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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Is an Effective Dementia Drug Treatment Getting Further Away?

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Sad to hear this week that Pfizer, the worlds largest research-based pharmaceutical company, so they say, are halting the development of any new drugs designed to tackle Alzheimer’s and Parkinson’s disease, with the loss of 300 jobs from their centres in Cambridge, UK; Andover, Mass., and Groton, Conn. Despite heavily funding research efforts into potential treatments in the past, Pfizer has faced high-profile disappointment in recent years from a number of different drug trials. This is a huge blow in the search for an effective drug to halt or slow both diseases just as some huge leaps are being made in other areas of diagnosis and treatment.

Any successful drug in this area would be seen by many in the pharmaceutical industry and others as having a multi-billion pound (dollar) sales potential and ongoing trials are a crucial beacon of hope for many people living with dementia and their families, so recovering from this may take a long while. Maybe we should not be leaving these decisions to private companies, perhaps its time to look at a different model for funding drug research that would make medicines more accessible to all. The World Economic Forum looked at this back in 2015 and this article, Can Megafunds Boost Drug Research?, certainly makes interesting reading now as we struggle to find new antibiotics, as well as new neurological enhancing drugs to tackle one of the World’s most costly disease processes. I’d be interested to hear what other people think.

Totally different topic and this is via the BGS Blog. This week they have published a collection of 8 articles from the last 10 years that demonstrate the way in which the application of qualitative research methods within the social science disciplines of sociology, anthropology and social psychology can enrich understanding of ageing and illness. Does sound like the greatest set of reading ever, but I am sure that if you look there will be something to love on the list!

See https://britishgeriatricssociety.wordpress.com/2018/01/18/qualitative-research-in-age-and-ageing/

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!

What’s Been Happening at NICE?

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This is probably the longest gap in posts since I started this weekly Blog so for regular followers my apologies for missing last week completely. I was unwell last week and didn’t feel well enough to post, which was followed by a very busy week when I just ended up each night too tired to write.

Hopefully, normal service is now resumed and I might even try and do an extra post this week.  So the question now that I am back, has to be why am I drawing your attention to the National Institute of Healthcare Excellence (NICE).

Well as many of my students know I have not been a big fan of what they put on their website until quite recently. I never thought that it was enough to just release Guidance and not really do much to show or explain how it should be used. However, that’s all changing. I am a big fan of their Pathways, very handy if you are trying to work out what ideal care in the UK should look like for particular illnesses and conditions. I am also probably an even bigger fan of their Clinical Knowlege Summaries which are really useful when you are considering what to do in practice. They are almost like checklists for what you should be doing in particular circumstances and incorporate all the appropriate NICE guidance.

Now they are doing it again. They have started producing a series of Quick Guides, developed jointly with the Social Care Institute for Excellence (SCIE) which are based on NICE guidelines and health and social care quality standards (Unfortunately the English ones and not the Scottish ones). There aren’t many yet but it’s really worth keeping an eye on these as the collection grows particularly if you are involved in integrated care, social care or providing care home care.

The most recent one is for intermediate care services, which help people to recover from illness or an accident, to regain independence and to remain in their own homes. This new guide gives people who use the services and their families and carers an overview of:

  • The types of service available
  • The four stages of intermediate care
  • The professionals involved in providing care

A new place to look for well-written evidence-based and useful materials.

 

 

Scotland’s Obesity Issue and What About Mental Health?

This week saw the publication of the Scottish Health Survey for 2016. Possibly the most significant piece of news from this for older people was the following information reported on BBC Scotland’s Health Page Scotland’s health: What we learned

From the report, they have stated that amongst adults men were significantly more likely than women to be overweight including obese (68% compared with 61%). Worryingly it was adults aged 65-74 who were most likely to be obese (36% of all adults this age). The average BMI (Body Mass Index) for both Scottish men and women was 27.7, up from 27.0 in 2003.A BMI of 25 or less is said to be normal and 25 to 30 is overweight.

A BMI of 25 or less is said to be normal and 25 to 30 is overweight.

Obesity was lowest in the 16 to 24 age group (14%) but it doubled to 28% in the 25-35 range. The largest jump between age groups. It would appear that while the message to reduce obesity in Scottish children is getting through to the public the same cannot be said of the message about the need for our older people to avoid obesity and stay active to reduce the likelihood of cardiovascular disease and diabetes. The Scottish Government are planning an ambitious new strategy to improve Scotland’s diet and help address obesity. Let’s hope they include older people in their plans.

For information about staying healthy in old age, this page on the Age Scotland site is useful

Perhaps a missing element from this survey is more detail on the mental health of older people. More will be reported about this but it’s perhaps worth remebering that up to 40% of people over the age of 65 experience mental health problems and about one-fifth of all suicides happen in older people. Last month Alistair Burns, the National Clinical Director for Older People’s Mental Health and Dementia took to social media to announce the launch of “A Practice Primer on Mental Health in Older People” a document which highlights for  primary care health workers in particular GP’s, symptoms often attributed to ‘old age’ but where a mental health diagnosis and follow-up may be more appropriate.

You can read what he said here and find the link to the document he is discussing (if you didn’t click the link above already) In the document he talks about this film that looks at Improving Access to Psychological Therapies. I am with him on this!

 

Dementia Awareness Month Begins

It’s the 1st of September, so as always this is the commencement of World Alzheimer’s Awareness Month.

 

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World Alzheimer’s Month has been observed in September every year since its launch in September 2012. The decision to introduce a full month, to contain the existing World Alzheimer’s Day, which is on the 21st. of September every year was made to enable national and local Alzheimer associations worldwide to extend the reach of their awareness programmes over a longer period. The 21st of September was chosen because it marked the opening of Alzheimer’s Disease International’s (ADI’s) annual conference in Edinburgh on 21 September 1994 which was the organisations 10th anniversary.

 

For more information about this years theme and campaign click here.

It also means that the next World Alzheimers Report will be released. This year the aim is to highlight the importance of early detection and diagnosis of dementia. So look out for it’s publication around the time of World Alzheimer’s Day.

Help Needed! Do you Live in Lanarkshire?

 

 

NHSlanarkshire
NHS Lanarkshire

 

I am helping to stage an event on behalf of the British Society of Gerontology and NHS Lanarkshire next week where it hoped we can bring staff, students and older people together to discuss and identify some local priorities for research in the coming years. If we create a list of priorities then people within the Health Board and at the university can encourage our Master’s students, in particular, to take on projects that look at these priority areas. So a win-win situation for everyone! However, we don’t have enough older people attending and we would really like their help since their priorities are everyone’s priority!

So if you are living in the area covered by the Health Board and are over 60 please come and join us. You will be made most welcome. You only need to come along in the afternoon from about 12:00, if you want to join us for lunch until 3 pm. If you stay afterwards you can find out what a Tovertafel is? For full details of the event click this link. If you can make it let Caroline know at caroline.gibson@uws.ac.uk or call her at 016984441.

Worth noting also this week was the report by Audit Scotland into the use of Self Directed Support. Since 2014 councils have been responsible for implementing Self-directed Support (SDS), which offers people more choices around their support and how it is managed. This is now largely provided by the new local health and social care integration authorities drawn from bothcouncils and the NHS.

The report published this week states that says while many people have benefited from SDS, integration authorities still have a lot to do to enable more people to take it up. Local Councils spend £3.4 billion a year on social care supporting more than 200,000 vulnerable adults and 18,000 children and their families. Assistance ranges from everyday tasks such as dressing and preparing meals to helping individuals live more fulfilling lives at home, at work and in their communities. The report highlights areas of good practice such as giving front line staff powers to spend small amounts that can make a big difference.

On the ground, however, not everyone is getting to choose and control their social care the way they want to and staff need more support to try new approaches. The majority of staff are positive about the principles of SDS but everyone involved faces challenges in offering flexible services, particularly recruiting and retaining social care workers. To access the full report click the link to

Audit Scotland Report