Do We Still Want Docile?

Sorry I went “missing” for a week, nothing unfortunate, just a holiday where I didn’t have the time or reliable access to the internet to sort my post out. I think its quite a while since I went a whole week without posting.

I’m back this week and many thanks to Kate Swaffer for bringing this to my attention. This month saw the release of a Human Rights Report into misuse of anti-psychotic medication in dementia care in USA

The report ‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia, estimates that every week in US nursing facilities, more than 179,000 people, mostly older and living with dementia, are given anti-psychotic drugs without a diagnosis for which their use is approved. Often, nursing facilities use these drugs without obtaining or even seeking informed consent. Using anti-psychotic medications as a “chemical restraint”—for the convenience of staff or to discipline residents— violates US federal regulations (and regulations in most EU countries including the UK) and may amount to cruel, inhuman, or degrading treatment under international human rights law.

Yet another reminder of the dangers of these drugs, a problem very effectively highlighted in UK healthcare on the publication of the Banerjee Report in 2009.

Things have been improving in the UK but it is still an issue worth highlighting and bringing to people’s attention. Particularly bearing in mind that the Department of Health in 2012 said antipsychotic use was still  “resulting in as many as 1,800 unnecessary deaths per year.” despite the improving awareness of the problem. Note that overprescribing of anti-psychotics is not confined to nursing homes. In fact many nursing homes have arrangements in place to minimise all over-prescribing that many healthcare professionals could learn from. See the HALT project in Sydney and this deprescribing anti-psychotics algorithm from Ontario if you want some inspiration for reducing anti-psychotic prescribing for the people living with dementia that you care for.

So I’ll leave you with a final thought,

How could we possibly think that it is a good idea to treat stress, distress and unmet needs using sedation?”

 

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Have You Seen RCP Commentary Before?

RCP Mag

Sorry for failing to post on Friday this week. Went off on Friday night for a week away with the family before the stress that my son sitting his Highers will cause. So what has caught my eye this month? Well, the Royal College of Physicians Commentary Magazine looks at end-of-life care. Palliative consultant Dr Ollie Minton and Prof Albert Weale, chair of the RCP Ethical Issues in Medicine Committee, introduce the features which include amongst other things an honest and emotive account of a death at home, and how more joined-up care could have lessened one family’s distress. Its worth a look just for this contribution but the magazine itself is one of these “gems” that more people should be aware of.  You can access this special issue here Thanks to Professor David Clark of the End of Life Study Group at the University of Glasgow for bringing this to my attention. If you are unaware of the work of this group you should visit their webpage at  https://www.gla.ac.uk/research/az/endoflifestudies/projects/imminence/ The home page of the “Imminence of Death Study” which might just be the most influential care study carried out in Scotland in recent years.

The second thing I’d like to bring to your attention this week, particularly if you do live in Scotland is the ScottsishGovernemnst current consultation on its plans to develop a first national strategy for tackling social isolation and loneliness. Currently labelled  “A Connected Scotland: Tackling social isolation and loneliness and building stronger social connections” If you click on the link the page takes you to where you can download the consultation paper and would encourage to add your views or to try and get your organisation to contribute as effectively reducing social isolation is a public health issue that has a devastating impact on our older population. See https://www.campaigntoendloneliness.org/campaign-end-loneliness-glasgow/

 

Sláinte: Alcohol Consumption and Older People

Well, it was food last week so this week let’s turn our attention to drink.

NHS Scotland this week released a new report, Hospital Admissions, Deaths & Overall Burden of Disease Attributable to Alcohol Consumption in Scotland that indicated that more than 3,700 deaths in Scotland could be directly linked to alcohol consumption. In addition, more than 41,000 people were admitted to hospital as a result of consuming alcohol. These findings overall show that alcohol has a wider impact on health than many people think, supporting the Scottish Government’s case that minimum alcohol pricing. This starts in Scotland in May 2018 and given this state of affairs has to be at least worth trying.

So why is this important to older people? Well, you have to look at alcohol consumption in the UK. In those that drink alcohol (about 83% of the total population) Drinkers aged 65+ years drank more frequently than any other group and were also more likely than any other age group to have drunk alcohol on 5 or more days in the previous week (24% of men and 12% of women) compared to 3% of men and 1% women aged 16 to 24 (Office of National Statistics, 2017). See Drinkaware if you want a more comprehensive view

There is an alarming lack of recognition of the extent of this problem in frontline healthcare staff who remain more likely to associate heavy drinking with the 16-24 age group, perhaps because they are more likely to binge drink, with all the problems that cause rather than older people steadily drinking more.

So it was really good this week to come across a new resource called Vintage Street Not the snappiest or most obvious name, unfortunately, that is purpose-built for people over 50 who are concerned that they are maybe drinking a little too much. It offers a range of online advice that older people, their families, employers may find useful. It also lets you know how to get in touch with the 5 Drinkwise Age Well centres.

Seems appropriate to put these here so you can check yourself out before you visit the site!

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