Advance directives
Written statements made by a competent person outlining their preferences for medical treatment or care in the event they lose capacity in the future.
Includes advance decisions to refuse treatment (ADRT) and advance statements of wishes and preferences. Legally binding if valid and applicable.
Anatomical and histological changes associated with agein
Structural changes in tissues and organs with age, including:
Skin: thinning of epidermis, loss of collagen and elastin.
Cardiovascular: arterial stiffening, myocardial fibrosis.
Musculoskeletal: sarcopenia, decreased bone density.
Renal: reduced nephron number, glomerulosclerosis.
Neural: neuronal loss, reduced brain volume.
These changes contribute to reduced physiological reserve and slower healing.
Autonomy
The ethical principle that individuals have the right to make informed, voluntary decisions about their own care and treatment, free from coercion. Central to consent and capacity assessments.
Best interests
A standard used under the Mental Capacity Act (2005) to guide decision-making for individuals who lack capacity.
Takes into account the person’s past and present wishes, beliefs, values, and consultation with family or advocates to determine what would most benefit them.
Biochemical, molecular, cellular, and genetic theories of ageing
Biochemical: Accumulation of metabolic waste and free radicals.
Molecular: DNA damage, telomere shortening, protein misfolding.
Cellular: Senescence (cells lose ability to divide), mitochondrial dysfunction.
Genetic: “Programmed ageing” theories suggest lifespan is partly genetically determined.
Together these explain the decline in function and increased vulnerability with age.
Community nursing care
Nursing services delivered outside hospitals — often by district nurses — providing wound care, medication administration, chronic disease management, and palliative care in patients’ homes or care settings.
Cardiopulmonary resuscitation (CPR) decisions
Clinical and ethical decisions regarding whether CPR should be attempted if a person’s heart or breathing stops.
Documented in DNACPR (Do Not Attempt CPR) or ReSPECT forms. Must consider clinical appropriateness, patient’s wishes, and best interests.
Community care at home
Health and social care services provided in a person’s own home to promote independence, prevent hospital admission, and support recovery.
Includes district nursing, occupational therapy, home help, and carer support.
Clinically assisted nutrition and hydration (CANH)
Provision of nutrition or fluids via medical means such as NG tube, PEG, or IV therapy when a person cannot eat or drink safely.
Ethical considerations include benefit vs. burden, capacity, and best interests.
Community matron service
Specialist nurses who coordinate care for people with multiple long-term conditions, aiming to reduce hospital admissions and manage complex health needs in the community.
Euthanasia and assisted suicide
Euthanasia: Deliberately ending a person’s life to relieve suffering, usually by another person.
Assisted suicide: Providing means or information for someone to end their own life.
Both are illegal in the UK under the Suicide Act 1961 (assisting suicide punishable by law).
Immediate care at home
Short-term, intensive support provided at home to prevent hospital admission or to facilitate discharge.
Often includes rehabilitation, physiotherapy, and nursing support for up to 6 weeks.
NHS continuing care
A package of care arranged and funded solely by the NHS for individuals with complex, ongoing health needs that are primarily medical rather than social in nature. Determined by a Continuing Healthcare (CHC) assessment.
Interim care
Temporary care provided (often in a residential setting) for individuals waiting for long-term placement, rehabilitation, or home support packages to be arranged post-discharge.
Mental capacity
The ability to make a specific decision at a specific time.
Under the Mental Capacity Act (2005), a person has capacity if they can understand, retain, weigh, and communicate information relevant to a decision.
Assumed to have capacity unless proven otherwise.
Nursing home care
Care provided in a residential facility where qualified nurses are available 24/7 to deliver medical and personal care for residents with significant healthcare needs.
Pathology associated with normal ageing and age-associated disease processes
Normal ageing: Predictable physiological decline (e.g., mild cognitive slowing, reduced renal clearance).
Age-associated disease: Conditions more common with age (e.g., Alzheimer’s, atherosclerosis, osteoarthritis).
Distinguishing normal vs. pathological change is vital in geriatric assessment.
Physiology of ageing
Functional decline in organ systems due to reduced reserve capacity:
Cardiac output ↓
Renal function (GFR) ↓
Pulmonary elasticity ↓
Metabolic rate ↓
Immune response ↓ (immunosenescence)
Leads to increased vulnerability to illness, slower recovery, and altered drug metabolism.
Practice of safe prescribing in older adults
Involves adjusting drug choices and dosages to account for:
Reduced renal/hepatic clearance
Polypharmacy and drug–drug interactions
Altered pharmacokinetics/pharmacodynamics
Increased sensitivity to side effects
Follows principles like “start low, go slow” and regular medication review.
Rehabilitation
A multidisciplinary process aimed at restoring or maximising function, independence, and quality of life following illness, injury, or surgery.
Includes physiotherapy, occupational therapy, and speech therapy.
Residential home care
Provides accommodation, meals, and personal care (e.g. washing, dressing), but no nursing care. Suitable for older adults who need assistance with daily living but not continuous medical support.
Residential immediate care
Short-term residential care designed to prevent hospital admission or provide respite care following discharge, before returning home or moving to long-term care.
Withdrawal and withholding of medical treatment
Withdrawal: Stopping a treatment already started.
Withholding: Not starting a treatment.
Both are ethically acceptable when treatment offers no benefit, is futile, or is against the patient’s wishes or best interests.
Decisions should follow ethical principles and legal frameworks (e.g. MCA 2005).
Safeguarding
Protecting individuals (especially vulnerable adults and children) from abuse, neglect, or exploitation.
Healthcare professionals have a duty to identify, report, and act on safeguarding concerns under the Care Act 2014.
