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This chapter intends to bring the suffering person's voice to this text. The perspectives include those of pediatrics, critical care, oncology, geriatrics, pain management, and family caregivers. These contexts were selected as clinical areas recognized as places of pervasive suffering and those with intense nursing involvement. The suffering seen in these settings is described in this chapter by nurses who have witnessed the suffering within these contexts. The discussion explores these contexts both in terms of common themes and in terms of the goals of nursing in caring for individuals under these circumstances.

The aging population in the United Kingdom has brought greater recognition of the heterogeneity of older people, and hence their varied health care needs. Elderly care medicine argues that the multiple and complex conditions often associated with aging call for specialist services, but the management of older patients now is moving into mainstream services. Health policies have been driven more by the views of professionals than the expressed wishes of older people, however, and has concentrated on adverse outcomes for the health system (rising hospital admissions, hospital bed blocking) rather than positive health outcomes for older people. While the entitlement of older people to health care is secure within a national health service, policies should aim to improve the quality of health care and quality of life for older people.

Complexity science methods offer new opportunities for prognosis and treatment in healthcare and clinical psychology because of the increasing need for integration of the detailed knowledge of physiological and psychological subsystems and the increasing prevalence of multiple disease conditions in our aging societies. This chapter explains how the frequently occurring acute transitions and related tipping points in physical and mental processes in these populations can be monitored with time series and dynamical indicators of resilience. The authors introduce slowing down of recovery, increase in variance and autocorrelation, and increasing cross-correlation between subsystem time series as valid predictors of the proximity of tipping points in diseases such as depression, heart failure and syncope. Using wearable devices, together with these complex systems analyses, yields new methods of forecasting and may improve resilience of individual persons and their mental or physical (organ) subsystems

This chapter examines how accounts of pathological hoarding emerged alongside accounts of pathological old age. It explores how cultural depictions of aging recluses fostered stereotypes of the aberrant hoarder. To so do it traces a history of senile squalor syndrome that associates the elderly with the accumulation of rubbish. Using the 1975 documentary film Grey Gardens and it subjects Edith Bouvier Beale and Edie Beale as its main case study, the chapter details how modern fears over late life material culture support depictions of elder hoarding. Surveying the cultural history of geriatrics and gerontology in the United States, the chapter describes how these disciplines advanced apprehension over the belongings of older men and women such as Edith Bouvier Beale. These discourses of the pathological aged and their departures from socially acceptable forms of keepsakes and memorabilia continue to influence popular and scientific accounts of hoarding.

This chapter describes how Robert Butler, as director of the National Institute of Aging (NIA), sought to expand the scope of geriatrics. Butler recommended that training people to care for the aged be integrated into all phases of medical education, particularly in primary-care specialties. He emphasized a “team approach”…of dentists, podiatrists, nurses, social workers, physical and occupational therapists, nutritionists, psychologists, physician's assistants, and others working together under the leadership of the physician—to provide the best possible care for the older patient. However, there were many obstacles to promoting geriatrics, including the lack of required geriatric rotations in residency programs as well as a dearth of continuing education courses dealing with geriatrics. Intramural politics in academic medicine, institutional constraints, and fiscal exigencies nationally and locally also conspired to thwart efforts to expand geriatrics.

In China, the growth of the middle class, lifting so many from poverty, is enabled by the very same urbanization and industrialization that is affecting the physical and mental health of many. From cancer to diabetes, obesity to cardiovascular disease, the chronic diseases of wealth are rising rapidly in China, while the health system is failing to keep up with people’s soaring demand for quality healthcare. But it should not be forgotten how far China has already come—implementing the world’s largest basic healthcare coverage. In this chapter, Mark Britnell discusses whether it can pick up the pace in terms of the reach and depth of care provision, with many patients still incurring significant out-of-pocket expenses. Looking forward, he also analyses the developments needed in China to provide healthcare for the growing older population.