Wrinkly hands or ‘cocaine ‘fro’? You decide…

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently a PhD student at The University of Nottingham. She tweets at @lizcharalambou and is a regular guest blogger for the BGS. Her blogs are her own opinion and do not represent the opinion of her employer or any other organisation.

I came across a USA you tube clip the other week which challenged my thinking on HCOP care. The footage was of a young man who has teamed up with his grandma to make, what I would describe as ‘stereotype-busting videos’ of his visits to see grandma in ‘the ‘hood’. I initially thought it was controversial and mildly exploitative (after all he talks to his grandma about her ‘cocaine ‘fro hairdo). I had to watch them a few times to decide that actually, this challenges my perceptions of how we engage with older people. Watching grandma rolling meatballs to ‘roll out’ rap music and shimmying her shoulders following a successful bottle flip challenge, I was hooked. The couple do Q & A sessions, mannequin challenges and twerking dance offs, cover naughty topics, and cause general mayhem and shenanigans at a pet store, among other (more saucy) clips, and seem to have a great deal of fun together in the process.

It led me to ponder on our own preconceived ideas about older people. After all, stereotypes abound in advertising and are well represented by the considerable number of stock images of wrinkly hands. I wonder, how do such thoughts affect our interactions when caring for older people? By way of example, I recently had a conversation with a student nurse concerned about how her employment chances on qualifying would be affected by her appearance. She had tattoos, facial piercings and every time we meet has a different hair colour. She is, incidentally, a capable, caring and competent nurse in the making. I subsequently questioned a senior nurse about her views on nurses’ appearance, only to be told she was against a non-generic look for nurses on the grounds that it ‘scares older people’.

Intrigued, I returned to my HCOP ward and asked a few of the patients what they thought. They were on the whole very laid back about what people look like. After all, many of their family have tattoos, and indeed some of our female HCOP patients themselves sport one or two. It led me to think maybe we are too conservative, too paternalistic and too blinkered by our own stereotypes in the care of older people. They are members of society, have led exciting (or steady) lives, have loved in passionate relationships (or remained single), have born countless children (or remained childless). In short, a hugely diverse population themselves, despite coincidently belonging to a common age bracket. What we must acknowledge is that they are people, not to be seen through the restricted and often distorted prism of age (which of course is unlawful in the UK).

The thing is, in caring professions  should we expect our nurses to be uniform, standardised, and all look the same to fit what we perceive to be society’s own expectations and stereotypes? I thought I was being old fashioned until I did a google image search to see swathes of clean-cut, smiling (non-tattooed) wholesome looking types, tempered of course by the inevitable fancy dress costumes. This suggests to me there is an expectation on public sector workers to emerge from a generic mould, particularly when I read about calls to lift the ban on visible tattoos for police officers.

Over the years I have worked with nurses who are a cross section of the population yet did not fit with existing ‘norms’ of what society says a nurse should look like, that is, I have had the good fortune to work with nurses who are transgender, gay, tattooed, and sport body piercings. They have also been kind-hearted, thoughtful, knowledgeable and competent nurses who passionately care for their patients, have excellent working relationships with colleagues, and are valued and valuable members of their team. There is no cause and effect between appearance and performance, the only correlation exists in our minds as we pre judge a person on their appearance. This is dangerous territory and could set a precedent for judging people further on the grounds of ethnicity, sexual orientation, colour, and indeed, age.

It is now well documented that discrimination exists in the NHS, as anyone who has read Roger Kline’s excellent snowy white peaks report which highlights that (despite robust evidence to link a diverse workforce to good patient care) discrimination persists in the NHS; and worryingly such discrimination prevents BME staff from accessing leadership and management positions.

If we are intolerant to the individual preferences of our colleagues then we are entering dangerous territory in how we approach patients? Do we want to standardise nurses to the point of churning out automatons from a generic predetermined mould, while simultaneously expecting them to value the patient as an individual and deliver bespoke services tailored to their particular needs and preferences as advocated by Kitwood?

One caveat is that older people can only be recognised, accepted, or valued in society if they are doing something remarkable, such as running a marathon, or working in their 90s, breaking abseiling records at 101 years of age, or even working as a nurse at 83.

The point is, who are we to judge? Have we travelled such a well-worn path to stereotyping each other, including older people, to expect a certain ‘type’? Do we expect to see wrinkly hands to personify and illustrate older people, sat quietly in a chair doing their knitting patiently waiting for relatives; and only see centenarian marathon runners, industrious nonagenarians, mature abseilers and senior street dancers as exceptional? Or are we ready to embrace and accept as standard, people of advancing years whatever their life choices and abilities?

With increasing numbers of older people sharing their experiences of loneliness and various groups such as the Be A Friend campaign and NHS choices taking steps to remedy this by integration and interaction, maybe it’s time for a rethink? Does age still matter, and does it matter to us as carers of older people? Should we, when caring for older people (also known as people) see wrinkly hands over a ‘cocaine ‘fro’ or just a person? Maybe it’s up to us to change our views?