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

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

 

I’ve missed a week again ūüė¶¬† 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

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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

 

Why Missed GP Appointments Matter

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The paper highlights that missed general practice (GP) appointments are a significant risk marker for all-cause mortality, particularly in patients with mental health conditions.  People with mental health conditions who missed appointments risk of death also increased with the number of appointments they missed. To the point that missing more than 2 appointments per year placed them at 8 times greater risk of dying (in the next year) than those who missed no appointments. They died prematurely, commonly from non-natural external factors such as suicide.
The research led by the University of Glasgow, used routinely collected primary care data from 824,374 patients across Scotland during a 3-year period from September 2013 to September 2016. They then took this information and linked it to the Scottish death records for patients who had died within a 16-month follow-up period.
The study also showed that patients with a greater number of long-term conditions had an increased risk of missing GP appointments, despite controlling for number of appointments made thus also placing them at risk. What is not obvious in the study is that that if you missed a GP appointment and had dementia and another long term illness this also placed you at a significantly higher risk of death.
So what can we learn from this. As the authors state
“…missing multiple appointments provides a risk marker of all-cause mortality even after you control for other factors. Also… GPs, the acute sector and other NHS services should consider how best to facilitate engagement of patients with patterns of repeatedly missing appointments because for non-attenders the existing primary health care appointment systems is ineffective.”
So rather than vilify people who miss GP appointments as time wasters who need to be penalised/punished maybe its time to ask “Why are you not here?”
An interesting view to take on this issue is provided by the Medical Defence Union who have an item on their website called
I would suggest reading it, particularly if you are a practice nurse or work in outpatients.

The Importance of Food Shopping

The University of Hertfordshire‚Äôs Food and Public Health Research team have recently completed a study calledFood provision in later life” which was a study about older people’s experiences of getting food in the UK.

The research aimed to show how older people from different household types acquired food, ¬†what food they bought¬†and the people and places they acquired it from. The study was funded by the Food Standards Agency and the Economic and Social Research Council to explore the resilience of older people within the UK food system. One of their outputs was a research briefing, ‚ÄėImproving food shopping for older people‚Äô is now available to read via this link.

It’s well worth reading before your next trip down to the supermarket, particularly if you shop with or for an older person as I do.

The video the team produced which is on the BSG’s Ageing Bites Youtube channel ¬†gives you an idea of why this is such an important topic to consider, although it is often taken for granted that older people will manage.

One of the things I like most about this study though is that the researchers have gone on to to develop a “The Food in Later Life Game” to help people learn more about malnutrition in older people and the actions they can take to help prevent/manage it.

Launched on the 3 October 2018, the game aims¬†to help retailers, professionals, volunteers and other members of the community who work with and live alongside older people to understand how to help the older generation remain ‘food secure’. You can find out more about the game at the following website:

http://www.foodinlaterlifegame.co.uk/index.html

The Ongoing Tragedy of the UK’s Excess Winter Deaths!

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In common with other countries, more people in the UK die in the winter than in the summer. Health Protection Scotland and other agencies point out that the deaths can often be attributed in part to cold weather directly (for instance deaths following falls, fractures, and road traffic accidents), in part to cold weather worsening chronic medical
conditions (for example, heart and respiratory complaints), and in part to respiratory infections including influenza.

Last winter though was carnage though particularly if you were a woman or aged 85 and over (See Excess Winter Deaths England and Wales)

If you combine the England, Wales and Scottish figures the number of excess UK winter deaths last winter was 54,879.

Sadly, our national disgrace continues and if anything things might slowly be getting worse after many years of improvement when the overall trend had been downwards since 2013-14 there has been a rising trend.

To give this more of a context in Scotland the  +4,797 deaths considered to be excess was the largest number since winter 1999/2000. The +50,100 deaths in England and Wales was the highest recorded since winter 1975 to 1976.

Research released by the E3G group in February 2018 indicates not just why this happens but why this should be a source of national embarrassment. Iceland, Finland, Norway and Sweden all have fewer winter deaths per capita population than we do and there is little doubt that they are colder. To learn more and access the E3G group report CLICK HERE

I agree with the authors of the report that this preventable tragedy must end. It’s time for the UK Government’s (England Wales and Scotland) to get a move on and do something significant to provide the capital investment necessary to make many more UK‚Äôs homes warmer and safe for human habitation.

 

 

 

 

 

“Alexa… What does Gran/Grandad want for Christmas this year?”

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What about Tablet?

This week saw the release of a New NIHR Themed Review called “Help at Home”.

Help at Home brings together recent National Institute of Health Research (NIHR) and other government funded research which has a focus on the use of technology in the home and designing better environments for older people.

This review features the work of 40 published studies. It also sets about giving care providers questions to ask about how technology can support older people living with complex conditions and what designs could help create an ageing friendly environment.

I am a big fan of making use of technology when it can help people to stay living well and safely at home as they get older. However my caveat is always that it has to be the right technology, tailored to the individual. BUT that alone is not enough, the person its for has to be willing to use it (and capable of learning how to use it), or you quickly find its a waste of money, time and effort.

There has been considerable investment recently in developing and evaluating assistive technologies for older people. However this is a relatively new field and there are still important gaps in what we know.

What is in the review has been selected with help from an expert steering group who focused on research around the use of technology in the home, remote monitoring systems and designing better environments for older people. You can read more at:

Help at Home Review

I am hoping this is arriving in your inbox just in time for Christmas. Christmas isn’t just for children

“Alexa… What does Gran want for Christmas this year?”

Maybe her own smart speaker or tablet!