#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.

Covid-19 and Health and Social Care Workers

The Westminster government in England and as a consequence the other jurisdictions of the UK are now pursuing policies that require the population to effectively get used to living with COVID-19. The Secretary of State for Health and Social Care Sajid Javid is on the record as saying that the UK is leading the way in learning to live with the virus “…thus enabling the country to begin to manage the virus like other respiratory infections.” So is Coronavirus like other respiratory Infections? Well, we know it is not, just by looking at the impact that the virus has had on health and social care workers.

The WHO in September 2021 estimated that between 80 000 to 180 000 health and care workers could have died from COVID-19 in the period between January 2020 to May 2021, converging to a medium scenario of 115 500 deaths. This estimate is derived from the 3.45 million COVID-19 related deaths reported to WHO as of May 2021; a number considered to be much lower than the real death toll (which could be 60% or more than this estimate). See the John Hopkins Coronavirus Resource Center figures.

In March 2021, Steve Cockburn, Head of Economic and Social Justice at Amnesty International stated that “For one health worker to die from COVID-19 every 30 minutes is both a tragedy and an injustice. Health workers all over the world have put their lives on the line to try and keep people safe from COVID-19, yet far too many have been left unprotected and paid the ultimate price,”

Unsafe working conditions and a lack of personal protective equipment (PPE) have caused huge problems for health workers worldwide throughout the pandemic, especially in the early phases. Some groups were particularly neglected cleaners, auxiliary staff and social care workers even faced reprisals including dismissal and arrest after demanding PPE and safe working conditions in some countries. In a significant number of countries, the neglect of care workers has been a consistent feature of the pandemic. At least 1,576 nursing home staff have so far died from COVID-19 in the USA. In the UK, 494 social care workers died in 2020, and UK government data shows that those working in nursing homes and community care were more than three times as likely to have died from COVID-19 as the general working population. 

Death though is only one outcome. What about Long Covid? There have been many reports from healthcare professionals experiencing mild symptoms during their initial infection with COVID-19 and thereafter a prolonged course of symptoms of fatigue, dyspnoea, joint pain, and chest pain, many of which are characteristic of autoimmune mediated responses. How many healthcare workers are we talking about though who may have Long Covid?

In September 2021 the ONS estimated that the percentage of healthcare workers living in private households with self-reported long COVID of any duration by sex and age group in the UK, for the 4 week period ending 5 September 2021 was as follows

Amongst men it was 2.28% in women it was 3.36% rising to a worrying 4.01% in women over 50.

Their estimates relate to self-reported Long Covid, as experienced by study participants in the ONS Coronavirus infection Survey. Although they were not clinically diagnosed as having Long Covid they were asked to respond to the following questions: “Would you describe yourself as having ‘long COVID’, that is, you are still experiencing symptoms more than 4 weeks after you first had COVID-19, that are not explained by something else?” and, if so: “Does this reduce your ability to carry-out day-to-day activities compared with the time before you had COVID-19?” and “Have you had any of the following symptoms as part of your experience of long COVID? Please include any pre-existing symptoms which long COVID has made worse.” So it is fairly certain that they were experiencing Long Covid at the time.

Again you have to consider this an underestimate, as health professionals have been overwhelmed with the surge in workload posed by the rise in cases and growing demand on the health systems that have limited capacity. Symptoms of chronic fatigue, joint pains and dyspnoea could easily be attributed to the additional workload, or accompanying work related stress. Healthcare workers are likely to be silently suffering while experiencing Long Covid, even while continuing to save lives during this ongoing pandemic. So let’s just say that we are losing around 4% of the health and social care workforce worldwide for some considerable periods, as a consequence of Long Covid. One product of this is that if we are to protect the health and social care workforce, research into the role of repeated exposure in a healthcare delivery setting and/or in the community to COVID-19 needs urgent evaluation. While we know vaccinations are saving lives, we have very little knowledge of the protection they offer to Long Covid should you get infected or re-infected as is occurring now.

There are also the other consequences that are concerning all healthcare organisations currently, as an increasing proportion of the workforce are suffering from burnout, stress, anxiety and fatigue.

So back to my original question. Should we be managing this virus like other respiratory infections. Well clearly not… because if we do the outcome will be more health and social care staff dying and developing Long Covid etc. and they are in short supply worldwide as it is. In October 2021 the WHO and its partners began calling on all Member State governments and stakeholders to strengthen the monitoring and reporting of COVID-19 infections, ill-health and deaths among health and care workers. They should also include disaggregation by age, gender and occupation as a standard procedure, to enable decision makers and scientists to identify and implement mitigation measures that will further reduce the risk of infections and ill-health. As a society we have a moral obligation to protect all of our health and care workers, ensure their rights and provide them with decent work in a safe and enabling practice environment and that includes not exposing them to further risk because of our and our respective governments’ complacency.

Restraint, Segregation and Seclusion

Its very disappointing that I find myself writing about this is 2022 but the report released today (25 March 2022) by the Care Quality Commission the regulator for health and social care in England is sombre reading. In 2018 the Department of Health and Social Care commissioned the CQC to review the use of restrictive practices in services for people with a learning disability, autistic people, and people with mental ill health. See Out of Sight – Who Cares?

To get a flavour of the distressing findings from this report you can watch this.

Progress on meeting the recommendations made by CQC in its review has been limited with only four of the seventeen recommendations made in the 2020 report being partially met and thirteen not met. For details of the report and to download it GO HERE

The progress report highlights that although there are still too many people with a learning disability in hospital, this has nearly halved since March 2015. However, the number of autistic people has increased considerably over the same period.

Not enough progress has been made in reducing the use of restraint and challenges persist in the system which are preventing people from accessing early intervention and crisis support in the community. This can be particularly difficult for autistic people.

The report also highlights persistent challenges with the commissioning of services. Currently people are fitted into services that are available, rather than providing support tailored to the individual’s needs. Commissioners are often not working in partnership with people, their families and between different organisations when delivering services.

The CQC’s progress report also found:

• Although Independent Care (Education) and Treatment Reviews took place, they have not resulted in real changes to people’s lives as they are still unable to leave segregation and be discharged from hospital.
• There are more people known to be in long-term segregation now than when the CQC review was commissioned in 2018.
• All people with a learning disability and autistic people who are admitted or who are at risk of admission to a mental health inpatient service should have a Care Education and Treatment Review. However, recommendations made in Care (Education) and Treatment Reviews are often not being progressed by providers and commissioners.

Jemima Burnage, CQC Deputy Chief Inspector of Hospitals and Lead for Mental Health, said:

“Almost 18 months have passed since we recommended what must change to improve the care and support received by people with a learning disability, autistic people, and people with mental ill health. Some investment has been made into projects supporting people to come out of long-term segregation, and funding has been allocated to increase community support. However, for real impact to be felt progress must be accelerated.”

All I can say is that this is a huge understatement. It is just not good enough that we still disregard vulnerable people’s human rights like this, in what is supposedly the 5th largest economy in the world

Tackling Ageism: The Power of Words

Age Scotland, the national charity for older people, has published a guide outlining good practice on reporting on older people and tips to avoid ageist attitudes. Their guide is aimed at helping the media, politicians and their stakeholders to improve the language that they use when they talk about older people, encouraging them to avoid ageist and negative stereotypes in the messages and images they use. The guide has been endorsed by the National Union of Journalists (NUJ) for Scotland and can be downloaded from this site.

Ageist attitudes are rife in the workplace, in health and social care and in the media. Age Scotland’s Big Survey 2021 provided a voice for older people across Scotland and revealed that just 7% agreed that older people are represented positively in the media. Within tis report a third of respondents felt that older people were made to feel a burden to society and that life is getting worse for older people in Scotland and only 9% of respondents reported that they felt very positive about the future and only one in five believed that older people were valued for their contribution to society.

Age Scotland are not alone in trying to change the language used in the media around older people. In 2018 the Alzheimer’s Society also published their Dementia-friendly media and broadcast guide: A guide to representing dementia in the arts, culture and popular discourse in response to similar issues about media portrayals of dementia. As they have said dementia is the greatest health and social care challenge facing society now and into the future. The growing movement for change has seen public interest and the appetite for stories about dementia increase dramatically. While we have seen a number of sensitive portrayals of dementia there are sections of the media that continue to trivialise and sensationalise this condition. This discourse has a huge impact, both positively and negatively, on different groups and individuals and it is essential that we take responsibility for the words we choose when reporting about dementia (and older people) to ensure accuracy and fair representation.

Remember that the pen (and the language that we choose to use) is mightier than the sword.

@GeriSoc Improving Healthcare in UK Care Homes 2021

Another Month has passed since my last post 😦 . So what brought me back this time. This week the British Geriatrics Society published a new report aimed at improving the quality of healthcare for care home residents. As they state, the COVID-19 pandemic has had a devastating impact on older people, with 35.6% of the 130,000 UK deaths ( and more, who knows the real figure) occurring in people living in care homes. Many others suffered from worsening physical, mental and emotional health as a result of lockdowns and visiting restrictions. Their new report sets out how care home staff and visiting healthcare professionals can work together to ensure high-quality healthcare is delivered to the 400,000 older people who live in care homes.

The report which you can access and download HERE is called “Ambitions for Change: Improving Healthcare in Care Homes. It notes that the COVID-19 pandemic created extraordinary challenges for care homes, and argues that government, commissioners, care home providers and other stakeholders must now ensure that the structures, support and skills are consistently in place to ensure care home residents have access to the same standard of healthcare as everyone else in the UK. It advocates for treatment on site whenever possible, to avoid the potential harms of hospitalisation. It also recommends the systematic use of Comprehensive Geriatric Assessment to ensure personalised individual care is planned and delivered. It also points out that person-centred, compassionate care is paramount because many care home residents from admission to a home are already frail and in the last two years of their life.

If you don’t do anything else read their 11 recommendations which you can view at: https://www.bgs.org.uk/resources/ambitions-for-change-improving-healthcare-in-care-homes

The Burden of Healthcare Associated Infections in #Scotland

Well, a month since my last post. So apologies as I am not contributing as I am supposed to be. Let’s hope I am a bit more consistent from now on as we head towards a new academic year. So what’s made me come back to the Blog?

This month an article appeared quite quietly in the Journal of Hospital Infection which is the official journal of the Healthcare Infection Society. Not one of my usual sources for this blog. They have reported a study carried out by Glasgow Caledonian University on behalf of the Scottish Government that is the first comprehensive study in Scotland which shows the the full impact of Hospital Acquired Infections (HAI’s) on patients and the cost to the NHS.

Understanding how widespread HAI’s are prevention and control measures can be be targeted to those people who would benefit the most. Perhaps not surprisingly that will be the old and the frail.

The study has found that 1.1% of Scottish patients (or 11 in every 1,000) develop infections in hospital. This compares with estimates in the rest of the UK of 7.8% and around 3% in Europe. The most common infection type is urinary tract infection (UTI) followed by septicaemia, lower respiratory tract infection, gastrointestinal infection, surgical site infection and pneumonia. Most of the infections are caused by E.Coli, Norovirus and S. Aureaus. The most likely place to pick up an HAI is in intensive care.

There are many reasons why a person can develop an HAI but being ill or receiving treatment in hospital may mean that your immune system is compromised and people as a result are more prone to infection.

So none of this is unknown except the very low rate in Scotland, so why is this study so important that I thought I should blog about it? This is the most comprehensive study of incidence and and impact of of HAI’s done in the UK in the last 20 years and the first of its kind to focus on the healthcare system in Scotland. More studies like this are required to ensure that whole systems are learning from best practice across all Westernised healthcare systems. Whatever Scotland is doing other countries need to learn from and, of course, 11 in 1000 is a number that perhaps could be reduced further !

To see the complete study go to Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK available at:

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00190-0/fulltext

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00190-0/fulltext

and Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland and

https://www.journalofhospitalinfection.com/article/S0195-6701(21)00189-4/fulltext

Deconditioning Increasing in Lockdown? Try the LifeCurve App!

According to a new survey by Age Scotland released this week, older people are in danger of losing the ability to do daily tasks because of the pandemic. This had led to concerns that the restrictions could have a serious impact on our health over the next few years. Tens of thousands of older people could be experiencing “deconditioning” – declining physical fitness caused by lack of activity and spending long periods of time sitting. This can lead to a loss of muscle strength, balance, flexibility and overall mobility, which can leave people more vulnerable to falls, more likely to become frail and therefore likely to require social care support in the years to come.

According to the survey, two thirds of people over 50 say they are now less active than they were before the pandemic. About half fear that spending so much time at home has led to a loss of strength and mobility. Age Scotland are also reporting that almost half of the 3,000 people who responded to their survey had reduced their social interactions significantly, and 53% of respondents stated that the pandemic had made them feel lonelier.

This survey is in line with an Observatory for Sport in Scotland Survey published on the 6th of June that reported In total, 47 per cent of the adult (18 years plus) population of Scotland (just over two million people) felt that their participation in sport and exercise activity was a lot or a little less over the last 12 months than the equivalent period before Covid-19, with men reporting more of a drop than women. Around 32 per cent reported doing about the same as pre-pandemic and 14 per cent reported doing more activity in the past year. Just over four in 10 people said that they were walking more in their local area during the 12 months of the pandemic compared with the 12 months previously, but his has not compensated for the declines in activity through sport and exercise. To access this report CLICK HERE

Researchers at Strathclyde University who carried out the Age Scotland survey say that after the closure of vital support services during lockdown, it is important that people get back to being physically and socially active as soon as possible, to stop further decline. Older people need to get back to attending groups where they can be physically, mentally, socially active as soon as possible in order to protect both their current and long term health.

One way to combat this deconditioning could be by using an innovative app called LifeCurve, developed by researchers at Strathclyde and Newcastle University, It’s based on research that found that we lose the ability to do things in a particular order as we age. The good news though that the types of loss and speed of loss is not set in stone at a particular age. We can improve our position by staying physically active and keeping up with regular daily tasks. This can slow the ageing process and help us to live a healthy, independent life for longer. People often assume that as they get older it is inevitable that they will stop being able to do the everyday activities that are important to them. This is not the case.

The app aims to provide evidence-based information and advice that can help people have a better ageing journey. 

To find out more about the project from the which the App was developed go to https://stillgoingproject.co.uk/

To download the App go to The Life Curve App

#DementiaAwareness #LetsTalk Good News!

This week is #DementiaAwareness week across Scotland. So I thought I’d post some good news.

The NHS has introduced a revolutionary new app to help diagnose Alzheimer’s Disease that only takes five minutes to complete and is more accurate than established pen-and-paper tests like the Montreal Cognitive Assessment Test. (MoCA).

The test uses artificial intelligence to assess a person’s brain function by showing them large numbers of black and white photographs and asking them to identify which ones contain an animal. It is hoped it will identify people at high-risk of developing the disease up to 15 years before symptoms appear, so that steps can be taken to slow its progression. Animals are used because they elicit strong reactions in people giving a greater insight into brain activity. The test can identify differences in reaction speed and accuracy that become evident long before the memory loss that current tests focus on.

It is hoped it will identify people at high-risk of developing the disease up to 15 years before symptoms appear, so that steps can be taken to slow its progression. It was created by two Cambridge University PhD graduates, through their company, Cognetivity, and has been approved by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA).

You can find out more about the test by watching the video below.

North Staffordshire NHS trust and the Sunderland GP alliance of 35 practices have just started using the app to help monitor and diagnose patients with suspected dementia.

Dr Rebecca Chubb, who is in charge of older people’s services at the North Staffordshire NHS Trust and has just started using the app, said:

“We’re very excited by the potential of the test to drive improvements in how we assess our patients in the dementia pathway. This is a fantastic piece of innovation that could one day be used in clinics up and down the country.”

Even more good news! Very soon, the first drugs that can slow, or even halt, progression of the disease could become available. These drugs would be a gamechanger – especially if cases of dementia were picked up very early, giving the drugs plenty of time to work. The US Food and Drugs Administration is expected to due to rule by June 7th on whether the most advanced of these drugs can be used in clinical practice and it is hoped that the UK and Europe will also allow this shortly afterwards. The drug, known as aducanumab, works by helping to untangle clumps of plaque in the brain and could be the first to slow, or even halt, disease progression. Trials have found that patients given the drug saw improvements in their language skills and ability to keep track of time and place, with a slower loss of memory. The drugs currently used to help those with dementia can only mask symptoms and it is over 20 years since most of these medicines were approved.

This post has been adapted from a report that appeared in the i newspaper on Saturday 29th of May 2021