Improving Well-being: Step 1-Physical Activity

Public Health England have recently published new evidence and online guidance to help healthcare professionals embed physical activity into daily life.

Called Physical Activity: Applying All Our Health  the resource aims to help health professionals prevent ill health and promote well-being as part of their everyday practice.

The information provided aims to help front-line health and care staff use their trusted relationships with patients, families and communities to promote the benefits of physical activity. It also recommends important actions that managers and staff holding strategic roles can take.

It includes examples to help healthcare professionals understand specific activities or interventions which can:

  • prevent physical inactivity
  • protect through physical activity
  • promote healthier more active lifestyles

Also in the post is a link to an eLearning version of the information provided by eLearning for Healthcare (Worth signing up to because of the number of resources you can access).

The NHS Scotland equivalent page can be found at http://www.healthscotland.scot/health-topics/physical-activity/physical-activity-overview

but its perhaps not as interesting.

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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/ 

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

Everyday Ageism! Time to #retireageism

According to a new report published last week, which surveyed 4,000 UK adults and analysed thousands of tweets and blogposts in the UK one in 30 people admitted to regularly discriminating against anyone aged over 50 – and more than one in 10 admitted that they don’t even know if they were ageist or not.

More than a third of British people admit that they have discriminated against others because of their age, according to new research on everyday ageism, with those in their 30’s most guilty.

The Ageist Britain? Report published by the Sun Life Group aims to shine a light on the issue of casual ageism and the impact it has.

The report shows that people over 50 are  bombarded with phrases and behaviours which imply that life as an older person must be awful. Language is particularly revealing with “Old fart”, “little old lady”, “bitter old man” and “old hag” used frequently in conversation and on social media

Everyday ageism has an impact on mental health with growing awareness that this ageist societal narrative negatively impacts on our personal experiences of ageing and perhaps even our health and well being it can also hasten the onset of dementia and even shorten life expectancy.

The report also found that 40% of British people over 50 regularly experience ageism, with one in three commonly experiencing it at work, one in 10 on public transport, and one in seven while shopping.

As Shelley Hopkinson, public affairs manager at Independent Age said, “Part of the problem is that people often don’t even realise that the language they’re using can be ageist or cause offence”

So what should people in the UK do about this. Well the reports says a good bit more but when the public were asked the top 3 most popular ways people think we can combat ageism are:

• If more brands used different models of all ages for their advertising campaigns (37%)
• If the issues associated with ageism had the same level of attention as racism and sexism (33%)
• If people were more aware of the use of ageist language and avoided derogatory terms (33%)

Hospital Admissions of Older People Continue to Rise

This week the SCoOP report was published. Otherwise known as the Acute Hospital Outcomes Report 2017/18; it provides an overview of the outcomes of acute geriatric medicine services in Scotland and is published by Scottish Care of Older People National Audit Project which amongst other things is trying to evaluate the variation in service provision for older people who require health and social care in various settings, to serve as a driver for standardisation and improvement of care across Scotland.

They have reported that admissions to geriatric medical wards in Scotland’s 19 largest hospitals with major emergency departments have risen by 10% for three consecutive years, reaching 43,311 in 2017/18.

The report has also concluded the length of stay dropped across all sites by an average of one day over the same period.

More concerningly they have noted the number of admissions varied widely across sites in Scotland, with some areas showing large increases in activity while others are in decline. There was also a large variation in the typical length of time patients spent in different hospitals. In some cases, there were up to 12-fold differences in the length of stay, while hospitals with higher activity levels usually had lower lengths of stay.

There was also a strong relationship between the time waiting to get to a specialist bed and the overall length of time patients spent in hospital; suggesting that delays in accessing specialist services contribute markedly to longer stays in hospital.

Differences in readmission rates and mortality were less marked between hospitals, broadly remaining stable over the last three years.

The report does not attempt to explain the variations but aims to stimulate discussion, learning and action that could be used to help benchmark some key patient outcomes and encourage interorganisational learning.

Professor Graham Ellis, Co-Chair of SCoOP Steering Group and the National Clinical Lead for Older People, Healthcare Improvement Scotland said:

“The wider goal is to reduce unwarranted and unjustifiable variation in outcomes, which may represent a threat to patient safety and/or a failure to learn from best practice.”