Identifying and Managing Frailty in Care Homes

People in care homes are the most likely group of people in society to experience Frailty. However the Registered Nurses working in care homes are the least likely to receive any education or training specifically targeting frailty issues. They are though, a crucial component of care delivery to frail older people and are in an excellent position to support frail people who have complex care needs and comorbidities and are at risk of unplanned admissions to secondary care (because that is what they are doing every day).

Identification of frailty is important because aspects of the factors contributing to it may be reversible.

In July an article by Lynn Craig, a Senior Lecturer, Northumbria University and Clinical Development Managerwith North Tyneside Clinical Commissioning Group, published an article

Craig, L., 2019. The role of the registered nurse in supporting frailty in care homes. British Journal of Nursing28(13), pp.833-837.

In the article she explores frailty and the role of the nurse in assessing for frailty particularly in relation to 4 aspects, nutrition status, polypharmacy, exercise and cognitive function; areas which she suggests nurses could target in order to better support reducing the negative health outcomes of frailty.

Usually I’d provide a link to let you see the article for yourself but this time you will need to look for it and download it yourself.

If this has sparked an interest in frailty you should probably look at

Janet’s story: Frailty. which is an NHS RightCare resource that compares a suboptimal care pathway with an ideal pathway. which you will find at https://www.england.nhs.uk/rightcare/products/ltc/ 

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Dementia Stigma is an International Concern

Its the end of September so as always at the end of World Alzheimers Month,  Alzheimer’s Disease International publish a new World Alzheimer’s Report.

The report reveals the results of the largest attitudes to dementia survey ever undertaken, with almost 70,000 people across 155 countries and territories completing the survey. It spans four demographic groups: people living with dementia, carers, healthcare practitioners and the general public. Analysis was carried out by the London School of Economics and Political Science (LSE).

Some of the key findings of the report include:

  • Almost 80% of the general public are concerned about developing dementia at some point and 1 in 4 people think that there is nothing we can do to prevent dementia
  • 35% of carers across the world said that they have hidden the diagnosis of dementia of a family member
  • Over 50% of carers globally say their health has suffered as a result of their caring responsibilities even whilst expressing positive sentiments about their role.

For me the two findings that cause the most concerns were that almost 62% of healthcare providers worldwide think that dementia is part of normal ageing.

Perhaps worse 40% of the general public think doctors and nurses ignore people with dementia and and 33% of people thought that if they had dementia, they would not be listened to by health professionals.

Now those figures are bad, but unbelievably over 50% of healthcare practitioners agreed that their own colleagues ignore people living with dementia.

The report reveals that stigma around dementia still prevents people around the world from seeking the information, advice, support and medical help that could dramatically improve their length and quality of life for what is globally one of the fastest growing causes of death.

“Stigma is the single biggest barrier limiting people around the world from dramatically improving how they live with dementia,” says ADI’s Chief Executive Paola Barbarino.

“The consequences of stigma are therefore incredibly important to understand. At the individual level, stigma can undermine life goals and reduce participation in meaningful life activities as well as lower levels of well-being and quality of life. At the societal level, structural stigma and discrimination can influence levels of funding allocated to care and support.

“…currently, there is very little information about how stigma manifests in relation to people with dementia and how this may vary around the world. This detailed survey and report now give us a baseline of information for dementia-related stigma at a global, regional and national level. We’re hopeful these findings can kick start positive reform and change globally.”

If you want to read more about the report and download a copy go to https://www.alz.co.uk/research/world-report-2019

Older People Are Concerned About Climate Change Too!

Thousands of young people are taking part in school strikes across Scotland and around the world today to demand urgent action on climate change. The protests are the latest in a series of strikes started a year ago by 16-year-old Swedish schoolgirl Greta Thunberg, which have have now spread across 150 countries. Today’s action is the largest so far. Events are planned in all of many of the UK’s major cities, many towns and some islands including Iona and Skye.

What is often forgotten though is that older people are disproportionately affected by climate change.

The relationship is very clear. In cold weather extremes and in heatwaves and in any other kind of extreme weather or natural disaster, its older people that experience the most morbidity and mortality. Essentially older people have fewer resources to deal with disaster and they can’t get out of harm’s way fast enough.

For an example nearly half of the individuals who died during Hurricane Katrina in 2005 were 75 or older. When Hurricane Sandy hit New York in 2012, almost half of those who died were over 65.

A New York Times article, reproduced recently in the Independent called them the “forgotten generation”. Not just because they were forgotten in disasters but also because they were an untapped resource. Baby boomers, because of their huge numbers and voting power have great potential to make a difference to this protest movement.

Age International and Help Age International have been very aware of the problems of older people during disasters and even a quick look at Age Internationals Emergency Aid page (CLICK HERE) and this article by Help Age International (CLICK HERE) will give you a clearer idea of just how disproportionately they are effected.

Rather ironically the best resource that I could find explaining the impact of climate change on older people’s health is from the United States Environmental Protection Agency. Called ‘Climate Change and the Health of Older  Adults’ you can download it here!  

Reducing Type 2 Diabetes Through Weight Loss Alone

This is a bit of a departure for me as I have picked something that’s not necessarily relevant to older people but more relevant I think to the people who might read this Blog. Thanks to UNIVADIS for bringing this to my attention.

We often hear that Type 2 diabetes (T2D) can be avoided by losing weight and altering your diet, See Understand Your Risk but what if you have Type 2 diabetes already!

How much weight reduction is required to achieve T2D remission?

A recent paper published by a team from the University of Cambridge, School of Clinical Medicine, conducted a study that looked at this question and found that achieving weight loss of ≥10% within a few years of getting a T2D diagnosis is strongly associated with remission at 5 years. About a third of people who managed this achieved remission.

Why this matters

  • About 422 million people worldwide have diabetes, a number likely to more than double in the next 20 years. Type 2 accounts for around 90% of all diabetes worldwide. Reports of Type 2 diabetes in children have increased globally (WHO 2019)
  • Previous studies have shown that T2D remission is possible with intensive caloric restriction/lifestyle intervention, but few have addressed less-intensive interventions.

Study design

  • Prospective cohort study of 730 people aged 40-69 years newly diagnosed with T2D

Key results

  • Diabetes remission (HbA1c <48 mmol/mol; 6.5%), without any diabetes medication or bariatric surgery, was achieved in 257 participants (30%).
  • Those achieving remission were more often male, smokers, and with full-time education beyond age 16 years.
  • Compared with no weight change and after adjustments, people who lost ≥10% of body weight in first year after diagnosis were significantly more likely to achieve T2D remission at 5 years (risk ratio, 1.77; P<.01).
  • Remission likelihood was non-significantly increased for 5%-10% weight loss (risk ratio, 1.24; P=.17).
  • In subsequent 1-5 years, ≥10% weight loss was also associated with remission (risk ratio, 2.43; P<.01).
  • No consistent patterns of associations between unit changes in health behaviours (energy intake, physical activity, etc.) and T2D remission.
  • The study was conducted within a primarily white population.
  • Funding was published by Wellcome Trust; Medical Research Council and the UK National Institute for Health Research.

You can access the whole paper via

Dambha-Miller H, Day AJ, Strelitz J, Irving G, Griffin SJ. (2019) Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabetic Medicine. 2019 Sep 3 [Epub ahead of print] at  doi: 10.1111/dme.14122. PMID: 31479535

Happy 30th. Birthday “Nursing Older People”

Thought I’d join the Editor Lisa Berry (@RCNi_Lisa) in wishing her journal Nursing Older People a Happy 30th Birthday since it falls in June. I’ve been a subscriber since 2013, possibly a little longer. Just occasionally my colleagues, students and former students get something published in it. So thanks for being there and spreading the word about some of the great things they do.

Unfortunately you generally need to subscribe or buy it to get to see the articles but just occasionally they make some items freely available and that’s why I am bringing it to your attention this week.

Ahead of the RCN Congress they released a free to access frailty resource that contains an RCNi Learning module called “Reframing frailty as a long-term condition”

Some video case studies on using the Comprehensive Geriatric Assessment (CGA) tool in both acute and community settings and some further advice on managing frailty are included. I think this resources might be due to close soon, so pay a visit and take a look while you still can. It’s at https://rcni.com/features/frailty-resource-collection-84906#.XOP-wrRGOtM.twitter

@LuminateScotland and@MH_Arts Are on Now! Go to Both and be Inspired!

 

I’ve missed a week again 😦  Had to spend some time dealing with a death in my family so my weekly postings seemed a lot less important than usual. However, back to Blogging and at a very good time if you have an interest in the arts.

May 1st saw the launch in Scotland of the Luminate Festival  a month long festival of events celebrating what growing older means to each of us.

Luminate has a wide diversity of events held in a wide variety of venues from care homes to music halls from Ullapool to Kirkudbright. Highlights include “In the Ink Dark” a dance and poem inspired by conversations with people in Glasgow and Dundee and “Come and Sing” a massed Singing event in Aberdeen where the nationwide “Dementia Inclusive Choirs Network” will be launched. Dementia choirs are quite prominent in the news this week after the BBC Programme “Our Dementia Choir” documentary was shown on BBC One last night (Thursday 2nd of May). Available now on the BBC iPlayer HERE (Hankies required).

Not only does Luminate run over the month the Scottish Mental Health Arts Festival also  starts today.. This includes over 300 events across Scotland including film screenings, theatre productions, exhibitions talks and even walks. The events run from May 3rd through to May 26th.  For more details about the events CLICK HERE 

So my message for this month get out and take part in something from both events taking place near you. Be inspired or have your thoughts provoked by some of the fabulous showcase events and exhibitions hosted during this month.

How to…Reduce and Manage Delirium

WDAD2019_-prelim

I missed posting completely last week… first time in a long while. This week though I have to mention Delirium, because March 13th was World Delirium Awareness Day 2019. If you want to know more about this day CLICK HERE 

Delirium or (Sudden onset confusion) can have many different causes. If a person is confused, they may:

  • not be able to think or speak clearly or quickly
  • not know where they are (feel disorientated)
  • struggle to pay attention or remember things
  • see or hear things that aren’t there (hallucinations)

To check if it is delirium, try asking the person their name, their age and today’s date. If they seem unsure or can’t answer you, they probably need medical help immediately. It’s a very common symptom and is one of the most common medical emergencies. In hospitals, the prevalence is around 20% in adult acute general medical patients, and higher in particular groups, 75% of patients in intensive care; 50% of those who have a hip fracture. So it is worth knowing as much as you can about it and how it should be treated. This year’s Delirium Awareness Day; See #WDAD2019 was very significant because the Scottish Intercollegiate Guidelines Network (SIGN) published the first evidence-based guideline on Risk Reduction and management of Delirium. If you are a healthcare worker in any setting then you really need to download and read the Full Guidance and keep the Quick Reference Guide that can download from THIS PAGE handy.

So if you are one of my students then that’s two items you need to remember SIGN 157 and NICE’s NG97