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.

One in Five UK Hospital Patients are Harmful Drinkers

A team mainly from Kings College in London conducted as part of the first author’s MRC Addiction Research Clinical (MARC) Fellowship, has found that 1 in 5 in-patients in the UK hospital system uses alcohol harmfully, and that 1 in 10 is alcohol dependent.

They conducted a systematic review and meta-analysis that looked at studies of any design that reported the prevalence of one of 26 wholly attributable alcohol conditions defined by the WHO’s International Classification of Diseases, Version 10 (ICD‐10).

They looked at 124 studies which were all conducted in one or more of the constituent nations of the United Kingdom and in an in‐patient setting (general wards, intensive care units, accident and emergency departments or mental health in‐patient units). The 124 studies meant that they were reporting on a total of 1 657 614 patients.

Having arrived at what is a shocking statistic they have rightly suggested that hospital staff need to be skilled in the diagnosis and management of alcohol‐related conditions given the number of people that they will see as inpatients. They have also pointed out that formal screening for alcohol‐related conditions in hospital remain low and that needs to change

Given the fact that other less prevalent diseases such as diabetes, are routinely screened for and often have dedicated in‐hospital specialist care teams their study provides weight  for increased routine universal screening and support to improving everyone’s training concerning alcohol‐related conditions given this high frequency of encounters.

This study is very pertinent given the UK government’s development of a new alcohol strategy and the NHS 10‐Year Plan which included funding allocations to combat alcohol‐related conditions.

Last year figures suggested that at least 41 English hospitals do not currently have an alcohol care team (ACT’s) in place. This is despite the 10 year plan including a commitment to place ACT’s in hospitals with the highest rate of alcohol dependence-related admissions (according to this study that will be all of them!) although the plan for increasing ACT’s, does not seem to have to any material funding.

To view the whole report see

Roberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta-analysis and meta-regression. Addiction. 2019 Jul 3 [Epub ahead of print]. doi: 10.1111/add.14642. PMID: 31269539

Looking Forward to 2020 and Looking Back

In 2015, the world united around the World Health Organisation (WHO) Agenda for Sustainable Development, pledging that no one will be left behind and that every human being will have the opportunity to fulfil their potential in dignity and equality. The following year they released their Global strategy and action plan
on ageing and health committing the member states to ensure the goals are applied as a response to population ageing and urging them to make efforts to further support Healthy Ageing.  Now as a response the WHO has set out 10 Priorities that are needed to achieve the objectives of their strategy and action plan and now we are about to embark on a decade of concerted action on the Decade for Healthy Ageing from 2020-2030. 

The 10 priorities make for interesting reading so a link to the WHO publication 10 Priorities: Towards a Decade of Health Ageing is HERE 

The link between the Sustainable goals for healthy ageing and the sustainable development goals is best explained HERE

More about the WHO’s work in Ageing and the Lifecourse can be found by watching the video and on this webpage which includes what they say about Age-Friendly Environments.

In a bit of a contrast to looking forward, there is a new exhibition at the RCN Library and Heritage Centre in London exploring the place of nursing within the care of older people in the UK, which has changed dramatically in the past two centuries. Created with the help of the RCN Older People’s Forum, Aspects of Age charts the shift from the days of Victorian workhouses to at-home care and future technologies. It also looks at how specialist nurses can help destigmatise old age.  Information related to the exhibition is available at the Aspects of Age exhibition page HERE 

You can also visit the exhibition at RCN headquarters in London from 11 April to 20 September, then at RCN Scotland in Edinburgh from October.

@TheKingsFund, @HealthFdn and @NuffieldTrust Warn of Urgent Need to Tackle NHS Workforce Crisis

In the three years or more that this Blog has existed, this topic is one that I have kept returning to. Finally we seem to have reached a point where what is going on is obvious to everyone.

According to The Nuffield Trust, The King’s Fund and the Health Foundation the UK is facing massive staff shortages across the National Health Service that are so severe that services will suffer, with no chance of the shortfall in GP’s ever being fully addressed. The report predicts that without the kind of actions the new report called Closing the Gap proposes, nurse shortages will double to 70,000 and the GP shortage in England would triple to 7,000 in just 5 years (by 2023/24).

For nursing alone the report concludes that even with grants and expansion of postgraduate training, bringing 5,000 more students onto nursing courses each year and actions to stop nurses leaving the NHS, the gap cannot be entirely filled domestically and that in order to keep services functioning, 5,000 nurses a year must therefore also be ethically recruited from abroad. Essentially rubbishing the salary restrictions to recruitment proposed in the Immigration White Paper.

In fact they suggest that the government needs to fund the visa costs incurred by NHS Trust recruitment. Also, as I have said on numerous occassions before in this blog a comprehensive overhaul of social care funding is needed immediately to stop the poor pay and condition that both drives staff away and makes new recruitment near impossible.

Apparently the NHS England’s own Workforce Implementation Plan is expected next month. My guess is that is being ripped up and binned as we speak along with the aspirations of the recent NHS Long Term Plan

To download the report in full GO HERE

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Inappropriate Prescribing: A Reminder

In 2017 the World Health Organization launched its third global patient safety challenge with the aim of reducing severe avoidable medication-related harm by 50% over a five year period. See Medication Without Harm

Demonstrating success in achieving this may be difficult, but countries such as the UK are in a strong position to meet the spirit of this challenge because we have strong integration of our healthcare systems and electronic health records which we could probably use more effectively.

A very important approach is to identify potentially inappropriate prescribing and correct it where necessary, with the expectation that intervening will avoid serious harm. Yet, around half of older patients are exposed to potentially inappropriate prescribing each year and hospitalisation puts them at an increased risk, a new study conducted in Eire shows.

See: https://www.bmj.com/content/363/bmj.k4524

The authors of this study point out that medicines management services for inpatients in Ireland are broadly similar to those in the UK.

Their finding is worrying because inpatient admissions can provide the opportunity for specialist teams to review and optimise management of older patients’ chronic conditions, including their drugs. So, although hospital admissions have the potential to improve management of drugs, this study suggests that the possible benefit of more appropriate prescribing after discharge to primary care is not being realised.

Something somewhere seems to be going wrong. The authors suggest that improving coordination of transitional care (hospital to home and vice versa) particularly for older patients with complex care needs has the potential to reduce mortality, hospital readmissions, and the number of readmissions. Time to look again I think at the UK’s electronic drug management systems and the organisation of discharges from hospitals.

Why is it so difficult to get an electronic summary care record from A to B in order to reduce discrepancies arising from transitions between hospital and primary care?

This is not a new problem its an old one but surely one that could be tackled and eradicated now

 

 

 

 

More Progress Required on Health and Social Care Integration in Scotland

For the first time in quite a while, I failed to make a post last week. Sorry… 😦

Anyway, back now in a week where the news has been totally dominated in the UK by Brexit. Anyone that knows me will know that as a person working closely with the NHS in Scotland its something I don’t want to see happen. You can see the NHS against Brexit Campaign by clicking the link HERE if you want to understand why. 

So what else has been going on that’s important to older people’s care? Well in Scotland the Audit Commission released its latest report on the progress of Health and Social Care Integration. Rather than me discussing what they say here, the Audit Commission has produced a short video of the highlights from the report that you can view here.

 

You can read and watch more about the findings of their report by going to this Audit-Scotland Webpage where you will also find some good infographics you can use.

As the report states, there has been some progress but the challenges remain significant.

They also find that success will depend on long-term integrated financial planning and stable and effective leadership and also states that all bodies involved need to tackle these issues as a matter of urgency in order to transform the way services are provided for Scotland’s ageing population.

One of the last statements they make in their news release is  perhaps the most telling

“A collective effort from the Scottish Government, COSLA, NHS Boards, councils and the Integration Authorities is needed for health and social integration to make a more meaningful difference to the people of Scotland.”

Stroke; More Prevention Required

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Cerebrovascular disease (CVD) is a condition that develops as a result of problems with the blood vessels supplying the brain. Despite a substantial decrease in rates of death over the last decade across the UK, there were still 4,310 deaths in Scotland alone in 2015.  Every year there are more than 100,000 strokes in the UK each year.
That is around one stroke every five minutes. There are over 1.2 million stroke
survivors in the UK. (Including my Mother-in-Law, which probably explains my interest in this currently.) If you want to know more see The State of the Nation; Stroke Statistics (Feb.2018)

A stroke occurs when the blood supply to part of the brain is interrupted and brain cells are starved of oxygen. This usually occurs because a blood vessel becomes blocked by fatty deposits or a blood clot. Stroke is more common in older people.

The UK  has high prevalences of people exposed to the risk factors associated with CVD such as smoking, high blood pressure, poor diet, lack of exercise and alcohol consumption above recommended limits. Stroke care is also an area of substantial health and social care spending. It represents around 5% of total NHS costs and still remains the fourth largest cause of death in the UK, which is why treating and preventing stroke continues to be a national clinical priority.

So as health professionals what can we do?

There is a themed review from the NHS’s NIHR called “Roads to Recovery” This themed review looks at the configuration of stroke services, identifying stroke and acute management, recovery and rehabilitation, and life after stroke. Are we doing what the review suggests? See https://www.dc.nihr.ac.uk/themed-reviews/stroke-recovery-services-research.htm

Today (5th of November 2018) the Health Secretary for England, Matt Hancock will set out his long-term vision for the NHS and it will focus on preventing illness. CVD and Stroke are one of the most preventable illnesses but we continue to spend 10 times more money on treating disease than we do on prevention. Perhaps its time to consider spending differently and invest in more prevention and in our communities rather than continuing just providing a “national illness service”. Only better prevention will continue the improvement in care and treatment for CVD and stroke and other illnesses that we have been experiencing. What that involves though is not the culture of “victim blaming” which you may hear about today.  See the story about this announcement in the Guardian today HERE

My Blog is 3 Years Old Today!

birthday-492372_1280This is a bit of a landmark because when I started out this blog it was really as an experiment to see what I could do to keep my own MSc in Gerontology students up to date with developments in older people’s care occurring during their programme.

So 3 years on and I have posted 162 times. The site has been viewed by 2,299 different people, I have 33 followers and the most popular day to come to this site is a Monday (about 20% of all viewers)

So thanks to everyone who visits and spreads the word about this blog. It’s gone well beyond the “classroom” although I know many of my students do visit regularly. Please keep following and visiting. And remember that despite everything that’s going on, things are getting better.

For example; in the last 5 years across European mortality from the four major noncommunicable diseases (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases have been on a 2% decline per year on average based on the data from 40 of the 53 countries in the European Region. In addition, a WHO 2017 progress review established that the WHO European Region is likely to achieve its target of reducing by one-third premature mortality from non-communicable diseases through prevention and treatment and promoting mental health and well-being earlier than 2030 and will probably exceed it.

See the WHO Factsheet by clicking here

Fantastic news that you probably haven’t heard.

Incontinence is Hurting the Dignity and Health of Millions

At the end of August, 10 charities published the findings of a shared workshop they had on the topic of incontinence which had taken place in December 2016.  The resulting report which is called “My bladder and bowel own my life.” A collaborative workshop addressing the need for continence research” recommends tackling the stigma of incontinence and funding research into this often ignored issue. This new report describes the impact of continence issues on patients with long-term conditions and older people as discussed by the workshop participants and makes 8 clear recommendations for researchers, research funders,  policy makers, commissioners and others in a position to make research into urinary and faecal continence problems more of a priority.

Research into urinary and faecal continence problems have been identified by patients, carers, family members and health and social care professionals as one of the key areas where further research is needed.  This is because there are are a lot of areas in this field where further research could be done to improve the quality of life for people with a variety of conditions and circumstances, such as long-term neurological conditions and terminal illness. The 10 charities suggest that more research is needed into:

  • the patient experience
  • health economics
  • clinical research into self-management techniques, co-morbidities, continence assessment and products, the impact of education, combined urinary and bowel continence research, side-effects and the interaction of medication prescribed for other long-term health conditions and their effect on incontinence symptoms.
  • fundamental research to better understand bladder and bowel function
  • the effect of non-surgical interventions.

Quite a knowledge gap, that needs to be tackled particularly since the NHS estimates that between 3 and 6 million people in the UK have some degree of urinary incontinence. Studies also suggest that in the UK “major faecal incontinence” affects 1.4% of the general population over 40 years old and that constipation affects between 3% and 15% of the population. It’s also widely believed that continence problems are under-reported so these figures could be quite a bit off as the numbers seeking treatment might be as low as 20% of those affected, which would mean around 15 million around a 1/5th of the UK population at any one time may be troubled by poor continence symptoms.

If you are affected by incontinence it is probably a good idea to be aware of NICE’s Topic Page on Urinary Incontinence and their Urinary incontinence in women interactive flowchart and to take some time to look at The Urology Foundation’s Urology Health Pages

 

Could Specialist Palliative Care in the UK be Ageist?

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Providing good end of life care is an NHS priority. Good end of life care tries to ensure that people can die with dignity, with access to appropriate specialist care wherever that person chooses to die. There is no arguement that referrals to hospice-based specialist palliative care would benefit older people most but it appears from a large National Institute of Healthcare Research study that people aged under 50 years were referred to hospice specialist palliative care about a month before people over 75 years.

The majority of people referred for specialist palliative still have cancer which you might expect but specialist palliative care should be available to people with other illnesses that may be equally difficult to manage. However, if you are person with dementia or are in the terminal stages of a stroke were referred about nine days before death compared to much earlier for those with other diseases.

The NIHR study, which you can download here,  is the first to provide detailed data on patterns of referrals to UK hospices in England and Wales. I am not sure whether something similar has been done for Scotland or Northern Ireland.

The study clearly highlights variations in referral patterns that depend on your age, disease and where you live. It also highlight a need to better understand the reasons for the delay, which looks suspiciously ageist to me amongst services whose priority you would think would be older people.

Something else new this week. Have you downloaded the FREE Cochrane Library App?

Get the latest evidence when and where you need it. See   Available for iPads, iPhones, and Android.