alert healthcare professionals or family members if further assessment is needed.
Taking care of nails, hands and feet is essential for anyone, but especially so for older adults who may have additional health issues. When something as simple as an ingrown toenail could affect mobility issues, the importance of hand and foot care cannot be overstated.
If you have an older loved one experiencing issues with their feet or hands, keeping on top of this is crucial to help them feel their best and remain in good health. In addition, foot problems can sometimes be a sign of a more serious underlying issue, so understanding the signs to look out for is important – more on these later.
As we age, our hands and feet become more vulnerable to issues like dryness, thinning skin, decreased circulation, and more. Neglecting their care can lead to a number of issues, including:
There are a few common problems that tend to come up for older adults regarding the hands, feet and nails, but the ones that can become more of a cause for concern are usually issues with the feet. Some of the problems you may come across include things like:
61% of those aged 65 and olderlive with a musculoskeletal condition such as arthritis, and although there are different types of this condition, most are characterised by joint inflammation and pain, leading to limited mobility and dexterity. This could mean for older adults it is more difficult to check their own feet and hands, and they could have trouble walking and balancing, which could result in falls.
While dry skin may not seem like a major issue for most people, in older adults, dry skin can become worse over time, leading to cracked skin and potential infections. Dry skin is common due to decreased oil production in the skin as we age, so maintaining an effective moisturising routine is important for older people.
The rate at which nails grow decreases by around 0.5% per year from age 25 onwards, so for older adults, nails grow very slowly. Studies also suggest they can become thicker, more brittle, misshapen, and discoloured, so they require regular nail care. Onychomycosis (a fungal condition) is thought to be the most common nail disorder, but others include onychorrhexis (causing nails to split and become brittle, flakey or soft), and ingrown toenails (resulting from infrequent trimming).
Bunions (hallux valgus) and corns (hyperkeratosis) are common issues experienced by older adults. They often develop from points of pressure and friction on the feet, and can be extremely uncomfortable when wearing shoes or walking around. A 2019 study found that one of the most common foot problems experienced were bunions, followed by toe deformities and nail issues.
Foot deformities (such as hammertoe) are common in older adults, and these can be present from an early age or can develop after an injury. However, many foot deformities and pain issues develop as a result of ill-fitting shoes, like high heels or footwear with pointy toes. Ensuring issues with the feet are corrected as soon as possible can avoid problems in future, so appropriate shoes and regular foot check-ups from a care worker or health professional are important.
Addressing foot and nail issues through regular upkeep and any necessary medical interventions can help to improve comfort and maintain mobility in older adults. In particular, if you are caring for someone who lives with a long-term condition such as diabetes, chronic circulation issues or something else, regular checks are vital to ensuring good health. If you notice any potential problems, let the person’s doctor know as soon as possible so action can be taken if needed. Remember, studies have found that older adults may be unable to perform foot care themselves due to physical challenges and other factors, so if you are caring for an older person you may need to help them maintain healthy feet, hands and nails.
The hands, feet and nails can provide clues about what might be going on with a person’s health, so older adults and their loved ones should be aware of certain symptoms that could indicate an underlying problem, or could escalate further without treatment. For example:
In general, if you notice any signs of ill-health in the feet, hands and nails – whether it be cuts, bruises, pain, swelling, numbness, discolouration, stiffness, or something else – it is best to see a GP or podiatrist to check everything is OK and there are no underlying issues.
There are a few things older adults (or their caregivers) can do on a regular basis to maintain good health in their hands, feet and nails. These include:
Remember, if you are caring for an older loved one who is unable to check their own feet due to mobility issues, you should routinely examine their feet and hands for the aforementioned signs and symptoms. One of the things you may need to do on a regular basis for them is cut their nails, so here are a few tips that could help with this:
Important: If your loved one has diabetes, it is extremely important to ensure that cutting their nails does not result in cuts on their feet, as these can lead to infections. Often using a nail file instead of clippers can be helpful to avoid any sharp instruments near the feet, but you may also wish to have regular podiatry appointments to cut nails safely instead.
As well as some of the common issues mentioned above, older adults can face specific challenges with their hands and feet due to arthritis, general pain, decreased sensation and more. Having reduced flexibility and strength can lead to difficulties performing tasks that require fine motor skills. For example, buttoning up their clothes, tying their shoelaces, or getting a glass of water. Similarly, those with foot issues may struggle to get up and down stairs, go out for a walk, or even put their shoes on without help.
It is important to keep an eye on your loved one’s foot and hand issues if you are caring for them, as even something that may seem insignificant and easy to deal with for the majority of people (such as an ingrown toenail) could become a major issue for an older person. This can lead to pain, discomfort, and reduced independence, and can result in stressful podiatry or GP appointments to deal with issues that have not been caught early.
For these reasons, it is incredibly important to address any challenges your loved one is facing so their health and independence remains a priority.
While hand, foot and nail care may seem like the least of your priorities as a caregiver, it is an extremely important step in maintaining the health of your loved one. By enlisting the help of a home care service with skilled caregivers, they can help with tasks like:
By providing personalised care in the comfort of the person’s own home, these simple hand, foot and nail care services can significantly enhance the quality of life of an older adult, and can promote their independence.
In addition, live-in caregivers can offer dedicated support for many different types of care, and can help to maintain a personalised hand, foot and nail care routine for older adults while assisting with everyday tasks like washing feet, putting on socks, and ensuring shoes are comfortable and fit well – this is important for safe mobility in the home.
Living with a feeding tube inserted will undoubtedly alter a person’s routine and mindset, but they can provide a number of useful (and potentially life-saving) benefits while ensuring the person gets the nutrients, fluids and medication they need. Here, we are taking a look at what a feeding tube actually does, why you might need one, the different types you could be offered, the benefits and risks to know about, how it impacts quality of life in older adults, how to manage your own feeding tube at home, and how complex care from a professional caregiver could help people with feeding tubes to manage their health from home.
A feeding tube may also be referred to as enteral nutrition, or a PEG tube, depending on the exact type a person has. It is a medical device that can deliver essential nutrients directly into the stomach or intestines of a person who cannot consume food orally, either on a temporary or permanent basis. This thin, flexible tube is inserted through the nose or mouth, and passes down through the throat into the digestive tract. It may also be surgically implanted if needed.
According to studies, more than 790,000 feeding tubes are inserted in the NHS every year in order to help the relevant patients receive the nutrients, hydration and medications they need to sustain their health and support recovery from a number of health conditions.
Tube feeding means creating direct access to your digestive system by bypassing the typical route food would take through your gastrointestinal tract (mouth to oesophagus to stomach to small intestine). Through this tube, nutritionally complete liquids are passed, and these will be created to fit the person’s individual needs.
It can be difficult for loved ones to decide whether or not a feeding tube is a good idea for older people, so fully understanding what they do, how they impact quality of life, and the risk-to-benefit ratio is important.
There are a number of reasons a person of any age may require a feeding tube, such as:
For older adults, one of the most common reasons for feeding tube insertion is dysphagia, which is described as an “inability to swallow without aspiration of oral intake”. In addition, moderate to severe malnutrition that cannot be rectified by oral intake is cited as a common reason for the insertion of a feeding tube to help support digestive health and metabolism.
While most feeding tubes have a similar function, there are a few different types that will be inserted in a number of ways, depending on the condition a person has and their individual health needs.
The combinations of feeding tubes that may be inserted include:
While many feeding tubes can be either temporary or permanent, often the ones inserted via the nose or mouth are temporary, while the ones inserted via surgery through an opening in the abdominal wall are intended to be permanent. The PEG tube stands for Percutaneous Endoscopic Gastrostomy or Percutaneous Endoscopic Jejunostomy depending on where the tube ends, and these are often inserted as a permanent solution.
Feeding tubes offer several benefits for older people who may be facing difficulties with eating or swallowing. These include ensuring consistent and adequate nutrition is given, preventing malnutrition as a result, reducing risk of aspiration pneumonia (a common complication of swallowing difficulties), and alleviating caregiver burden when hand feeding is involved. For individuals with serious health conditions who would not be able to gain enough nutrition on their own, feeding tubes can be nothing short of life-saving.
There is also the option to decompress the stomach by removing trapped air, remove stomach contents if necessary, and administer medications if a person cannot take these orally – this should be discussed with the person first as consent to administer in this manner is important.
While feeding tubes offer nutritional support, they – along with all medical procedures – come with some risks, particularly for older people. Prolonged use can lead to complications such as infections, aspiration pneumonia, discomfort and agitation, and a reduced quality of life. In addition, becoming dependent on a feeding tube could reduce a person’s ability to take food and medicines orally as their swallowing muscles may weaken over time.
There is also a risk of tube displacement or clogging, which would require prompt intervention to avoid complications. Studies have found that displacement of a feeding tube is very common (for an estimated 25% to 82% of patients), and this can increase the risk of adverse events for the person.
Other post-surgery risks that should be considered include temporary soreness, digestive issues, sores in the feeding tube passageway, and leakage at the insertion site.
There is ongoing debate about the ethics of inserting a feeding tube for someone with severe dementia. People with this late-stage condition typically have a reduced appetite (read more about this in our guide to handling loss of appetite in older adults), develop issues with eating and drinking, and experience swallowing difficulties. As a result, food or saliva can start to enter their windpipe which can cause serious issues and infections such as aspiration pneumonia. Feeding tubes can help continue to provide adequate nutrition for those with dementia, however the decision is a very personal and nuanced one.
Studies have found that feeding tubes are not always effective at preventing malnutrition in those with severe dementia, nor have they been found to prevent aspiration pneumonia. There is a risk that a feeding tube can cause unnecessary discomfort for a person with severe dementia, and they may attempt to pull one out. There is also debate as to whether these offer any comfort for a person with dementia, and whether they will extend life.
The National Institute for Health and Care Excellence confirms a lack of evidence showing that feeding tubes help to extend the life of those with severe dementia, so the choice can be a difficult one to make for families who are worried their loved one is malnourished or dehydrated.
A feeding tube can significantly impact an older person’s quality of life, both positively and negatively. It provides essential nutrition and hydration when oral intake is compromised, ensuring the person receives vital nutrients and maintains their overall health – this can reduce anxiety for both patients and caregivers. It can also enhance a person’s comfort by alleviating any pain or discomfort they felt when attempting to swallow as normal. However, it also inevitably comes with downsides.
Life with a feeding tube – particularly if it is permanent – can be more challenging when undertaking physical activities, and when socialising around feeding support activities. For the most part, older people can carry on with their usual routine while taking care of the feeding tube insertion site and performing any maintenance tasks they need to at home; this may be done by the person themselves if they feel confident enough doing so and have been educated in the best practices, or it can be done by a caregiver.
Simplified tube designs and user-friendly equipment enhance ease-of-use for older adults, and more recent advancements – like portable feeding pumps and remote monitoring systems – can make the process much easier. With the appropriate support, older individuals can successfully manage their feeding tubes at home and maintain their independence.
The length of time a person may need a feeding tube for will vary due to their specific medical needs, so if this is likely to be a long-term addition to their routine, they may wish to learn more about managing this at home themselves, and enlist the help of regular home care visits to assist if they have issues with mobility, dexterity or something else.
Professional caregivers who specialise in complex needs can help with the management of a feeding tube for older people. Some of the ways in which a carer can help at home include things like:
If you are looking to organise feeding tube management for yourself or a loved one, our Care Professionals are trained to the highest clinical standards and will work with your own doctors and health teams to ensure you are receiving the best possible care at home. Our flexible packages can be tailored to whatever you need to feel confident with your feeding tube, enabling you to maintain your independence, routine and lifestyle.
Lung function is an important element to consider when looking after an older adult, particularly if they suffer from a health condition that could impact breathing. Here, we are breaking down what caregivers need to know about lung function, why it could be a concern for older people, what can be done to help, breathing exercises to improve lung function, other methods of breathing support, when to seek medical help for breathing issues, and how a home carer can help monitor and support breathing in older adults.
Lung functionis vital for keeping us alive, and efficient lung function ensures our bodies receive an adequate amount of oxygen in order to help with cellular metabolism and energy production. Our airways are made up of tissue and bands of muscle that expand as we inhale and contract as we exhale.
As air flows into the lungs, small sacs (known as alveoli) fill with air and blood circulates around them. As a result, oxygen is transferred from the airways to the bloodstream, and carbon dioxide is passed back to the lungs to be exhaled.
Breathing facilitates the removal of carbon dioxide from the body (which can be dangerous if it accumulates), and healthy lung function supports physical endurance in people of all ages, whether in a young athlete running marathons or an older adult simply walking around their home – sufficient breathing is essential for all.
For older adults, maintaining optimal lung function becomes even more critical. The ageing process often leads to natural declines in certain bodily functions due to general wear and tear over many years, and lung capacity is one of those functions.
This could mean changes to the bones and muscles in the chest and spine, lung tissue, nervous system, immune system, and more. As a result, older adults may have less lung elasticity, reduced mobility as a result of breathlessness, and are more susceptible to respiratory infections and complications. According to NHS data, respiratory disease affects 1 in 5 people and is the third most common cause of death in England after cancer and cardiovascular disease.
Conditions like lung cancer, pneumonia and chronic obstructive pulmonary disease (COPD) are some of the most common lung-related conditions that can negatively impact the life of an older person. In fact, with a reduced ability to fully expand and contract the lungs, an older individual may be receiving less oxygen.
Studies have found that reduced lung function is associated with overall mortality, so preserving this in older people can help to promote longevity, encourage independence and improve quality of life, making the measurement and management of lung function highly beneficial for this age group.
Lungs can hold a maximum of around 6 litres or 1.5 gallons, and despite a potential reduction in lung function, older people can take proactive measures to enhance their respiratory health with just a few changes. Here are some suggestions, many of which are recommended by the NHS:
There are a number of benefits to breathing exercises, including reduced stress and anxiety, reduced blood pressure, improved sleep, and of course increased lung capacity and oxygenation. Studies even show the positive effects that have been found on using Inspiratory Muscle Training (a type of resistance training designed to strengthen breathing muscles) to improve inspiratory muscle performance in older people.
Without regular breathing exercises, older individuals may start to notice things like a stiff feeling in the ribcage, muscle weakness around the lungs and shallow breaths, leading to a poor oxygen supply. Here are a few breathing exercises that could be effective for improving lung function in older people:
Perhaps the easiest exercise to start with is to inhale deeply through the nose, filling the lungs with air as much as comfortably possible, then exhale slowly to release. Repeat this between 2 and 3 times daily and aim for 5-10 minutes of this per session.
Otherwise known as Belly Breathing, this exercise requires inhaling deeply through the nose and allowing the abdomen to rise, then exhaling slowly through pursed lips while the abdomen falls back to the starting position. Older people can set aside around 5-10 minutes each day to try this, and gradually increase duration. It can also help to lie down for this exercise if possible.
Start by inhaling through the nose, then exhaling slowly through pursed lips as if blowing out a candle. This type of breathing helps to keep the airways open for longer and reduces shortness of breath. It can be done around 4-5 times a day, taking around 10-15 breaths per session. Doing this during activities that tend to cause shortness of breath can help to reduce this sensation.
Often used in yoga practice for relaxation, this can also help to control breathing. Use a finger to push one nostril closed and inhale deeply through the other. With lungs full, switch the finger to the other nostril and exhale. Repeat this for several breaths for around 5-10 minutes each day, and try to focus on smooth, controlled breaths.
For this exercise, breathing can be considered in 3 parts. First, breathe in slowly, focusing on expanding the stomach. Once this feels full, expand again to inhale into the ribcage. Lastly, exhale and engage the core muscles to release all air from the lungs.
By regularly practising these exercises, older adults can continue to maintain their current lung function or improve it, but always speak to your nurse or GP before starting a routine like this to ensure you are doing suitable exercises for you, particularly if you suffer from a respiratory condition.
Also, if you require surgery for any reason, sometimes Inspiratory Muscle Training may be recommended for a few weeks after the surgery to help keep your lungs healthy. This exercise requires a resistance device that helps to strengthen the inhalation muscles used to breathe in, improving respiratory muscle strength and endurance as a result. Medical professionals visiting the home may be able to provide this device during visits, so speak to them about this option. It can be used for 2-3 sets of around 10-15 breaths up to 2-3 times a day.
Breathlessness is thought to be an issue for around 9-11% of the general population (with varying levels of severity recorded), however this increases with age, and is thought to be around 25% in people over 70 years old. The reasons for this include conditions like:
While breathing exercises can help to improve lung function in some of the above conditions, often older people will rely on other interventions alongside this, or instead of. Various devices and techniques can be tailored to the respiratory needs of older individuals, and there are a number of options for breathing support, including:
The word ‘ventilation’ in a healthcare context tends to suggest that a person would be unconscious and rely solely on a device to breathe, however non-invasive ventilation (NIV)devices can help to deliver controlled air pressure to aid breathing without the person relying on only this. A common example of a non-invasive ventilation device is a CPAP machine (Continuous Positive Airway Pressure) which is often used for conditions like sleep apnea, motor neuron disease (MND), and multiple sclerosis (MS).
Oxygen therapy is another intervention for those who cannot gain enough oxygen on their own through breathing. This method delivers supplemental oxygen through nasal cannulas, oxygen masks or a portable oxygen concentrator to ensure adequate oxygen levels in the bloodstream.
These interventions require assessment and consultation with a healthcare professional, but can be arranged for use within an older person’s own home if needed for breathing support, as well as having a fully trained Care Professional visit the home to provide assistance with breathing monitoring and other respiratory needs.
For older people and their caregivers, it is important to recognise when breathing may be insufficient, as this can mean not enough vital oxygen is being brought into the body. Understanding this involves paying close attention to subtle cues and symptoms. You should seek the advice of a GP if you notice:
If you are caring for an older adult, monitoring their respiratory rate is an important part of vital sign monitoring, and you can learn more about this in our guide to monitoring and vital signs ranges for older adults.
You can do this by observing chest movements and assessing their overall comfort during breathing. If you notice any persistent or worsening breathing difficulties, it is always best to seek a medical evaluation to help identify the underlying causes and ensure their health is not being affected.
Remember, you should call 999 or go to hospital if your loved one experiences severe difficulties breathing (gasping or choking), chest pain, pain that spreads to the arms, back, neck and jaw, blue or pale skin, or sudden confusion.
If breathing is becoming a problem for your loved one, you may feel worried about effectively monitoring any changes and ensuring health is not compromised by a lack of sufficient oxygen intake. One way to put your mind at ease and monitor breathing is to enlist the help of a trained home care worker. Home care workers can monitor breathing, note any changes or signs of distress, support an older person in performing regular and consistent breathing exercises to increase lung function, and help with non-invasive ventilation procedures if necessary.
Ventilator care at home allows older individuals to benefit from non-invasive ventilation in the comfort of their own home.
Certain health conditions can manifest in different ways as we age, and diabetes is one condition that must be handled differently for older adults.
Here, we are looking at the various considerations for diabetes in older people, the types to be aware of, why diabetes can be a bigger challenge for older adults, warning signs in older people, ways to minimise your risk of developing the condition, potential complications of diabetes as you age, how to manage diabetes at home, where to find additional support, and how a carer can help with the monitoring of diabetes.
Diabetes is a chronic condition characterised by high levels of glucose in the blood. According to the World Health Organization, diabetes occurs either when the pancreas is not producing enough insulin (a hormone that regulates blood glucose) or when the body cannot effectively make use of the insulin it produces. Without proper insulin function, glucose accumulates in the bloodstream which can lead to a number of complications.
Diabetes is estimated to affect around 4.4 million adults in the UK, with around 1.2 million people thought to be potentially living with undiagnosed diabetes. Some of the symptoms can include increased thirst, frequent urination, fatigue and blurred vision. The condition can be managed through medication, diet, exercise and monitoring blood sugar levels to prevent any serious health issues, but uncontrolled diabetes can lead to hyperglycaemia, also known as raised blood glucose or raised blood sugar. Over time, this can result in damage to many of the body’s systems, leading to serious outcomes like blindness, kidney failure, strokes, heart attacks or lower limb amputation.
Older adults may find the condition presents different symptoms and complications, and could be harder to manage. For example, diabetes symptoms in older adults could include wounds taking longer to heal, dizziness or fainting due to blood sugar issues, headaches, tingling in the hands or feet due to nerve damage, gum issues, an increased appetite, or a dry mouth.
There are three variations of diabetes older adults should be aware of:
This type occurs when the body doesn’t produce enough insulin on its own, or produces none at all. Older people can develop type 1 diabetes, however it most often begins in childhood or young adulthood. This type of diabetes cannot be prevented, and will remain a health condition for the duration of the person’s life. Those with type 1 diabetes will need to take insulin every day in order to stay healthy.
This type occurs when the body cannot effectively use the insulin it produces on its own. This is the most common form, affecting over 95% of those with diabetes. The risk of developing type 2 diabetes as an adult is higher if a person is overweight, leads a largely sedentary lifestyle, has a family history of the condition, or has a history of gestational diabetes (which can occur during pregnancy). The risk of type 2 diabetes is also thought to be 2-4 times higher for those of Asian (including Indian, Pakistani and Bangladeshi) Chinese, Black African and Black Caribbean ethnicity. Those with type 2 diabetes may need to take insulin in order to maintain control of their blood sugar, change their diet, and/or take oral medication depending on their individual health.
Pre-diabetes is a condition that occurs before type 2 diabetes develops, and can be considered a warning for those on the verge of type 2 diabetes. This happens when glucose levels are higher than normal in the body, but not yet high enough to be diagnosed as having type 2 diabetes. Those with pre-diabetes have a higher chance of developing type 2 diabetes, however they can still prevent or delay this through some of the lifestyle changes mentioned later in this article.
Studies show more and more people with type 1 diabetes are living into old age, however type 2 diabetes is the most common of the two, and is prevalent in older age groups.
Hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar) can be the result of unmanaged diabetes, and this can impact anyone with diabetes no matter what age they are. However, there are a number of reasons why older adults need to consider diabetes more carefully than other age groups. These include:
In people with diabetes, hypoglycaemia or hyperglycaemia are the issues to watch out for. These are sometimes referred to as a “hypo” or “hyper”, and can cause a number of unpleasant symptoms.
Hypers can occur in both type 1 and type 2 diabetes, but these can be far more severe and potentially life threatening for those on insulin. If your diabetes is managed by oral medication, the signs of this may be less severe, but continued long-term hyperglycaemia can increase the risk of organ damage, neuropathy, skin issues and eyesight damage.
The signs of hyperglycaemia (high blood sugar) in type 1 diabetes can include:
The signs of hypoglycaemia (low blood sugar) can include:
The warning signs of diabetes issues in older people may be slightly different, so it is important to understand what each person’s individual signs may be. For older adults, this could also include slow wound healing, recurrent infections, and neuropathy symptoms such as tingling or numbness in the hands or feet.
There are some lifestyle modifications older adults can make to minimise their risk of developing type 2 diabetes. Many clinical trials have found that in those with a high risk of developing type 2 diabetes, this was able to be prevented or delayed by either lifestyle interventions or medication. Lifestyle modifications that could help include:
As we age, our risk of health complications increases, and this is the case especially for those with diabetes. Older adults with diabetes have a heightened risk of complications due to age-related changes, as well as the cumulative effects of diabetes. These include an increased risk for:
Diabetes in older adults has been linked to higher mortality rates, so diabetes complications can significantly impact the quality of life and independence of older adults, reaffirming the importance of proactive diabetes management.
Yes. Older adults can effectively manage diabetes at home with proper education, support and resources, however as age-related changes take place and other health conditions impact things like mobility, dexterity, cognitive abilities and more, many older people struggle to manage their diabetes at home by themselves, and will need the help of a loved one of caregiver to continue to do this effectively.
Depending on the type of diabetes, managing this from home usually means monitoring blood sugar levels regularly using home glucose monitors that track fluctuations in levels. This can also advise on necessary medication adjustments.
If the person is on medication for diabetes, managing this condition will require adherence to medication schedules, including insulin injections or oral medications. Attending regular health check-ups to monitor diabetes is also an important part of diabetes care, as well as maintaining a healthy diet, managing weight, managing stress levels, and avoiding smoking – all of these changes can help to effectively manage diabetes, and in some cases a healthy lifestyle could help to put type 2 diabetes into remission, even for older adults.
Older adults who suspect they have symptoms of diabetes can speak to their GP to obtain information on the best ways to manage this condition. They may also advise on additional support in the form of local community health centres, diabetes education classes, support groups, counselling services, and more. Specialist diabetes care teams may also become involved, including dietitians, endocrinologists, and other experts in this field of medicine.
If you are caring for someone with diabetes and would like to find out more information, you will find lots of resources online, including helplines and educational materials tailored to older adults. Take a look at Diabetes UK, the International Diabetes Federation, or Diabetes.co.uk for more information.
Over time, older adults may find it more difficult to manage diabetes themselves due to physical or cognitive limitations. Diabetes monitoring is a form of complex care provided by professional caregivers, so if you have diabetes and think you need help monitoring and managing it, this can be arranged for you.
A carer can assist an older person in this area by:
If your loved one requires insulin therapy, our look for Care Professionals who are trained to the highest clinical standards and can help manage diabetes with the full support of your healthcare provider. They can check blood sugar, administer insulin, clean and maintain equipment, order stock, prepare healthy meals, supervise safe exercise, promptly respond to low or high blood sugar readings, and more. Enlisting the help of a trained carer can enhance independence, and reduce health complications and hospital admissions for older people living with diabetes.
We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.