Post #COVID #Antipsychotic Use for Dementia in Care Homes #Dangerous

Recent research led by the University of Exeter and King’s College London, which has still to be published compared pre-pandemic care home prescribing rates for antipsychotic drugs to treat severe dementia in 2016-17 with those in 2021-2.

The pre-COVID-19 data included 971 residents from 69 care homes, and the post-COVID-19 figures involved 747 individuals across 149 care homes taken from baseline data of the “Improving the Wellbeing and Health for People Living with Dementia” (iWHELD) study. Both study participant groups had an average age of about 85 and a similar gender balance of approximately 70% women and 30% men. There were fewer people with severe dementia in the iWHELD cohort compared with the earlier study (6.7% v 23%).

Analysis found that antipsychotic usage was 55% higher post-COVID when compared with pre-COVID (28% v 18%), despite similar rates of neuropsychiatric symptoms. 64% of participating care homes had experienced an outbreak of COVID.

To ensure that the results were not confounded by the lower number of people with severe dementia in the most recent study, the researchers widened the scope to include residents with ‘moderate’ and ‘moderately severe’ dementia. However, the results remained very similar.

Any study that identifies a substantial rise in antipsychotics given to people with dementia in UK is shocking, because of the risk of serious side effects, such as stroke, accelerated decline, and mortality from these medicines that has been known about since the findings of Professor Sube Banerjee’s (2009) Report entitled “The use of antipsychotic medication for people with dementia”. This report highlighted that only one in five patients in the UK derived positive benefits from antipsychotic medication and that approximately 1,800 patients in the UK at that time it was estimated died annually as a result of inappropriate antipsychotic prescribing. Since 2010, significant efforts have ben made to significantly reduce the number of prescriptions for antipsychotic drugs since 2010 with guidance issued to all GPs, pharmacists, and other healthcare professionals on how to provide care that meets the specific needs of each patient. Expert pharmacy teams have also been rolled out across the country to give advice to patients and maximise other treatment options, where appropriate. So it is hugely concerning to see such a significant rise in such a short period. I doubt that the presence of COVID-19 in the population is a suitable justification for this alteration in practice. I would agree with the research team who have said that said prescribing levels should be a “major focus” in the aftermath of the pandemic because of the risk of serious side effects to many current residents.

A further analysis found that care homes that had increased antipsychotic prescribing had significantly higher levels of overall neuropsychiatric symptoms and significantly higher levels of agitation compared with those which had lower prescribing rates. There were also 31% more staff sick days in the higher prescribing homes, more details about their findings can be found at https://alz.confex.com/alz/2022/meetingapp.cgi/Paper/67089

Clive Ballard, Professor of Age-related Diseases the University of Exeter College of Medicine and Health, commented:

“COVID-19 put tremendous pressure on care homes, and the majority of them must be applauded for maintaining relatively low antipsychotic prescribing levels amid incredibly difficult circumstances. However, there were very significant rises in antipsychotic prescribing in one third of care homes and we urgently need to find ways to prioritise support to prevent people with dementia being exposed to significant harms.”

Dr Richard Oakley, Associate Director of Research at the Alzheimer’s Society, said:

“This study shows the shocking and dangerous scale of the use of antipsychotic drugs to treat people with dementia in care homes. The Alzheimer’s Society has been campaigning for a move away from the model of ‘medicate first’, and funded research into alternatives to antipsychotic prescriptions, focused on putting people living with dementia at the centre of their own care. This drug-free, tailored care can help avoid the loss of lives associated with the harmful side effects of antipsychotic medications.”

So a message for Care Home staff and to the Regulators, let’s make an effort to reverse this ASAP, before more people are harmed.

Is #COVID-19 the Only Pandemic? What About #HIV #AIDS?

As the world arguably come to terms with the idea of living with Covid-19 the United Nations released its Global AIDS update for 2022 at the end of July. The new data from @UNAIDS reveals that during the last two years of COVID-19 and other global crises, progress against the HIV pandemic has faltered, resources have shrunk, and millions of lives are now at risk as a result. 

Every day, 4000 people—including 1100 young people (aged 15 to 24 years)—become infected with HIV. If current trends continue, 1.2 million people will be newly infected with HIV in 2025—three times more than the 2025 target of just 370 000 new infections. In 2021, 650 000 people died of AIDS-related causes—one every minute, AIDS-related deaths remain a leading cause of death in many countries. Yet, these are preventable deaths with the right treatment.

The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026, crowding out health and human capital investments that are essential to help them end AIDS. As always it is the most vulnerable and marginalized that are being hit the hardest. 

A look at the Global HIV and Aids factsheet that accompanies the report which you can access HERE makes for concerning reading for a disease which the UN hoped could be eliminated by 2030.

The report suggests some key actions to get the World back on track suggesting that we:

• Make a new push for HIV prevention.
• Realize human rights and gender equality.
• Support and effectively resource community-led responses.
• Ensure sufficient and sustainable financing.
• Address inequalities in HIV prevention, testing and treatment access and outcomes and close the gaps that exist in specific localities and for certain key societal groups

You can get more information and read the full report at

https://indanger.unaids.org/

Worrying @WHO Report on the Obesity Epidemic Released

Overweight and obesity have reached “epidemic proportions” and cause an estimated 1.2 million deaths every year in Europe alone.

The WHO European Regional Obesity Report 2022 released this week has found that excess body fat not only leads to premature death but is also a leading risk factor for disability and causes around 200,000 cancer cases every year. For some countries within the region, it is predicted that obesity will overtake smoking as the main risk factor for preventable cancers.

In the first such study for 15 years, the WHO said overweight and obesity rates had hit deadly levels and were still rising. Across Europe, 59% of adults are overweight or obese as well as 8% of children under five and one in three children of school age. Obesity prevalence in Europe is higher than in any other part of the world except the Americas. Of all the countries in the Europe region, the UK ranks fourth for having the most overweight and obese adults, behind Israel, Malta and Turkey.

The COVID-19 pandemic has made things worse, including for children, due to drops in exercise and increases in the consumption of foods high in fat, sugar, and salt. These unfavourable shifts in food consumption and physical activity patterns that will have lasting effects on people’s health for many years and will need significant effort to reverse. The report has also stated that “obesity is a disease – not just a risk factor” and its causes are more complex than just an unhealthy diet and physical inactivity. It said that “…environmental factors unique to living in modern Europe’s highly digitalised societies are also drivers of obesity”, such as the digital marketing of unhealthy food products to children, apps to order unhealthy meals, and the proliferation of sedentary online gaming.

The report has called for high-level political commitment to tackling obesity, alongside measures such as sugar taxes on sugary drinks and subsidies on healthy food. Marketing of unhealthy food to children must end. Other measures include limiting the proliferation of takeaway outlets in low-income neighbourhoods and combining food voucher schemes with behavioural interventions during pregnancy to optimise the diet of vulnerable people during pregnancy. Baby food must also be properly labelled, breast-feeding recommended, and nutritional food standards in settings such as nurseries put into law.

It is only by creating environments that are more enabling, promoting investment and innovation in health, and developing strong and resilient health systems, we can change the trajectory of obesity across the region

Dr Hans Kluge, the WHO Regional Director for Europe.

UK’s Osteoporosis Guidelines Newly Updated

Osteoporosis affects approximately 5.2% of the UK population overall, rising from approximately 2% at age 50 to almost 50% at age 80, and causing 180,000 new fragility fractures annually. These fractures are a major cause of disability and loss of independence in older adults, and place an enormous burden on the healthcare system. So the new comprehensive national recommendations for the prevention and treatment of osteoporosis produced earlier this month by the UK National Osteoporosis Guideline Group (NOGG) is most welcome.

The updated guideline reviewed the assessment and diagnosis of osteoporosis, therapeutic interventions available, and the approaches that can be used to prevent fragility fractures, applicable both to postmenopausal women and to men aged 50 or older.

The new guideline received accreditation from the National Institute of Health and Care Excellence (NICE) and represents a major revision of the 2017 guidelines. The guideline has been reviewed and supported by 18 professional and patient organisations in the field, including the Royal Osteoporosis Society.

To produce their recommendations, the multi-centre NOGG team, led by researchers from the University of Bristol, conducted a literature review to provide the evidence base behind the new guidelines which you can access HERE

The updated guideline is accompanied by downloadable information for patients and the public which you can access HERE. The guidance also includes recommendations for fracture liaison services, training of clinicians and allied health professionals, service commissioning, and criteria for audit and quality improvement in service provision. So it is fairly comprehensive and worth looking at, if you are dealing with any older people prone to falls and fractures, or whom you know have osteoporosis.

Deconditioning Increasing in Lockdown? Try the LifeCurve App!

According to a new survey by Age Scotland released this week, older people are in danger of losing the ability to do daily tasks because of the pandemic. This had led to concerns that the restrictions could have a serious impact on our health over the next few years. Tens of thousands of older people could be experiencing “deconditioning” – declining physical fitness caused by lack of activity and spending long periods of time sitting. This can lead to a loss of muscle strength, balance, flexibility and overall mobility, which can leave people more vulnerable to falls, more likely to become frail and therefore likely to require social care support in the years to come.

According to the survey, two thirds of people over 50 say they are now less active than they were before the pandemic. About half fear that spending so much time at home has led to a loss of strength and mobility. Age Scotland are also reporting that almost half of the 3,000 people who responded to their survey had reduced their social interactions significantly, and 53% of respondents stated that the pandemic had made them feel lonelier.

This survey is in line with an Observatory for Sport in Scotland Survey published on the 6th of June that reported In total, 47 per cent of the adult (18 years plus) population of Scotland (just over two million people) felt that their participation in sport and exercise activity was a lot or a little less over the last 12 months than the equivalent period before Covid-19, with men reporting more of a drop than women. Around 32 per cent reported doing about the same as pre-pandemic and 14 per cent reported doing more activity in the past year. Just over four in 10 people said that they were walking more in their local area during the 12 months of the pandemic compared with the 12 months previously, but his has not compensated for the declines in activity through sport and exercise. To access this report CLICK HERE

Researchers at Strathclyde University who carried out the Age Scotland survey say that after the closure of vital support services during lockdown, it is important that people get back to being physically and socially active as soon as possible, to stop further decline. Older people need to get back to attending groups where they can be physically, mentally, socially active as soon as possible in order to protect both their current and long term health.

One way to combat this deconditioning could be by using an innovative app called LifeCurve, developed by researchers at Strathclyde and Newcastle University, It’s based on research that found that we lose the ability to do things in a particular order as we age. The good news though that the types of loss and speed of loss is not set in stone at a particular age. We can improve our position by staying physically active and keeping up with regular daily tasks. This can slow the ageing process and help us to live a healthy, independent life for longer. People often assume that as they get older it is inevitable that they will stop being able to do the everyday activities that are important to them. This is not the case.

The app aims to provide evidence-based information and advice that can help people have a better ageing journey. 

To find out more about the project from the which the App was developed go to https://stillgoingproject.co.uk/

To download the App go to The Life Curve App

Introducing #socialcarefuture

This week I am introducing you to #socialcarefuture This is a growing movement of people with a shared commitment to bringing about major positive change in what is currently called “social care.” #socialcarefuture is a broad movement in the UK working towards a new vision where we can each be supported to make choices about where and with whom we live, on equal basis with others, to pursue our life goals and to be and feel connected to our wider community.

The group has started with the premise that examples of doing things better are already with us. Innovators have been developing better approaches to social care in spheres including management and ownership and the use of professional skills. Groups of people using social care and community organisations have led the development of mechanisms that can transfer power to those requiring care and organisations that can support individual and group advocacy. This movement aims to move these approaches from the margins to the mainstream.

Over the past year, with their partners Equally Ours, research company Survation they have been exploring how to shift how people think and feel about social care. In April 2021 #socialcarefuture published their report Building Public Support to Transform Social Care which you will find HERE.

Well worth looking if you are involved in changing how others think about and value social care.

They have a very interesting Blogging page. I’ll pick out a recent one (20th of April 2021) where you can access their guidance regarding communicating about social care. To view this CLICK HERE.

There you will find the link to another of their Blogposts  5 tips for changing the way people think about social care

NOW is the time to support their stance. Follow them on Twitter, Facebook and via WordPress.

@ScotHumanRights Call for an Immediate Return of Social Care Support

I think I am getting a bit more random about when I decide to post to my Blog. I’ll need to get back to being a bit more consistent especially now I have new students looking at it. However today I couldn’t ignore this.

Research published on the 6th of October 2020 by the Scottish Human Rights Commission has shown that a considerable proportion of people who use social care support at home have experienced either a reduction or complete withdrawal of support during the COVID-19 pandemic.

The new monitoring report details how the removal of care plans during COVID-19 has had a direct and detrimental effect on people’s rights, including potential unlawful interferences and non-compliance with rights contained in the European Convention on Human Rights and the United Nations Convention on the Rights of Persons with Disabilities. Rights affected include people’s rights to physical and psychological integrity, private and family life, and to independent living in the community.

Evidence from research participants showed how the reduction or withdrawal of care and support at home has led to circumstances in which people were left without essential care, such as assistance to get up and go to bed, to wash and use the toilet, to eat and drink, and to take medication.

The report sets out 24 recommendations for action, including:

1. The Scottish Government and the Convention of Scottish Local Authorities (COSLA) should jointly commit to the return of care packages and support at pre-pandemic levels, as a minimum.
2. The Scottish Government should immediately establish data collection mechanisms to monitor the nature and extent of the reductions and withdrawals of care packages.
3. The Scottish Government and COSLA should develop an emergency decision making framework for social care which is grounded in rights-based principles of inclusion and participation in decision making, and transparency. This should also meet critical human rights standards.
4. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) should be incorporated into Scots law and therefore into policy design and delivery so that this situation never happens again

Judith Robertson, Chair of the Commission, said:

“Social care is an essential investment in realising people’s rights, particularly those of us who are disabled, older or provide unpaid care. Delivered properly, social care should enable people to access their rights to family life, health, education, employment and independent living in the community, among others. That’s why the Commission is deeply concerned about the reduction and withdrawal of social care support to people during COVID-19, and the impact this is having on their rights.

While the report is concerning I am absolutely sure that what is documented here is probably occurring across the UK. Concerning times for all and only goes to show that we need to “…build back better” as this report highlights.

To access the full report CLICK HERE

Easter Advice on PPE; April 2020

Next week many of the final year undergraduate nursing students at my University go out to join the health and social care workforce. The University, my colleagues at UWS and I are very proud of the 1,200 UWS students joining the frontline fight against COVID-19 next week – a huge thank you to those who have volunteered to join the workforce, to help protect us all 🌟 https://www.uws.ac.uk/…/uws-students-join-nhs-frontline-co…/ #WeAreTogether

However, its far from a bed roses out there, particularly in relation to the Personal Protection Equipment (PPE) that you all require. On Tuesday the BMA published a snapshot survey that 2,000 doctors had responded to. According to their survey, more than half of doctors working in high-risk environments said there were either shortages or no supply at all of adequate face masks, while 65% said they did not have access to eye protection. Alarmingly many felt pressurised to work even in high-risk area despite not having adequate PPE. The shortage appears worse among GP’s with more than half saying they bought their own and only a small number feeling adequately protected. See BMA Survey HERE

So if you are going out to look after our older people and others who may have COVID-19 what do you need to know?

Health Protection Scotland have a page dedicated to COVID-19 that provides an extensive guide to using PPE in the fight against COVID-19  that includes a number of workforce education resources. You can access them at https://www.hps.scot.nhs.uk/web-resources-container/covid-19-guidance-for-infection-prevention-and-control-in-healthcare-settings/

With a weekend to go this would be a good time to sit down and do some reading and learning if you haven’t done this yet. If you do encounter someone with COVID-19 as some inevitably will, then make use of these COVID_19 NICE Guidance and make your clinical colleagues aware of them.

Finally, if you are concerned about your PPE or the supply of PPE, in Scotland there is a helpline which has has been set up for services registered with the Care Inspectorate regarding access to personal protective equipment (PPE).

All services who are registered with the Care Inspectorate and are providing social care support, who have confirmed/suspected cases of COVID-19, and have an urgent need for PPE after having fully explored local supply routes/discussions with NHS Board colleagues, can contact a triage centre that is being run by NHS National Services for Scotland (NHS NSS). This helpline is to be used only in cases where there is an urgent supply shortage after business as usual routes have been exhausted and a suspected or confirmed case of COVID-19 has been identified. The following contact details will direct providers to the NHS NSS triage centre for social care:

Email: support@socialcare-nhs.info

Phone: 0300 303 3020. The helpline will be open (8am – 8pm) 7 days a week.

This helpline is not for NHS staff or for NHS providers who have an NHS BAU supply route.

New Website for @RealisticMed Launched

A new website dedicated to practising Realistic Medicine has been launched this week. Realistic medicine refers to putting the person receiving health and social care at the centre of decisions about their care and creates a personalised approach. It encourages health and care workers to find out what matters most to their patients and clients so that the care of their condition fits their needs and situation. Realistic medicine recognises that a ‘one size fits all’ approach to health and social care is not the most effective approach for the patient or for the NHS.

Its important to older people because it encourages services to adapt to the way in which people with multiple, complex and frequently changing conditions require to access care and support. Those people are primarily over 65. Current models of healthcare services are stretched and there is need to re-examine how we can deliver person-centred and integrated healthcare that embraces both statutory and non-statutory agencies. Cath Calderwood, the Chief Medical Officer for Scotland has said, realistic medicine involves

• Listening to understand patients problems and preferences;
• Shared decision making between healthcare professionals and their patients;
• Ensuring that patients have all the understandable information they need to make an informed choice;
• Moving away from the ‘doctor knows best’ culture to ensure a more equal partnership with people;
• Supporting healthcare professionals to be innovative, to pursue continuous quality improvement and to manage risk better;
• Reducing the harm and waste caused by both over-provision and under-provision of care;
• Identifying and reducing unwarranted variation in clinical practices

The new website which you can access HERE, features resources, good practice case studies and the contact details of Realistic Medicine Leads within the NHS Scotland Boards.

Helping To Prevent Winter Deaths

Every year that I have been running this Blog round about this time of year I make a post about the alarming rate of UK excess winter deaths. For example this is my post on this topic from last year  https://raymondsolderpeopleblog.wordpress.com/2018/12/16/the-ongoing-tragedy-of-the-uks-excess-winter-deaths/ However this year something different and something positive. This month NICE and SCIE have worked together to produce A quick guide for home care managers aimed at helping to prevent winter deaths and illnesses associated with cold homes. You can access the new resource HERE! As they note, vulnerable people, living in a cold homes are at an increased risk of serious illness or death at this time of year. There new guide explains how some simple preventative actions can help to save people’s lives. They emphasise that care home managers and staff can play an important role in preventing harm caused by a lack of heating. I think this guide is useful for everyone, not just for Social Care staff so I would urge everyone looking after an older person to take a look and perhaps download and print the pdf version of this guide available from the resources webpage. Let’s try and get these tragic statistics down.