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?”

 

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Have You Seen RCP Commentary Before?

RCP Mag

Sorry for failing to post on Friday this week. Went off on Friday night for a week away with the family before the stress that my son sitting his Highers will cause. So what has caught my eye this month? Well, the Royal College of Physicians Commentary Magazine looks at end-of-life care. Palliative consultant Dr Ollie Minton and Prof Albert Weale, chair of the RCP Ethical Issues in Medicine Committee, introduce the features which include amongst other things an honest and emotive account of a death at home, and how more joined-up care could have lessened one family’s distress. Its worth a look just for this contribution but the magazine itself is one of these “gems” that more people should be aware of.  You can access this special issue here Thanks to Professor David Clark of the End of Life Study Group at the University of Glasgow for bringing this to my attention. If you are unaware of the work of this group you should visit their webpage at  https://www.gla.ac.uk/research/az/endoflifestudies/projects/imminence/ The home page of the “Imminence of Death Study” which might just be the most influential care study carried out in Scotland in recent years.

The second thing I’d like to bring to your attention this week, particularly if you do live in Scotland is the ScottsishGovernemnst current consultation on its plans to develop a first national strategy for tackling social isolation and loneliness. Currently labelled  “A Connected Scotland: Tackling social isolation and loneliness and building stronger social connections” If you click on the link the page takes you to where you can download the consultation paper and would encourage to add your views or to try and get your organisation to contribute as effectively reducing social isolation is a public health issue that has a devastating impact on our older population. See https://www.campaigntoendloneliness.org/campaign-end-loneliness-glasgow/

 

Sláinte: Alcohol Consumption and Older People

Well, it was food last week so this week let’s turn our attention to drink.

NHS Scotland this week released a new report, Hospital Admissions, Deaths & Overall Burden of Disease Attributable to Alcohol Consumption in Scotland that indicated that more than 3,700 deaths in Scotland could be directly linked to alcohol consumption. In addition, more than 41,000 people were admitted to hospital as a result of consuming alcohol. These findings overall show that alcohol has a wider impact on health than many people think, supporting the Scottish Government’s case that minimum alcohol pricing. This starts in Scotland in May 2018 and given this state of affairs has to be at least worth trying.

So why is this important to older people? Well, you have to look at alcohol consumption in the UK. In those that drink alcohol (about 83% of the total population) Drinkers aged 65+ years drank more frequently than any other group and were also more likely than any other age group to have drunk alcohol on 5 or more days in the previous week (24% of men and 12% of women) compared to 3% of men and 1% women aged 16 to 24 (Office of National Statistics, 2017). See Drinkaware if you want a more comprehensive view

There is an alarming lack of recognition of the extent of this problem in frontline healthcare staff who remain more likely to associate heavy drinking with the 16-24 age group, perhaps because they are more likely to binge drink, with all the problems that cause rather than older people steadily drinking more.

So it was really good this week to come across a new resource called Vintage Street Not the snappiest or most obvious name, unfortunately, that is purpose-built for people over 50 who are concerned that they are maybe drinking a little too much. It offers a range of online advice that older people, their families, employers may find useful. It also lets you know how to get in touch with the 5 Drinkwise Age Well centres.

Seems appropriate to put these here so you can check yourself out before you visit the site!

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Is an Effective Dementia Drug Treatment Getting Further Away?

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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/

Unfavourable Views of Hospital Care in England are Strongly Linked to Nurse Numbers. Is That a Surprise?

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Now at a time when the Government and all of the national media looks hell-bent on convincing everyone here in the UK that the NHS is broken, rather than being underfunded and under-resourced in terms of staff and beds; there has been very little space given to the published results of the 2010 NHS Survey of Inpatients and a BMJ paper published this month which shows that Patients’ unfavourable views of hospital care in England are strongly linked to insufficient numbers of nurses on duty, rather than uncaring staff, indicates observational research. The paper was published in the online journal BMJ Open so it’s not exactly hidden from journalists politicians etc.

Perhaps pointing out that the number of vacancies in the NHS has soared by 15.8% over the last year, prompting warnings that the service is facing “desperate” problems of understaffing is not what politicians want you to hear. Particularly concerning were the figures for England released in July 2017 by NHS Digital that showed that the number of full-time equivalent posts available rose from 26,424 in March 2016 to 30,613 in March 2017 – the highest number on record.

What this has done is fuel a public view that the NHS is worse than it used to be and that staff are less caring etc. The reality is really very different as any9one working for it knows. Can we please celebrate the success of the NHS at 70 (which happens on the 5th. of July 2018) and stop trying to undermine it. Yes the NHS does need to be reformed, but it would help to see it properly staffed first.

NHSat70

This week I was involved in publishing a Blog for “Ageing Issues” The blogging space for members of the British Society of Gerontology (BSG) where they discuss contemporary issues raised by ageing societies. The blog was about the BSG small event we held here @uwshealth in Hamilton in August. To read more about it see:

https://ageingissues.wordpress.com/2018/01/09/past-present-and-future-supporting-novice-researchers/

Another great find this week. The Joseph Rowntree Foundation this month launched a new Data Information Source that collects together the latest UK poverty data, statistics and analysis from the JRF’s Analysis Unit. This page is a great tool for to finding information about poverty rates and related issues in the United Kingdom and you can access it from here:

UK Poverty Data

 

Countering ‘Age Apartheid’ to Unite a Divided Society

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A strange piece of augury last week picking a ‘Care home for 4 year-olds’ as my topic. Today a report by the group United for all Ages warns that there is a widening gap between older and younger generations, largely fuelled by the UK housing crisis, which has forced young people to live in cheaper urban areas, while their parents and grandparents live in the suburbs or the countryside. They say that urgent action is needed to create 500 shared sites across the country by 2022 to try and end ‘age apartheid’ in Britain.

Britain is one of the most age-segregated countries in the world, particularly for the oldest and youngest generations and age segregation has been growing in recent decades

Their report called Mixing Matters was published today (5 January 2018). Worth downloading and reading (even the News Release) to get an idea just how divided a society we are becoming.

Shared sites, such as care-home nurseries (as featured on Channel 4); opening up sheltered housing schemes to students in return for volunteering and support; expanding the Homeshare scheme where older people let spare rooms to young people in return for practical support and companionship; Locating reception and year one classes for primary school children in care homes, as demonstrated by shared sites in the USA; and tackling the stigma around ageism and dementia by encouraging school pupils to visit care homes as part of the national curriculum bring young and old together and are practical methods for tackling some of the big social ills facing our country – from poor health and care and loneliness to ageism and division.

What’s not to like about this!

Catch-up on Old People’s Home for 4 Year Olds

Earlier this year Channel 4 in the UK ran a documentary series where pre-schoolers shared their classroom with pensioners from a retirement home in Bristol for six weeks. The two programmes can still be viewed on Catch up at All 4

 

Just before Christmas to highlight the problem of isolation over the holidays as an issue for older people at Christmas a new programme was created in the same format that brought the pensioners and their young friends together again as they prepare for a Christmas concert.

For a bit of life-affirming and interesting television take a look at Old People’s Home for 4-Year-Olds: Christmas

The coldest day of the winter so far with temperatures plunging below minus 13C in Scotland happened this week on the 28th. of December. A good time again to remind everyone to look out for and pop in to see their older neighbours.  Make sure they have enough food are staying warm because you could be saving their lives. Remember,  the estimates are that 80 frail and vulnerable people per day in the UK are at risk of dying as a result of fuel poverty. Interested in finding out more about fuel poverty there is a charity called Energy Action Scotland (EAS) which campaigns for an end to fuel poverty in Scotland and is the only national charity with this sole remit. If you want to know more about what they do Click Here!