Guide Health difficulties: How to cope with changing needs Guide 8

Guide 8
Health difficulties: How to
cope with changing needs
As we age, we’re more likely to develop difficulties because of illhealth or disability. This guide explains what help and support is
available from the local council and the National Health Service
The Independent Age advice service offers free information and advice
on issues affecting older people. All the guides we publish are available
from our website and paper versions can be
ordered by calling 020 7241 8522.
You can also call our advice line on 0845 262 1863 to arrange an
appointment to speak to one of our experienced advisers.
Independent Age is a unique and growing charity providing
information, advice and support for thousands of older people
across the UK and the Republic of Ireland.
There are differences in the ways each country cares for and
supports older people. The information in this guide applies
essentially to England, although there may be similarities with
countries in the rest of the UK.
We also produce five separate guides for both Scotland and Wales
covering the needs assessment process; paying care home fees and
making a formal complaint, which are the key areas where the
policy and legislation differs significantly from England.
All of the guides we publish may be downloaded from or posted to you if you call our guide order line
on 020 7241 8522.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
1. Health difficulties......................................................... 4
2. Assessment of your needs.............................................. 5
3. Equipment and adaptations in your home........................ 7
Occupational therapists................................................. 7
Specialist equipment..................................................... 8
Mobility equipment....................................................... 9
Motability.................................................................... 10
Disabled Facilities Grant................................................ 10
Home Improvement Agencies........................................ 11
4. Health services............................................................ 12
Your GP...................................................................... 12
Community nursing...................................................... 12
Intermediate care........................................................ 12
Re-ablement services................................................... 13
Foot care.................................................................... 13
Eye care..................................................................... 14
Dental care................................................................. 15
Stopping smoking........................................................ 15
Reducing alcohol consumption....................................... 15
5. Transport.................................................................... 17
6. Travelling to hospital.................................................... 19
Visiting someone in hospital.......................................... 20
7. Falls........................................................................... 21
8. Incontinence issues...................................................... 24
Types of incontinence.................................................... 24
What help is available.................................................... 26
9. Financial assistance towards health costs......................... 28
10.Health tips to remember............................................... 31
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
Health difficulties
Many older people lead full, active and healthy lives, although some
people will face health difficulties at different times, or over a longterm period. Health difficulties can be caused by different reasons,
not all of which are related to your age. Physical illnesses, such as
arthritis or a stroke, can affect your mobility, while mental health
difficulties, such as memory loss or disorientation, can make it more
difficult for you to go out alone. However, there may be help and
advice available, as outlined in this guide, which can assist with your
health problems and may go some way towards making you feel
better or more able to cope with daily activities.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
An assessment of your needs
The social services department at your local council can provide a
needs assessment which will identify what your needs are, and will
look at the types of care, support, aids or adaptations to your home
that you may benefit from.
If the council social services agree that your assessed needs meet
the local eligibility criteria, they can organise support services
directly from social services or through another organisation, such
as a private home care agency or a voluntary group like Age UK.
Support services may also be available from the housing
department or health authority. If you are eligible, you can also
arrange your own care and support by asking for a Direct Payment
or a personal budget, which provides you with the money to directly
‘purchase’ your own care. For more information, see our guide,
Home Care: using Direct Payments and Personal Budgets
(Guide 23).
The contact details for social services will be on the council’s
website or in your local telephone directory. For more information
about needs assessments, see our guide, Assessment and
Service from your local council in England (Guide 12).
If you care for someone who has physical or mental health
difficulties, you are entitled to an assessment of your needs as a
carer, from your local council social services. This is known as a
carer’s assessment. The assessment might result in more services
to help the person you look after, or services to support you in your
role as a carer.
Guide 8: Health Difficulties: how to cope with changing needs
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For more information about carer’s assessments and Carer’s
Allowance, contact Carers UK (0808 808 7777, - a
national charity which gives advice and information to carers - or
see our guide, Carers: what support is available (Guide 10).
Guide 8: Health Difficulties: how to cope with changing needs
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3 Equipment and adaptations in your home
If you are experiencing health difficulties, you may benefit from
having specialised equipment or adaptations added to your home to
make it easier for you to carry out daily tasks or move about.
Occupational therapists
An occupational therapist (OT) is a professional trained to work with
people who are ill, recovering from an illness, or have a chronic
disability. They can advise you and refer you to receive disability
equipment and adaptations to your home. Disability equipment (up
to the value of £1,000) should be provided free of charge. OTs may
be based in a hospital or in the social services department of your
local council.
If you are in hospital, the OT assessment and provision of any small
items of portable equipment should take place as part of the
discharge process. Once you are discharged from hospital, the
hospital OT should refer your case to the OT in the community if
you need any larger pieces of equipment or adaptations. Once
discharged, any intermediate care services that you are eligible for
should be provided free of charge for up to six weeks. For more
information, see our guide, Hospital care in England: Everything
you need to know before, during and after your stay (Guide
If you are living at home, the OT’s assessment and the provision of
equipment or adaptations may be a longer process. If you need
equipment urgently, you should make this clear when you contact
social services or to the person making the referral to the OT
Guide 8: Health Difficulties: how to cope with changing needs
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To access the help of an OT, you may be referred by a social worker
following a needs assessment. Alternatively, you can ask your GP to
refer you or you can contact the OT department directly by calling
social services. A friend, relative or carer can also contact them on
your behalf. For more information about OT assessments, see our
guides, Assessment and services from your local council in
England (Guide 12) and Housing: adapting your home to stay
independent (Guide 28).
Specialist equipment
If an OT assesses you as needing specialist equipment to help you
in your home, social services have a duty to provide this equipment,
as long as it can be installed or removed with little or no structural
modification to your home. This equipment may include:
handrails next to the bath, toilet, stairs or front door
a community alarm system so that if you fall in your home
your relatives and the emergency services can be alerted
specially designed or adapted furniture.
Many councils have now implemented a new procedure for the
provision of Simple Aids to Daily Living (SADLs) which may include
eating and drinking utensils, grabrails, raised toilet seats and other
small items which will help you remain independent in your home.
These changes to the provision of community care equipment,
known as Transforming Community Equipment Services (TCES), is
part of the government’s ongoing programme of personalisation in
social care services, and is aimed at giving users more control and
choice over the equipment they receive.
Following an assessment by an occupational therapist, a
physiotherapist or a community nurse, you will be given a
prescription in the form of a voucher which you can then exchange
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
for suitable products at an accredited retailer. Information about
local retailers may be found on your council’s website if they are
operating this scheme. If you wish to purchase a better quality
item, you will be able to pay the difference. You can also look up
the range of equipment available on
If you need more substantial adaptations fitted inside your home,
for example, a stair lift, a ramp or a walk-in shower, the local
council have a ‘duty to assist’ in arranging for the work to be carried
out, but they are not obliged to carry out the adaptation
themselves. This may simply mean the the local council just advises
you on a suitable company that will provide the equipment.
However, the council is not allowed to use ‘lack of resources’ as a
reason for not providing the assistance it has agreed that you need.
For more information about getting adaptive equipment, see our
guides, Assessment and services from your local council in
England (Guide 12) and Housing: adapting your home to stay
independent (Guide 28).
Mobility equipment
If you have difficulty walking, social services can assess you as
needing a walking stick, a walker or even a wheelchair (either manual
or automatic). You may prefer to use an electric mobility scooter to
get about, but unfortunately this type of equipment is not available
from your local council social services. It may be possible to get an
electric scooter through the Motability scheme (see section below) or
by raising the money through a charitable grant. For more
information about applying for charitable grants, see our guide,
Grants from charities for people on a low income (Guide 21).
Guide 8: Health Difficulties: how to cope with changing needs
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Motability (0845 456 4566, is a scheme that allows
people to exchange the higher rate mobility element of their Disability
Living Allowance, the enhanced rate of the mobility component of
Personal Independence Payment (PIP), or their War Pensioners'
Mobility Supplement to lease or hire purchase a motability car,
electric scooter or automatic wheelchair. If you receive Attendance
Allowance, this benefit does not qualify you for help from Motability.
To find your nearest provider, visit the Motability website
Disabled Facilities Grant
A Disabled Facilities Grant helps disabled people in England and
Wales to pay for essential adaptation work to make their home
more suitable for their needs. This is conditional on you meeting the
eligibility criteria, and on an occupational therapist recommending
the work needed. Anyone aged over 18 with a disability is eligible to
apply, whether they are a private tenant, housing association
tenant, or an owner occupier. If you are a council tenant, the
housing department will receive the grant directly. However, the
grant is subject to a means test, and the person with the disability
must agree to live in the property for at least five years after the
work has been completed, unless this becomes impossible for health
reasons. You can apply for a Disabled Facilities Grant from the
council you pay your council tax to (or claim your Council Tax
Benefit from). Social services can give you more information and
your local Home Improvement Agency (see below) can help you
through the application process. For more information, see our
guide, Housing: adapting your home to stay independent
(Guide 28).
Guide 8: Health Difficulties: how to cope with changing needs
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Home Improvement Agencies
Home Improvement Agencies (HIAs) are local, not-for-profit
organisations which help older or disabled, home owners on a low
income and private tenants to have repairs carried out, as well as
adaptations or improvements to their homes. They can tell you if
you are entitled to any financial help, for example, grants such as
the Disabled Facilities Grant, or disability benefits to help you pay
for the work and can provide you with a list of local builders and
contractors. Some HIAs can arrange for minor repairs or
adaptations to be carried out at a subsidised rate by a member of
their staff, or an approved company.
HIAs are sometimes also known as Care and Repair agencies. They
are provided by about two-thirds of local councils and their contact
details may be obtained from their national body Foundations
(08458 645 210, If there is not a HIA in your
area, you can contact your local council or advice centre to find out
what help is available.
If you are a council tenant and you need a repair to your property,
contact the council housing department. If you rent your home
privately and need a repair to your property, contact your landlord.
You will need your landlord’s permission before any repairs or
adaptations can be carried out.
Guide 8: Health Difficulties: how to cope with changing needs
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Health services
There are many services available through the NHS which can help
with any mobility or health needs you experience in older age.
Your GP
This should be your first port of call if you have a health difficulty
which is causing you problems. It may be that you can be treated
easily or your GP may need to refer you on to other services if you
need more specialist advice. If you need non-urgent treatment and
are referred to a hospital, you should be offered a choice of
locations so you can choose which is most convenient for you.
Community Nursing
A community nurse can treat you for minor ailments in your local
GP surgery or they can visit you in your own home. Community
nurses can have a variety of specialisms for example, mental
health, skin breakdown or continence (see chapter 8).
Intermediate Care
Your GP or your local A&E department may be able to refer you to a
rapid response team who can set up a package of short-term (or
intermediate) care funded by the NHS, to prevent you having to go
into hospital. Rapid response intermediate care can be provided
from anything between a few days up to a usual maximum of six
weeks and should be provided in a community based setting or in
your own home. A rapid response team can assess and provide the
necessary care you require in your home. Some acute care can be
provided at home from specialist teams, for example, the
administration of intravenous antibiotics. Intermediate care may
also be provided to help you recover after your hospital discharge.
Guide 8: Health Difficulties: how to cope with changing needs
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Re-ablement services
If you are discharged from hospital or you have had a health crisis
at home, you may be eligible for re-ablement services. Re-ablement
services are provided free of charge, with the main purpose being to
help you to regain your confidence and daily living skills so that you
can stay at home for longer. Re-ablement is short-term help usually up to a maximum of six weeks - where carers visit you
during a short period to help you to achieve daily tasks rather than
doing them for you. Equipment may be provided to help you move
around your home more easily and to achieve everyday tasks
independently. You will need to be assessed for a re-ablement
package either by the hospital social worker at the time of your
hospital discharge, or by a local council social worker if you are at
home. You can refer yourself to your local council social services to
be assessed for a re-ablement service, or by someone else, such as
a family member, friend or your GP.
Looking after your feet can help with mobility problems and also
reduce the risk of falls. Older feet tend to develop more problems
because the skin is thinner, and wear and tear on the joints over
the years can cause discomfort or pain. However, this is not an
inevitable part of growing old, and there are treatments available
which can improve the condition of your feet.
If you have problems with your feet because of ageing, diabetes,
osteoarthritis or rheumatoid arthritis, you should be a priority for
NHS foot care services. Make an appointment to see your GP, and
ask them to refer you to a podiatrist or chiropodist. Chiropody is
available on the NHS free of charge in most areas, but what is
available will depend on health care provision in your local area.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
If you are not eligible for footcare from the NHS you will need to
arrange to see a chiropodist privately. Some local Age UK or Age
Concerns (0800 169 65 65, arrange group chiropody
appointments at a subsidised rate.
It is important that you have your eyes checked regularly. You are
entitled to a free eye test every two years if you are aged between
60 and 70, and every year if you are aged over 70. For contact
details of opticians in your local area, visit the NHS Choices website
( or contact NHS Direct (111). Some areas of the country
are still covered by the old NHS Direct telephone number: 0845 46
47, For more information on the financial help
available to purchase glasses or contact lenses, see chapter 9.
If you are unable to leave your home because of physical or mental
health reasons, you may be eligible to have an NHS-funded sight
test at home. This is known as a domiciliary sight test and a
qualified optometrist will visit you at home to carry out the sight
test. To arrange this and obtain a list of optometrists providing this
service, you will need to contact your local NHS Clinical
Commissioning Group (CCG), or Local Area Team (LAT), as these
have replaced Primary Care Trusts in local areas. To contact your
local Clinical Commissioning Group for details, you can either phone
NHS Direct (0845 46 47) or visit the NHS website
If your sight cannot be corrected by wearing prescription lenses,
you may wish to register as sight impaired (also called partially
sighted), or severely sight impaired (also called blind). Your
ophthalmologist, usually at an eye clinic, will ask you to sign a
‘Certificate of Vision Impairment’ and will notify your local sensory
Guide 8: Health Difficulties: how to cope with changing needs
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service. Registration is voluntary and may bring concessionary
benefits. For more information about sight loss, contact the Royal
National Institute for the Blind (0303 123 9999,
Dental care
To find an NHS dentist, contact NHS Direct (111, or the
NHS dental helpline (0300 1000 899, ). If
you are unable to find a dentist who accepts NHS patients you may
have to go on a waiting list or pay privately for treatment.
If you have a mobility problem that means you find it difficult to
visit your dentist, you may be able to arrange for a dentist to treat
you in your own home. You should contact your local Clinical
Commissioning Group (CCG) and ask for a visit from a domiciliary
dentist. There is a variation in availability depending where you live
in the country. The NHS dental helpline (0300 1000 899) can tell
you if this service is available in your local area.
Stopping Smoking
Smoking can have serious effects on your health. The NHS offers free
local support to help people quit smoking. A trained adviser will help
you put a plan into action to stop smoking. Your adviser will also
explain to you about the range of nicotine replacement products and
other stop smoking medications that are available. For further advice
or to find your local service, contact the NHS Quit Smoking service
(0800 022 4 332,
Reducing alcohol consumption
Having a glass of alcohol can be one of life’s pleasures, but drinking
too much can have a detrimental effect on your physical and mental
health. It can cause insomnia and anxiety, and increase the risk of
falls and accidents, incontinence and depression for older people. In
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more severe cases, heavy drinking can lead to dementia, neurological
(brain) disease and self neglect. If you think that you have a problem
with alcohol, you may want to discuss this with your GP and could
even ask about being referred to cognitive behaviour therapy (CBT),
or a group support programme. If you are concerned about your own
or someone else’s drinking, you can contact Alcohol Concern (0800
917 8282, to discuss safe drinking limits and
how to get help and support. If you believe that you have a severe
problem with alcohol which is affecting the quality of your life and
your relationships, you may wish to contact Alcoholics Anonymous
(0845 769 7555, Alcoholics
Anonymous is a self-help organisation that runs support groups
throughout the UK.
Guide 8: Health Difficulties: how to cope with changing needs
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If you have difficulties with mobility, you may have problems using
public transport. Community transport schemes, such as Dial-a-ride,
can provide door-to-door transport for older or disabled people. In
some areas, there are taxis or community buses that can transport
people with disabilities. For example, Taxicard is a scheme run by the
32 London boroughs and similar schemes can be found in other parts
of the country. The service provides a subsidised door to door taxi
service for people with mobility problems. Contact your local council
or your nearest Disability Information and Advice Line service (DIAL)
(01302 310 123, to find out what
transport services are available in your local area.
In some areas, there are schemes that can arrange transport by
trained volunteers who have had security checks. Contact your local
Age UK or Age Concern (0800 169 65 65,, Women’s
Royal Voluntary Service (WRVS) (845 600 5885,, or
Red Cross (0844 871 1111, to see if a service is
available in your area. You may be able to find details of schemes in
your local telephone directory or local library. Some local branches of
national charities, such as the Multiple Sclerosis Society (0808 800
8000, or Mind (0300 123 3393, have
their own transport schemes.
If you drive a car and have mobility problems, you may be eligible for
a Blue Badge from your local council social services. A Blue Badge
gives you access to priority parking so you can park closer to where
you need to go. It can also be used for your escort, providing you,
the disabled person, are a passenger. You can get information about
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
the Blue Badge scheme from your local council or the website,
You are entitled to a free annual bus pass, often called a ‘freedom
pass’, which gives you free off-peak travel on local buses anywhere in
England if you are of ‘eligible age’ or are ‘eligible disabled’.
The age of eligibility is rising in stages between 2010 and 2018 in line
with the government changes to the qualifying age for the state
pension. This means that the earliest age for men and women to get
concessionary travel passes will gradually increase from 60 to 65.
These changes do not affect existing ‘freedom pass’ holders.
You are eligible for an older person's bus pass from your 60th birthday
if you were born before 6 April 1950. If you were born after 6 April
1950, you will become eligible when you reach pensionable age (if you
are a woman) or when you reach the pensionable age of a woman
born on the same day as you (if you are a man).
Some local councils may offer free travel outside off-peak hours, or
free or reduced price tram or rail travel within the local area. People
who live in Greater London can apply for a Freedom Pass from their
local council, or obtain an application form from the Post Office. People
who live outside the Greater London area should apply to their local
pass provider. The Gov.UK website has further information on free bus travel and a list of
England’s concessionary pass providers.
Guide 8: Health Difficulties: how to cope with changing needs
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Travelling to hospital
The Healthcare Travel Costs Scheme (HTCS) is available to patients
who do not have a medical need for ambulance transport but who
cannot meet the cost of travel to hospital. If you are on a low
income, you may be entitled to a full or partial reimbursement of
your travel costs to the hospital under the HTCS scheme. To be
eligible, you must complete form HC1 available from your GP
surgery or hospital. You can call the HTCS customer enquiry line
(0845 850 1166) if you need help to fill in the form. If you receive
Pension Guarantee Credit or other qualifying benefits, you will be
entitled to full reimbursement of your travel costs to hospital. You
will not need to complete an HC1 form, but you will need to show
evidence of receipt of your benefits.
Under the HTCS scheme, eligible patients are also entitled to claim
for the travelling expenses of escorts/carers where their presence is
considered to be medically necessary by their GP or consultant.
Most hospitals refund fares at reception, or if not, they can advise
you on the procedure. You will have to produce evidence of receipt
of Pension Guarantee Credit or other qualifying benefits or a current
HC2 or HC3 certificate for entitlement to full or partial refund under
the NHS Low Income Scheme. If you are unable to claim at the time
of the appointment, you can apply for a refund using the HC5 form
but you must claim within three months. For more information on
help with health costs, contact the NHS Business Services Authority
on 0300 330 1343,
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Visiting someone in hospital
If you are visiting someone in hospital, you cannot claim under the
HTCS scheme. It was previously possible to receive assistance from
a discretionary grant or loan through the Social Fund, as long as
you were in receipt of Pension Guarantee Credit. However, the
Social Fund changed in April 2013 and your local council has now
taken over the funding, although they are allowed to decide how the
money will be spent. You could check with your council to see if
they are able to assist you with these travel costs. For more
information, see our guide, The Social Fund: Grants and loans
(Guide 4).
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August 2013
As you grow older you may become more prone to falls. Falls can
cause serious injury and leave long-lasting physiological effects.
Many falls can be prevented by following simple steps, such as:
staying active. Falls can be caused by weak muscles and
poor balance. You can improve muscle tone by taking regular
exercise, such as walking, swimming, gentle stretching
exercises or doing light gardening. Weight-bearing exercises
such as walking, tennis and lifting weights can strengthen
bone density. Your local leisure centre or swimming pool may
offer free or concessionary exercise classes and swimming for
older people. You can find out about local walking schemes by
visiting your local library or by visiting the Walking for Health
website (
reducing the risk. When you get out of bed or up from a
chair, try to do it slowly, as a sudden drop in blood pressure
when you stand quickly can make you feel dizzy. Try tensing
and then relaxing your arms and legs a few times before you
stand. Make sure your feet are firmly placed on the ground
before getting up. If you are having difficulty with activities
like getting into or out of a chair or getting to the toilet, you
can ask for an occupational therapy assessment from your
local council social services. The assessment will identify if
there is any equipment or adaptations that can help you carry
out daily tasks
visibility. You may wish to leave a dim light on at night in the
bedroom or hallway, or have a touch-operated bedside light.
Ensure good quality lighting is fitted throughout your
property. Walkways, corridors and halls should be kept clear
of objects, wires and clutter that could cause you to trip.
Guide 8: Health Difficulties: how to cope with changing needs
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awareness of health changes. Have regular check-ups to
monitor your health. If you are feeling unwell, let a relative,
friend or neighbour know. You are entitled to a free NHS sight
test if you are aged 60 or over. If you are taking several
different types of medicine, your GP should review them on a
regular basis. Let your GP know if the medicine causes you to
feel dizzy or unwell. Ask your GP about having a flu jab. You
are more at risk of developing a serious illness from catching
flu as you get older. Illnesses such as flu can, in the short
term, make you far more prone to falling. Each autumn, an
annual flu vaccine is provided free to people aged 65 years
and over
being aware of diet and fluids. Make sure you eat a
balanced diet. Having a regular calcium intake by eating dairy
products like cheese and milk can reduce the risk of bones
becoming brittle and weak. Vitamin D helps the body absorb
calcium so make sure you eat foods with high levels of
vitamin D, like oily fish, sardines, mackerel, tuna, and meat.
Remember also to make sure you drink enough fluids,
including water. Your GP or pharmacist can advise you on
nutritional supplements or any dietary concerns you have
suitable clothing and shoes. It may be a good idea to
avoid wearing loose-fitting or open-backed slippers, sandals,
shoes with heels, flared trousers, trailing nightdresses or
other footwear or clothing that might cause you to slip or trip.
Trainers can be comfortable to wear, and are sometimes
recommended to reduce impact when walking, which may be
helpful if you experience knee or back problems. If you feel
you are at risk of falling, you might consider buying hip
protector underwear that reduces the risk of a hip fracture as
a result of a fall. It is washable, not visible under clothing and
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
can be worn day and night. Ask your GP or a community
nurse for further information about this
keeping warm. Try to keep your home warm as cold
muscles work less effectively which can increase the risk of
reducing hazards. Small changes in your home can help
reduce accidents, such as:
o fitting a letterbox cage so you do not have to bend down to
pick up your mail
o highlighting the outer edge of steps with non-slip white paint
to make them more visible
o using non-slip mats under rugs to reduce the risk of you
tripping or slipping on them
o removing or repairing frayed carpet edges and loose carpets.
o storing frequently used items somewhere easily accessible
o asking for assistance with chores such as changing curtains or
light bulbs
o using a sturdy set of non-slip steps with a safety chain and
handrail, rather than standing on a chair or table
o spreading salt, salty sand, dishwasher ‘salt’ or cat litter on
wet or icy steps to make them less slippery
o keeping a mop to hand and always clear spills immediately to
reduce the risk of slipping
o having extra telephone extensions fitted around the home, or
getting an answering machine, so that you do not have to
rush to answer the phone
o considering installing a community alarm system so that if
you did fall, you can contact assistance and/or the emergency
services. For more information about alarm systems, see our
guide, Telecare and Telehealth: What it is and how to
get it (Guide 6).
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
Continence issues
It is estimated that up to six million adults in the UK currently
experience some form of incontinence. There may also be many more
who do not seek help and are not formally diagnosed.
Incontinence is not an inevitable result of growing older. However,
certain age-related changes do occur in the nervous system, kidneys,
bladder and urethra, which can make older people more vulnerable to
developing incontinence. Incontinence can also be caused as a result
of a trauma such as a stroke, an illness such as Parkinson’s disease,
or external factors such as excessive alcohol consumption.
Types of incontinence
There are two main reasons for incontinence. One is physiological,
and is caused because you do not know when you need to go to the
toilet or you cannot control your bladder or bowels because of a
disease, disability or illness. The other is environmental, and may
occur because you are not able to get to a toilet in time as a result of
mobility difficulties.
There are a number of different types of incontinence and the
treatment and support may be different for each type. The different
types are described below.
Stress incontinence
This is when you may ‘leak’ urine when you laugh, cough or sneeze.
It is caused by muscles surrounding the base of the bladder becoming
weak. It is possible to strengthen these muscles (pelvic floor muscles)
by doing special exercises. Your GP or a continence advisor working
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August 2013
with your local Clinical Commissioning Group can give advice about
these exercises and other sources of help.
Frequency incontinence
You may find that you need to go to the toilet more often than
normal. This can be caused by a number of conditions, although in
most cases the reason is not known. Drinks with caffeine (such as
tea, coffee and cola) or alcohol can increase symptoms.
Urge incontinence
This is a strong desire to go to the toilet, which you cannot ignore.
Dribbling or leaking
In men, this problem may be due to changes in the prostate gland.
In both men and women, it may be because of constipation causing
pressure on the bladder.
Environmental incontinence
This happens when your urinary system is working well but you
cannot get to the toilet in time. This can happen if you have mobility
difficulties or the toilet is difficult to access. There are a number of
aids or adaptations to improve your home so that getting to the toilet
is easier for you. Contact the occupational therapist at your local
council social services to ask for an assessment or for further
information, contact the Disability Living Foundation (0845 130 9177,, or home improvement agencies (0845 864 5210,
Bowel incontinence
This can be caused by a number of things, for example, eating
particular foods, not getting to the toilet in time or in combination
with constipation.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
People who have experienced physiological damage, for example,
caused by a stroke, may no longer be aware of when they need to
empty their bladder or bowels. Loss of mental capacity can also lead
to people being unaware that they need to go to the toilet. If
someone you care for may be having problems with continence
because they lack awareness, you should seek professional advice to
find out if the symptoms are temporary or likely to be permanent.
Seeking help at an early stage increases the chances of the problem
being resolved or at least improved. You may find that by changing
diet, daily routine, carrying out special exercises and drinking at
different times of the day, it is easier to cope with continence
What help is available
The first step is to visit your GP for a check-up to see if there is a
medical reason for the incontinence. If the problem cannot be
resolved with medical treatment you can ask your GP to refer you to
see a continence advisor, a health visitor or a community nurse. A
continence advisor will be able to give you specific advice about ways
of reducing and managing incontinence. They will discuss your
problem with you in confidence, and together you can work out what
can be done to help you cope with your continence difficulties.
A full investigation will mean that your condition might be improved
either by treatment, exercise, advice, training, suitable continence
aids or adaptations to your home. Try to overcome any
embarrassment you may feel to seek support as, in many situations,
incontinence can be improved or even overcome.
For more information and advice about continence issues, contact the
Bladder and Bowel Foundation (0845 345 0165,
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
26 This charity also produces a Toilet
Card, ‘Just Can’t Wait’ which uses the universally recognised image
for a toilet. This may help holders of the card find and access toilets
in countries where English is not the spoken language. The toilet card
states that the holder has a medical condition and needs to use the
toilet quickly and may help you gain access to toilets in most places.
The charity asks for a £5 donation towards the production and
postage of the card. For more information, contact the Bladder and
Bowel Foundation (0845 3450165,
RADAR, the disability rights organisation, operate a National Key
Scheme which provides, for a small price, a key to access locked
disabled toilets and a guide to over 9000 disabled toilets across the
UK.Toilets fitted with the National Key Scheme (NKS) can be found in
shopping centres, department stores, restaurants, bus and train
stations and many other locations, giving peace of mind to people
who may need quick access to the toilet. For more information, go to
the website RADAR keys can also be purchased
from other organisations, including the incontinence advice service of
Age UK (0800 849 80322,
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
Financial assistance towards health costs
Prescription costs
If you are over 60 you are entitled to receive prescriptions free-ofcharge from your GP or hospital. On the back of the prescription
form there is a box to tick to say you are over 60. The chemist may
ask you to show proof that you are over 60.
Glasses and sight tests
You are entitled to free routine NHS eye examinations if you are
aged 60 or over. You are also entitled to a free sight test if you
have certain health conditions, such as diabetes or glaucoma.
Before you have your eye test, tell your optician or the receptionist
that you are eligible (or think you may be eligible) for a free eye
test. You will be asked to sign a NHS Sight Test form.
If your sight test shows you need glasses, you will be provided with
a prescription which you can take to any optician or supplier to have
prepared into glasses. If you are eligible for a NHS complex lens
voucher (your optician will be able to advise you), you receive
Pension Guarantee Credit, or you are named on a HC2 or HC3 form,
you are also entitled to an NHS optical voucher to assist you with
the cost of your glasses.
For more information, ask for advice from your optician or contact
the RNIB (0303 123 9999, who have leaflets available
on this subject.
Dental work
Free NHS dental treatment is provided to people who receive
Pension Guarantee Credit. You may also be able to get help with
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
paying for dental care if you are on a low income of this guide.
There are maximum charges for NHS dental care; a complex course
of treatment is currently £209 and other more straightforward
treatments like check-ups, fillings and extractions cost either
£17.50 or £48.
Low income and health costs
If you receive Pension Guarantee Credit, you can claim financial
help with health costs for things like dental treatment, NHS
prescriptions, sight tests, glasses and contact and travels costs to
and from hospital for NHS treatment. You will need to show proof of
age and qualifying benefit.
If you do not receive Pension Guarantee Credit because your
income or savings are too high, you may still be entitled to help
toward the costs of dental treatment, sight tests, glasses and fares
to hospital if you are on a low income. To claim this help, you have
to fill in form HC1.
The form HC1 is available from your GP surgery, dentist or optician.
The Health Benefits Division can give you information on the NHS
Low Income Scheme Patient Services (0845 850 1166). An advisor
will ask you for information about your income and savings and
inform you how much help you are entitled to. You are only eligible
for financial help under the Low Income Scheme if you have savings
of £16,000 or under. If you live permanetly in a care home and the
council helps towards your fees, you are entitled to this service if
you have savings of £23,250 or under.
The Health Benefits Division will send you a certificate, which will
show what help you are eligible for. You might receive help towards
some or all of your charges. You will be sent an HC2 Certificate for
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
full help, or an HC3 Certificate for partial help. The certificate will
last for one year. If you have paid NHS charges in error you can fill
in form HC5 to claim a refund. You must send the form to the
Health Benefits Division within three months of the date that you
paid the charges.
War Pensioners
If you are a War Pensioner you may be entitled to additional
financial help with NHS treatment and other needs. Contact the
Service Personnel and Veterans Agency (0800 169 22 77, for more information.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
10 Health tips to remember
These tips will all be familiar, but can help towards making you feel
better, despite your existing health conditions.
Exercise as often as you can – a little bit of exercise like a
short walk or a gentle swim can tone your muscles,
strengthen joints and make you feel better about yourself.
Go out and socialise – seeing friends and doing new things
can make you feel good, reduce feelings of isolation and can
take your mind off health worries.
Eat well – eating healthily, little and often, can help to keep
your weight within a normal range and give you plenty of
energy. Try to find new ways of preparing food that are likely
to increase its flavour and thus increase your appetite.
Drink plenty of fluids – even if you are not thirsty, it is
important to top up your fluid intake, as it is easy to become
dehydrated. Having a drink of water, milk or juice every time
you eat, for example, can make sure you are drinking enough
which will give you more energy.
Get plenty of sleep – a good night’s sleep is sometimes hard
to achieve, but is important for your wellbeing. Having a
regular bedtime routine can help, as can reading a book or
playing gentle music just before you go to bed in a suitably
dark and quiet room.
Guide 8: Health Difficulties: how to cope with changing needs
August 2013
This guide is not a full explanation of the law and is aimed at people
aged over 60.
If you would like free, personal advice on coping with health
difficulties or any issues related to social care, benefits,
loneliness or isolation, please call our advice line on 0845
262 1863.
If you have found our advice useful, please consider making a
donation. We receive no state funding and rely on income from
individuals, trusts and other sources to continue providing our
services to hundreds of thousands of people in need. For further
information on how to support us, please see our website or call 020 7605 4288.
© Independent Age, August 2013
Independent Age
6 Avonmore Road
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T 020 7605 4200
E [email protected]
Advice line 0845 262 1863
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