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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Digging is Good, Hunger is Bad!

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Congratulations firstly to Sarah Noone @SarahNPhD who had her first article about her PhD work published in the Journal Ageing and Mental Health. Called Digging for Dementia it about the experience of community gardening from the perspectives of people living with dementia. You can see her work by Clicking Here

So after the positives, unfortunately a negative as I’ll add my support to the BGS Call for urgent action on hunger and malnutrition amongst older people. See their Blog Post here.  The UK governments All Party Parliamentary Group (APPG) on Hunger’s Report published this week highlights that malnutrition is most likely to arise among older people following an accumulation of setbacks which leave them unable to access food easily. Like winter detahsits hard to understand how we got to a situation where we put the most vulnerable people in our community at such high risk.

Finally, a warning for all my students the National Institute for Health and Care Excellence (NICE) are currently consulting on updating their guidance for Dementia.The new guidnace will be called  “Dementia – assessment, management and support for people living with dementia and their carers” and is due to be published in June 2018. You can come back and look here nearer the publication time as no doubt It will feature since its so important to what I teach people about.

If you or your organisation want to contribute to the consultation it is at Dementia Consultation

Unfavourable Views of Hospital Care in England are Strongly Linked to Nurse Numbers. Is That a Surprise?

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Now at a time when the Government and all of the national media looks hell-bent on convincing everyone here in the UK that the NHS is broken, rather than being underfunded and under-resourced in terms of staff and beds; there has been very little space given to the published results of the 2010 NHS Survey of Inpatients and a BMJ paper published this month which shows that Patients’ unfavourable views of hospital care in England are strongly linked to insufficient numbers of nurses on duty, rather than uncaring staff, indicates observational research. The paper was published in the online journal BMJ Open so it’s not exactly hidden from journalists politicians etc.

Perhaps pointing out that the number of vacancies in the NHS has soared by 15.8% over the last year, prompting warnings that the service is facing “desperate” problems of understaffing is not what politicians want you to hear. Particularly concerning were the figures for England released in July 2017 by NHS Digital that showed that the number of full-time equivalent posts available rose from 26,424 in March 2016 to 30,613 in March 2017 – the highest number on record.

What this has done is fuel a public view that the NHS is worse than it used to be and that staff are less caring etc. The reality is really very different as any9one working for it knows. Can we please celebrate the success of the NHS at 70 (which happens on the 5th. of July 2018) and stop trying to undermine it. Yes the NHS does need to be reformed, but it would help to see it properly staffed first.

NHSat70

This week I was involved in publishing a Blog for “Ageing Issues” The blogging space for members of the British Society of Gerontology (BSG) where they discuss contemporary issues raised by ageing societies. The blog was about the BSG small event we held here @uwshealth in Hamilton in August. To read more about it see:

https://ageingissues.wordpress.com/2018/01/09/past-present-and-future-supporting-novice-researchers/

Another great find this week. The Joseph Rowntree Foundation this month launched a new Data Information Source that collects together the latest UK poverty data, statistics and analysis from the JRF’s Analysis Unit. This page is a great tool for to finding information about poverty rates and related issues in the United Kingdom and you can access it from here:

UK Poverty Data

 

A Xmas Mash-up

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Firstly a Very Merry Christmas to everyone who reads this that celebrates. If you don’t, hope you are enjoying the winter solstice which is a much older festival and was celebrated more widely (Stonehenge for example is aligned to sunrise on the winter solstice).

So after a few weeks of mainly single topics this week I have decided to be a bit more eclectic!

Firtly, its good to see that Age UK have just launched a new resource which offers practical advice on providing the kind of services in which older lesbian, gay, bisexual or transgender (LGBT) people can feel safe to be themselves. Called the Safe to be me resource guide, it has been written for anyone working or volunteering in health, social care or the voluntary sector who supports older people who are LGBT. It will also prove useful for people involved in training because it encourages them integrate discussions and scenarios relating to the needs of people who are LGBT into what they provide.

Secondly another of these great papers which tells you more about the things you take for granted. This time its about the healing power of music! An easy thing to say and something we are all probably aware of BUT what is music actually doing?

Well this paper from a team based at the University of Helsinki in Finland has a go at answering that question for people with neurological conditions. It is a literature review that looks at music’s potential for aiding the rehabilitation of people with various neurological conditions. Evidence of an impact is greatest for stroke and dementia, but music-based interventions can also help cognition, motor function and emotional well-being in people with Parkinson’s disease, epilepsy and multiple sclerosis. More of their findings can be found HERE

 

Finally and totally unrelated to anything above, I found an open access literature review on appropriate ways to measure lying and standing blood pressure in hospital for frail older adults. So for all of you concerned about older people who fall frequently possibly because of postural hypertension here is a guide to the:

Measurement of lying and standing blood pressure in hospital

Can we have more open access article like this RCNi?

 

Austerity, and 5 Pieces of Advice You Should Listen To

 

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Can’t think of anything sadder than seeing older people in extreme poverty

 

Its Black Friday today so most of you will not be looking at this, you’ll be shopping! Its Black Friday though for other reasons after the budget being announced in the UK and no obvious end to austerity or scrapping the cap on pay rises that virtually all UK healthcare workers are experiencing. While that might seem like more moaning the implications for older people in hospital and requiring social care are discussed very effectively in this peice published by the British Geriatric Society on their Blog. So rather than me picking out something have a look at what Dr Eileen Burns, President of the British Geriatrics Society has said.

https://britishgeriatricssociety.wordpress.com/2017/11/23/the-budget-was-a-missed-opportunity-to-help-frail-older-patients-stranded-in-hospital/#more-4923

So as a counter to all that depressive talk about underfunding and its short and long term impact maybe we need to calm down a little and listen to our seniors.

This is another peice from the TED Blog. Yes TED again! You know I am big fan of the talks TED: Ideas worth spreading    So they also have a blog  and this was their Thanksgiving post; “5 Pieces of Essential Life Advice from Seniors” I bow to their wisdom. This is what they said:

  1. Think of hard times like bad weather — they too will pass.
  2. Draw inspiration from all the people you meet.
  3. Love your work — for the salary and for the people.
  4. Find mentors who can guide you and challenge you.
  5. Make the most of less.

To find out more and watch a TED talk about what we get when we listen to people’s stories CLICK HERE

 

Dying Comfortably

Last month saw the publication of one of those papers that helps confirm something that you always believed you knew. So what did it confirm?

Very old people are more likely to die comfortably if they die in care homes or at home when compared to hospitals. The study carried out by a nursing team at the University of Cambridge found that the oldest old do not always receive effective symptomatic treatment at the end of life. While that is true in most settings up to four times more are likely to die comfortably in a community setting when compared to hospital. So what’s the message? Training for end of life care needs to be improved for all staff, at all levels but perhaps more telling is the need for governments (not just in the UK) to review the funding of long-term care so that more people have the opportunity to die in their home/ care homes than currently so that late admission to hospital is less likely. Not a new message but maybe its time to sit up and take notice. To download the paper go HERE

Sticking with the same topic an End of Life Care resource called “Let’s Talk About Death and Dying” has been produced by Age UK and the Malnutrition Task Force. The materials were produced in a response to a survey showing yet again that conversations about death remain a taboo topic. The new video is below:

 

Oncogeriatrics? My “What’s wrong with the BBC’s Health Tracker” Rant

This week I am going to refer to another Blog piece from the British Geriatrics Society because it’s written by someone working locally in the West of Scotland. Dr. Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015 and her specialty is Oncogeriatrics. Not a term I am either familiar with or like but let’s just go with it. In her blog she discusses the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London. Worth a look even if it’s just to get your hands on the Cancer Services Coming of Age Report from 2012. I may not like the name chosen for what she does but I would support her in her efforts to see Comprehensive Geriatric Assessment used in cancer care as well as other areas where it’s also extremely useful. See this Cochrane Review   about its use.

This week also saw the release by the BBC of their NHS Tracker. The tracker uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

and pulls this data from currently published NHS and Government office data to allow comparisons across the UK, but be warned there are differences between how the targets are measured in each part of the UK. So is this a good thing or a bad thing? My own feelings are neither of these. It’s missing the point completely. Of course, the NHS is missing its targets. Its grossly underfunded, short of staff and very short of staff in key positions, like radiology, gerontology and more…. Do we really need another measure of how bad things may be getting, or should we tackle this! (chronic underfunding when compared with other westernised economies)

 

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From https://epianalysis.wordpress.com/2012/07/18/usversuseurope/