Post #COVID #Antipsychotic Use for Dementia in Care Homes #Dangerous

Recent research led by the University of Exeter and King’s College London, which has still to be published compared pre-pandemic care home prescribing rates for antipsychotic drugs to treat severe dementia in 2016-17 with those in 2021-2.

The pre-COVID-19 data included 971 residents from 69 care homes, and the post-COVID-19 figures involved 747 individuals across 149 care homes taken from baseline data of the “Improving the Wellbeing and Health for People Living with Dementia” (iWHELD) study. Both study participant groups had an average age of about 85 and a similar gender balance of approximately 70% women and 30% men. There were fewer people with severe dementia in the iWHELD cohort compared with the earlier study (6.7% v 23%).

Analysis found that antipsychotic usage was 55% higher post-COVID when compared with pre-COVID (28% v 18%), despite similar rates of neuropsychiatric symptoms. 64% of participating care homes had experienced an outbreak of COVID.

To ensure that the results were not confounded by the lower number of people with severe dementia in the most recent study, the researchers widened the scope to include residents with ‘moderate’ and ‘moderately severe’ dementia. However, the results remained very similar.

Any study that identifies a substantial rise in antipsychotics given to people with dementia in UK is shocking, because of the risk of serious side effects, such as stroke, accelerated decline, and mortality from these medicines that has been known about since the findings of Professor Sube Banerjee’s (2009) Report entitled “The use of antipsychotic medication for people with dementia”. This report highlighted that only one in five patients in the UK derived positive benefits from antipsychotic medication and that approximately 1,800 patients in the UK at that time it was estimated died annually as a result of inappropriate antipsychotic prescribing. Since 2010, significant efforts have ben made to significantly reduce the number of prescriptions for antipsychotic drugs since 2010 with guidance issued to all GPs, pharmacists, and other healthcare professionals on how to provide care that meets the specific needs of each patient. Expert pharmacy teams have also been rolled out across the country to give advice to patients and maximise other treatment options, where appropriate. So it is hugely concerning to see such a significant rise in such a short period. I doubt that the presence of COVID-19 in the population is a suitable justification for this alteration in practice. I would agree with the research team who have said that said prescribing levels should be a “major focus” in the aftermath of the pandemic because of the risk of serious side effects to many current residents.

A further analysis found that care homes that had increased antipsychotic prescribing had significantly higher levels of overall neuropsychiatric symptoms and significantly higher levels of agitation compared with those which had lower prescribing rates. There were also 31% more staff sick days in the higher prescribing homes, more details about their findings can be found at https://alz.confex.com/alz/2022/meetingapp.cgi/Paper/67089

Clive Ballard, Professor of Age-related Diseases the University of Exeter College of Medicine and Health, commented:

“COVID-19 put tremendous pressure on care homes, and the majority of them must be applauded for maintaining relatively low antipsychotic prescribing levels amid incredibly difficult circumstances. However, there were very significant rises in antipsychotic prescribing in one third of care homes and we urgently need to find ways to prioritise support to prevent people with dementia being exposed to significant harms.”

Dr Richard Oakley, Associate Director of Research at the Alzheimer’s Society, said:

“This study shows the shocking and dangerous scale of the use of antipsychotic drugs to treat people with dementia in care homes. The Alzheimer’s Society has been campaigning for a move away from the model of ‘medicate first’, and funded research into alternatives to antipsychotic prescriptions, focused on putting people living with dementia at the centre of their own care. This drug-free, tailored care can help avoid the loss of lives associated with the harmful side effects of antipsychotic medications.”

So a message for Care Home staff and to the Regulators, let’s make an effort to reverse this ASAP, before more people are harmed.

Is #COVID-19 the Only Pandemic? What About #HIV #AIDS?

As the world arguably come to terms with the idea of living with Covid-19 the United Nations released its Global AIDS update for 2022 at the end of July. The new data from @UNAIDS reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are now at risk as a result. 

Every day, 4000 people—including 1100 young people (aged 15 to 24 years)—become infected with HIV. If current trends continue, 1.2 million people will be newly infected with HIV in 2025—three times more than the 2025 target of just 370 000 new infections. In 2021, 650 000 people died of AIDS-related causes—one every minute, AIDS-related deaths remain a leading cause of death in many countries. Yet, these are preventable deaths with the right treatment.

The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026, crowding out health and human capital investments that are essential to help them end AIDS. As always it is the most vulnerable and marginalized that are being hit the hardest. 

A look at the Global HIV and Aids factsheet that accompanies the report which you can access HERE makes for concerning reading for a disease which the UN hoped could be eliminated by 2030.

The report suggests some key actions to get the World back on track suggesting that we:

• Make a new push for HIV prevention.
• Realize human rights and gender equality.
• Support and effectively resource community-led responses.
• Ensure sufficient and sustainable financing.
• Address inequalities in HIV prevention, testing and treatment access and outcomes and close the gaps that exist in specific localities and for certain key societal groups

You can get more information and read the full report at

https://indanger.unaids.org/

Mourning the loss of @SallyGreengross

Last month on the 23rd June 2022 one of the real heroes of older peoples’ care and rights, Baroness Sally Greencross died. Sadly I never met her, but she has been one of the most influential figures in redefining how societies across the world have responded to the changes resulting from our ageing world. Her passionate commitment to human rights and equality inspired all she met and underlined everything she achieved.

From 1987 to 2000 she served as the Director General of Age Concern (now AgeUK) and helped transform it by developing its links with the British Geriatrics Society (BGS) from whom she received a lifetime achievement award. During this time she also set up the International Longevity Centre-UK as part of the ILC Global Alliance.  As ILC’s Chief Executive and member of the House of Lords, she continued to work tirelessly to support government, business and the third sector to adapt positively to demographic change.

There are few people who have championed the rights and protections needed for older people as passionately and committedly as Baroness Sally Greengross.

Sally was also the founder and patron of the charity Action Against Elder Abuse now called Hourglass the UK’s only charity focused on the abuse and neglect of older people, which staff a  free-to-call helpline. She was an unconditional advocate for the victims of elder abuse. My thoughts go out to her family, friends and everyone fortunate to have known her or who have been affected by her sterling work in this area.  

Hourglasses tribute to her, the link is below, underlines the extent of her loss to all working at combatting ageism and elder abuse in the UK and worldwide.

https://wearehourglass.org/baroness-sally-greengross-hourglass-guiding-light-and-champion-fighting-elder-abuse

She was campaigning right up until the end. This is from the 15 June which was World Elder Abuse Awareness Day #WEAAD2022

https://wearehourglass.org/hourglass-launches-myth-busting-campaign-world-elder-abuse-awareness-day-2022

The Growing Issue of Elder Abuse

Last month on the 15th of June it was World Elder Abuse Awareness day #WEAAD2022. This day marking elder abuse was launched at the United Nations by the World Health Organization and the International Network for the Prevention of Elder Abuse. It aims to draw attention to the impact of elder abuse, how the abuse is perpetuated and what can be done to combat it.

According to World Health Organization (WHO), nearly 1 in 6 people over the age of 60 suffer from abuse; meaning nearly 141 million people globally are affected. With a growing global population of older people, and as longevity increases, abuse of older people is an increasing and serious problem that affects health and human rights and can cause death, so it is vital to raise awareness of it and thus prevent it whenever and wherever possible.

Elder abuse is global and comes in many forms including physical, emotional, sexual and financial abuse and also neglect. Older adults are particularly vulnerable to abuse and to being unable to defend themselves and get help as fear and infirmity can be major barriers to seeking and getting help, and sometimes spotting and challenging abuse in older people isn’t easy, some are isolated having outlived family and friends, and some are abused in institutions where abuse is not spotted or is covered up, and in some cases older people are not given priority by authorities in abuse matters.

It is also an important an uncomfortable truth that while famine was and natural disasters do not discriminate, the international response does. Time and again, the toll amongst older people of was and disasters on older people is overlooked as they struggle to survive and piece together their lives. So often they are left behind exhausted and traumatised by this form of societal neglect and abuse. See this report about the war in Yemen for example. I could easily have posted more about Afghanistan and the Ukraine.

This year #WEEAAD2022 coincided with two important events. The commencement of the United Nations Decade of Healthy Ageing. It marks the beginning of ten years of  sustained collaboration with diverse stakeholders on helping older people, their families and communities. The second event highlights the 20th milestone of the Second World Assembly on Ageing. It also includes the fourth review and appraisal of the implementation of the Madrid International Plan of Action on Ageing (MIPAA). These events will provide a chance to generate renewed momentum for action to advance the ageing agenda and hopefully turn some attention on the need to tackle worldwide elder abuse and discrimination against older people in all its forms.

For more information about #WEAAD2022 click on the link below.

https://www.un.org/development/desa/ageing/news/2022/05/weaad-2022/

#ThatLonelyFeeling ; Loneliness AwarenessWeek 2022

This week Loneliness Awareness Week in the UK fell between June 13th to June 17th. This is an annual campaign which raises awareness of loneliness and tries to get people talking about the issues it raises. I am a big fan of the work done by the Campaign to End Loneliness whose work I have featured on this Blog a number of times. However I failed to notice that the Charity behind Loneliness Awareness Week is actually the Marmalade Trust.

Marmalade Trust is the UK’s leading loneliness charity for all ages and the only charity in the world specifically dedicated to raising awareness of loneliness. They launched Loneliness Awareness Week (LAW) in 2017, and each year, it grows in momentum. The Trust’s aim is simple: to reduce the stigma of loneliness and encourage people to talk more openly about it.

Whilst more is being published on loneliness and its impact a stigma remains with it that it ‘this doesn’t apply to me’. I’m not lonely. However by identifying and acknowledging all the times that we have personally felt and experienced loneliness, we can start to accept it and understand how to take action to manage our feeling and work on our our social connections to improve and maintain our mental health. 

The Marmalade Trust have released a wealth of great new content to mark this year’s Loneliness Awareness Week. I would suggest that you go and check it out at their website https://www.marmaladetrust.org/ or follow the on Twitter @marmaldetrust

I was particularly drawn to one of their new resources which is a practical guide to some of the challenges of loneliness which are particular to men, the barriers men face and how to address feelings of loneliness. It was created by UK Council for Psychotherapy accredited psychotherapists Stephen Westcott, John-Paul Davies and Noel Bell explain. You can find this at: https://www.marmaladetrust.org/men-and-loneliness

This is one of their videos which is an interesting watch

https://youtu.be/e0xJgG0scB0

Make Caring Visible, Valued and Supported. #CarersWeek2022

Research released for UK’s Carers Week 2022 (6-12 June) has found that 84% of the general public think that the UK governments should provide additional support to unpaid carers including increased financial support and investment in care and support services so that unpaid carers can have a break. Only 3% disagreed. (I’d quite like to know who they were and what they were thinking?)

The report, which you can access here also shows that the number of unpaid carers remains higher than before the pandemic with 1 in 5 of all UK’s adults (approximately 10.58 million people) now supporting a relative, close friend or neighbour because of chronic illness, including mental ill-health, dementia, disability, or difficulties posed by aging  

The intensity of care they are providing has grown since earlier in the COVID-19 pandemic, with several factors possibly having an impact. These include, many health and social care services still operating in a reduced manner or closed and therefore no longer available. Many vulnerable people continuing to shield from the threat of COVID-19 and the vagaries of Long COVID and the pressures on primary health care and the UK’s ongoing chronic shortage of social care provision. The numbers of people providing over 50 hours per week as a consequence has risen by 30%!

At the same time, carers with lower household incomes were much more likely to be providing significant amounts of care (i.e., over 20 hours per week) with 2.2 million carers worried about their ability to cope financially.

The value of their care is staggering and has been estimated at £530 million per day during the pandemic, or the equivalent of £193 billion a year. There is no doubt that without them the whole health and social care service in Britain would collapse.

A big thank you this carers week and always to all informal carers out there. Currently I am not of you after many years of being a carer. For all of you I am posting this link to the Age-UK Help and Support for Carers Page so that you can try and source all the help that you need. For everyone else lets get behind the key recommendations of this report.

• Given the negative impact of the pandemic on carers and the people they care for, the governments in Wales, Scotland, Northern Ireland and the UK should bring forward a 12-month Recovery and Respite Plan to support carers, with
• Protect carers physical health with specific and targeted investment, including
• £1.5 billion for carers’ breaks in England with similar investment in Wales, Scotland and Northern Ireland.
• Improve and sustain carers mental health with specific and targeted investment in carer-focused wellbeing support.
• Planning before winter to ensure that targeted packages of support are in place for carers including practical support and in any infection control measures required make carers a priority.
• Put in place active measures to support their ability to juggle work and care, including making a right to Carer’s Leave a legislative priority.
• Protect carers from the cost of living crisis, helping them with energy costs and the ability to pay bills by introducing or increasing carer payments, including to those on the lowest incomes to ensure hat they are able to manage financially.
• Introduce Measures to increase the identification of carers and public awareness of the issues faced
• Embed transparent, measurable and long-lasting commitments to better value and invest in care, and carers, within relevant performance frameworks to drive transformative policy and spending action.

Its a big list but remember at some point in your life you are either going to be a carer or you are going be dependent on informal carers (usually your family friends). After all every year in the UK around 2.3 million people start
caring for the first time and are potentially new to a caring role.

  

#DementiaAwareness 2022 Alzheimer’s Disease has more impact on Women than Men

Last Month Alzheimer Research UK reported not only that Alzheimer’s Disease remained the leading cause of death in UK women but that nearly twice as many women as men – 46,000 compared with 24,000 – died from dementia in 2020. The female-male gap in the incidence of dementia is even higher, with women accounting for two-thirds (65%) of those affected. They noted also that women’s longer life expectancy on its own does not account for this.

The report called simply the ‘Impact of Dementia on Women’ can be downloaded HERE

Other facts the report reveals include:

• Dementia has been the leading cause of death for women in the UK since 2011 and remained at this position even during 2020 at the height of the COVID-19 pandemic
• Between 60% and 70% of people caring for loved ones with dementia are women
• The UK has the largest gender health gap of the G20 countries in terms of women receiving worse healthcare than men
• Women are less likely than men to be included in clinical trials, despite being more likely to experience drug reactions

The charity’s recommendations in the light of the new analysis includes recommendations that

• The Westminster Government’s forthcoming standalone Dementia Strategy for England should target brain health to help more people reduce their risk of dementia, with an emphasis on risk factors that particularly impact women
• Delivering on the Dementia Moonshot commitment to include research to better understand why dementia is more prevalent in women than men
• Research results should specify data from women and include sex-based analysis
• Research funders and drug regulators should develop clear plans to ensure women can contribute fully to dementia research, both as participants and as researchers

“It’s shocking to see that, despite dementia becoming the leading cause of death for UK women more than a decade ago, this situation remains unchanged today. Dementia is devastating for every person it affects, but this report shows that its impact is hitting women particularly hard.”

Hilary Evans, Chief Executive of Alzheimer’s Research UK

Despite its importance Dementia research and treatment falls well behind other major disease areas, such as cancer and HIV. If the Conservative Government’s Moonshot pledge were kept, Government funding would double to a total around £1.6 billion over the next decade. Of the top ten causes of death dementia is the the only one that can’t be cured, stopped or even slowed down. By 2040, it is estimated that dementia will cost the UK economy £94.1 billion. 

#MentalHealthAwarenessWeek 2022 #TackleLoneliness

Today marks the start of Mental Health Awareness Week and this year the aim is to raise awareness of the impact of loneliness on our mental health and the practical steps we can take to address it.  

To mark Mental Health Awareness week the Mental Health Foundation (MHF) have released a new report called “All the Lonely People” which explores the issues that loneliness impacts in relation to mental health. It Looks at why it matters why it matters, who experiences loneliness and what it feels like. The report also investigates how well people understand loneliness and suggests ways that we can respond as individuals and across society to tackle loneliness.

The report is available in 2 versions. A UK version and a Scotland Report with a policy brief attached. You can access the UK version of the report at: https://www.mentalhealth.org.uk/campaigns/Mental-health-awareness-week/loneliness-and-mental-health-report-UK

For the Scottish Version go to: https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week/loneliness-research-policy-recommendations-scotland

If you go to the MHF campaigns page. The link is below, yo can also access a Student Guide to Loneliness and Loneliness in Later Life Toolkit

 This Mental Health Awareness Week the MHF are also on a mission to let everyone living in loneliness know that their mental health matters and are asking people to share their experience of loneliness on social media to use and follow the hashtag #IveBeenThere, they are also asking people to use the #MentalHealthAwarenessWeek

Looking for other great resources on tackling loneliness go to the Campaign to End Loneliness Home page at https://www.campaigntoendloneliness.org/

Worrying @WHO Report on the Obesity Epidemic Released

Overweight and obesity have reached “epidemic proportions” and cause an estimated 1.2 million deaths every year in Europe alone.

The WHO European Regional Obesity Report 2022 released this week has found that excess body fat not only leads to premature death but is also a leading risk factor for disability and causes around 200,000 cancer cases every year. For some countries within the region, it is predicted that obesity will overtake smoking as the main risk factor for preventable cancers.

In the first such study for 15 years, the WHO said overweight and obesity rates had hit deadly levels and were still rising. Across Europe, 59% of adults are overweight or obese as well as 8% of children under five and one in three children of school age. Obesity prevalence in Europe is higher than in any other part of the world except the Americas. Of all the countries in the Europe region, the UK ranks fourth for having the most overweight and obese adults, behind Israel, Malta and Turkey.

The COVID-19 pandemic has made things worse, including for children, due to drops in exercise and increases in the consumption of foods high in fat, sugar, and salt. These unfavourable shifts in food consumption and physical activity patterns that will have lasting effects on people’s health for many years and will need significant effort to reverse. The report has also stated that “obesity is a disease – not just a risk factor” and its causes are more complex than just an unhealthy diet and physical inactivity. It said that “…environmental factors unique to living in modern Europe’s highly digitalised societies are also drivers of obesity”, such as the digital marketing of unhealthy food products to children, apps to order unhealthy meals, and the proliferation of sedentary online gaming.

The report has called for high-level political commitment to tackling obesity, alongside measures such as sugar taxes on sugary drinks and subsidies on healthy food. Marketing of unhealthy food to children must end. Other measures include limiting the proliferation of takeaway outlets in low-income neighbourhoods and combining food voucher schemes with behavioural interventions during pregnancy to optimise the diet of vulnerable people during pregnancy. Baby food must also be properly labelled, breast-feeding recommended, and nutritional food standards in settings such as nurseries put into law.

It is only by creating environments that are more enabling, promoting investment and innovation in health, and developing strong and resilient health systems, we can change the trajectory of obesity across the region

Dr Hans Kluge, the WHO Regional Director for Europe.

UK’s Osteoporosis Guidelines Newly Updated

Osteoporosis affects approximately 5.2% of the UK population overall, rising from approximately 2% at age 50 to almost 50% at age 80, and causing 180,000 new fragility fractures annually. These fractures are a major cause of disability and loss of independence in older adults, and place an enormous burden on the healthcare system. So the new comprehensive national recommendations for the prevention and treatment of osteoporosis produced earlier this month by the UK National Osteoporosis Guideline Group (NOGG) is most welcome.

The updated guideline reviewed the assessment and diagnosis of osteoporosis, therapeutic interventions available, and the approaches that can be used to prevent fragility fractures, applicable both to postmenopausal women and to men aged 50 or older.

The new guideline received accreditation from the National Institute of Health and Care Excellence (NICE) and represents a major revision of the 2017 guidelines. The guideline has been reviewed and supported by 18 professional and patient organisations in the field, including the Royal Osteoporosis Society.

To produce their recommendations, the multi-centre NOGG team, led by researchers from the University of Bristol, conducted a literature review to provide the evidence base behind the new guidelines which you can access HERE

The updated guideline is accompanied by downloadable information for patients and the public which you can access HERE. The guidance also includes recommendations for fracture liaison services, training of clinicians and allied health professionals, service commissioning, and criteria for audit and quality improvement in service provision. So it is fairly comprehensive and worth looking at, if you are dealing with any older people prone to falls and fractures, or whom you know have osteoporosis.