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?”

 

Advertisements

Is an Effective Dementia Drug Treatment Getting Further Away?

stop medications

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/

A Xmas Mash-up

Music-xmas-tree-300x286

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

MyLifeMyCareHome

 

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/

Contact Sport and Dogs. Why are they in the Headlines?

I’ve still to watch it but it was interesting to see the topic of head injuries in sport being raised this week in the BBC documentary “Alan Shearer: Dementia Football and Me”. Concerns about head knocks in American Football and Rugby have been a subject of quite a lot of research and concerns in the last few years but Soccer/football has been remarkably quiet about exposure to head injury from heading the ball and other head knocks apparently choosing to ignore the topic despite concerns being raised for at least the last 15 years. I was going to direct you to the documentary page but the BBC has a better resource written by their health editor Hugh Pym that includes links to the documentary on a page labelled £1m for football brain injury research Well worth reading because it also contains a link to a study about American Football conducted in Boston that is perhaps more concerning.

Is it time for change, or is their just so much money in these sports that we are happy to risk the futures of our children?

So for every negative their needs to be a positive so here it is!

Swedish Scientist have just published a huge study that suggests that dogs may be beneficial in reducing cardiovascular risk in their owners by providing social support and motivation for physical activity. The benefits are particularly noticeable for people living alone. I don’t really need to encourage a lot of my friends here, but when we talk about Pet Therapy that’s quite an artificial and temporary construct. Maybe we should just be saying “Go out and get yourself a dog!”

What’s Been Happening at NICE?

man-getting-better

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.