Families and carers play a major and ongoing role in providing support and care to older people, allowing the older person to maintain their independence and quality of care. Carers often provide:
- general care and nursing tasks – for example, medications, dressings, mobility
- intimate care – for example, hygiene, toilet needs
- meal support
- emotional support
- domestic care – for example, shopping, cleaning, gardening, paying bills.
For GPs, working constructively with families and carers is integral to providing high-quality healthcare for older people. Importantly, as the closest person to the older person, it is important to encourage the carer to discuss their concerns and suggestions for the older person’s health. The knowledge that carers have is useful in identifying and managing problems the patient may be experiencing. Additionally, family and carers can assist with the cooperation required to effectively implement any patient management plan.
There may be times when the wishes of the family conflict with those of the patient. Examples of this are withholding or requesting treatment, and withholding information regarding care from the older person. The GP’s first priority is to the patient, and advocating for them is vital. Communication with the family and discussing the reasons for decisions prevents most issues. For the rest, the GP’s interpersonal skill and emotional intelligence is needed.
A multidisciplinary team that includes family and carers can help to identify and respond to the older person’s individual needs (refer to Part B. Collaboration and multidisciplinary team-based care). In turn, this can lead to improved social, emotional and physical wellbeing and enhance the carer’s ability to provide ongoing support and care.
Even though families and carers play an important role in the healthcare of older people, it is important to acknowledge and respect the older person’s wish for privacy, confidentiality and self-determination. It is important to discuss the issues of information sharing with the older person and obtain their consent to disclose certain health information with their carer.
If the patient is not cognitively intact, gaining consent from the guardian for aspects of care is good practice.