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

Countering ‘Age Apartheid’ to Unite a Divided Society

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A strange piece of augury last week picking a ‘Care home for 4 year-olds’ as my topic. Today a report by the group United for all Ages warns that there is a widening gap between older and younger generations, largely fuelled by the UK housing crisis, which has forced young people to live in cheaper urban areas, while their parents and grandparents live in the suburbs or the countryside. They say that urgent action is needed to create 500 shared sites across the country by 2022 to try and end ‘age apartheid’ in Britain.

Britain is one of the most age-segregated countries in the world, particularly for the oldest and youngest generations and age segregation has been growing in recent decades

Their report called Mixing Matters was published today (5 January 2018). Worth downloading and reading (even the News Release) to get an idea just how divided a society we are becoming.

Shared sites, such as care-home nurseries (as featured on Channel 4); opening up sheltered housing schemes to students in return for volunteering and support; expanding the Homeshare scheme where older people let spare rooms to young people in return for practical support and companionship; Locating reception and year one classes for primary school children in care homes, as demonstrated by shared sites in the USA; and tackling the stigma around ageism and dementia by encouraging school pupils to visit care homes as part of the national curriculum bring young and old together and are practical methods for tackling some of the big social ills facing our country – from poor health and care and loneliness to ageism and division.

What’s not to like about this!

Catch-up on Old People’s Home for 4 Year Olds

Earlier this year Channel 4 in the UK ran a documentary series where pre-schoolers shared their classroom with pensioners from a retirement home in Bristol for six weeks. The two programmes can still be viewed on Catch up at All 4

 

Just before Christmas to highlight the problem of isolation over the holidays as an issue for older people at Christmas a new programme was created in the same format that brought the pensioners and their young friends together again as they prepare for a Christmas concert.

For a bit of life-affirming and interesting television take a look at Old People’s Home for 4-Year-Olds: Christmas

The coldest day of the winter so far with temperatures plunging below minus 13C in Scotland happened this week on the 28th. of December. A good time again to remind everyone to look out for and pop in to see their older neighbours.  Make sure they have enough food are staying warm because you could be saving their lives. Remember,  the estimates are that 80 frail and vulnerable people per day in the UK are at risk of dying as a result of fuel poverty. Interested in finding out more about fuel poverty there is a charity called Energy Action Scotland (EAS) which campaigns for an end to fuel poverty in Scotland and is the only national charity with this sole remit. If you want to know more about what they do Click Here!

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?

 

My Life, My Care Home. An Insight into Life in a Scottish Care Home When You Have Dementia

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Went to an event hosted by the Holyrood Magazine this week which looked at the challenges and progress of the Third National Dementia Strategy here in Scotland the highlight of which was the announcement of the release of this report by the Care Inspectorate. The report follows a year-long focused analysis of 145 care homes for older people by the Care Inspectorate, Scotland’s social care scrutiny and improvement body.

Inspectors noted that although more than half of care homes were now delivering good quality care, more could be done to challenge expectations of what living with dementia means and the quality of care that can be provided.

The report examined the way Scotland’s national standards of care for dementia in Scotland were being met.

The Standards of Care for Dementia in Scotland, which are set by the Scottish Government, were developed to meet three principle aims: help people with dementia and their carers to understand and protect their rights, indicate to care, providers, what is expected of them and improve the quality of dementia care homes.

The inspection focus found that more than a third of people living with dementia (35%) had no access to independent advocacy to help them express their needs and expectations.

It also found that while 55% of care homes had provision for ongoing organised activities every day of the week, 10% of care homes did not provide any opportunities for people to keep active and engaged.

So lots of progress, but more still needs to be done. To download and view the full report click here

If you want to know more about what the care Inspectorate do and more about their campaigns they have there own YouTube Channel click here to view 

Looking After Your Musculoskeletal Health

This week in Public Health England’s Health Matters Blog they have chosen to focus on older people’s Musculoskeletal (MSK) Health. A good time of year to focus on this as today the outside temperature across most of Scotland today fell to -2 degrees Celsius. So its a high risk of falls day (and a put on your big coat day as we’d say here)

The Public Health Blog focusses on the burden of the three groups of MSK conditions:

  • Inflammatory conditions such as rheumatoid arthritis
  • Conditions of musculoskeletal pain such as osteoarthritis and back pain
  • Osteoporosis and fragility fractures such as fracture after fall

As well as age, the prevalence of MSK conditions is being fuelled by rising levels of physical inactivity and obesity, and poor health habits such as smoking. MSK conditions are a substantial problem for individuals and the NHS. The blog looks at how local authorities, commissioners, healthcare professionals, and the private and voluntary sectors can all contribute towards promoting productive healthy ageing and preventing the onset of MSK conditions. It includes a set of infographics and slides to support local commissioning and service delivery, as well as best practice case studies, so why not have a look and make use of them.  See

https://publichealthmatters.blog.gov.uk/2017/12/06/health-matters-productive-healthy-ageing-and-musculoskeletal-health/