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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Oncogeriatrics? My “What’s wrong with the BBC’s Health Tracker” Rant

This week I am going to refer to another Blog piece from the British Geriatrics Society because it’s written by someone working locally in the West of Scotland. Dr. Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015 and her specialty is Oncogeriatrics. Not a term I am either familiar with or like but let’s just go with it. In her blog she discusses the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London. Worth a look even if it’s just to get your hands on the Cancer Services Coming of Age Report from 2012. I may not like the name chosen for what she does but I would support her in her efforts to see Comprehensive Geriatric Assessment used in cancer care as well as other areas where it’s also extremely useful. See this Cochrane Review   about its use.

This week also saw the release by the BBC of their NHS Tracker. The tracker uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

and pulls this data from currently published NHS and Government office data to allow comparisons across the UK, but be warned there are differences between how the targets are measured in each part of the UK. So is this a good thing or a bad thing? My own feelings are neither of these. It’s missing the point completely. Of course, the NHS is missing its targets. Its grossly underfunded, short of staff and very short of staff in key positions, like radiology, gerontology and more…. Do we really need another measure of how bad things may be getting, or should we tackle this! (chronic underfunding when compared with other westernised economies)

 

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From https://epianalysis.wordpress.com/2012/07/18/usversuseurope/

International Day of the Older Person 2017

The International Day of Older Persons is observed on October 1 each year. So today is the day and I thought I should mark it.

This year’s theme is about enabling and expanding the contributions of older people in their families, communities and societies at large. It focuses on the pathways that support full and effective participation in old age, in accordance with old persons’ basic rights, needs and preferences.

The UN has stated that this year’s theme underscores the link between tapping the talents and contributions of older persons and achieving the implementation of the 2030 Agenda for Sustainable Development and the Madrid International Plan of Action on Ageing, which is currently undergoing its third review and appraisal process.

The message for this year from the United Nations is here 

The World Health Organisation also has a message on their Ageing and Life Course pages. Given that their focus this year is on Universal health coverage it’s a good day to watch this!

Dementia Awareness Month Begins

It’s the 1st of September, so as always this is the commencement of World Alzheimer’s Awareness Month.

 

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World Alzheimer’s Month has been observed in September every year since its launch in September 2012. The decision to introduce a full month, to contain the existing World Alzheimer’s Day, which is on the 21st. of September every year was made to enable national and local Alzheimer associations worldwide to extend the reach of their awareness programmes over a longer period. The 21st of September was chosen because it marked the opening of Alzheimer’s Disease International’s (ADI’s) annual conference in Edinburgh on 21 September 1994 which was the organisations 10th anniversary.

 

For more information about this years theme and campaign click here.

It also means that the next World Alzheimers Report will be released. This year the aim is to highlight the importance of early detection and diagnosis of dementia. So look out for it’s publication around the time of World Alzheimer’s Day.

Ten Things We Need to Know About Dementia

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This week the Lancet Commission on Dementia Prevention and Intervention and Care published its findings which included 10 key messages that are the things we need to know!

Quite a lot of the media reports of this important paper have highlighted only the lifestyle changes that need to be made to reduce your risk of developing dementia but very few highlight the bottom line… which is even if you make the positive  lifestyle changes suggested that would reduce your potentially modifiable risk factors by  about 35% of your overall risk. The other 65% of dementia risk is thought to be potentially non-modifiable.

The paper though, says a lot more than this and “Being ambitious about prevention” the one the media focussed on is only No 2 on the list, so there are 9 more messages that got a lot less attention! To see the Lancet Paper click here Be warned it’s not short!

So what else caught my attention? Well this did the Commonwealth Fund, which surprisingly is a private American foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency in US Healthcare recently reported on a comparison they had made between 10 high-income countries health care systems performance: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Worryingly the USA came last in nearly everything. Surprisingly the top country was the UK! Who says our Health Care system is failing? I think it’s actually being failed by a Government that wants to adopt an American Healthcare Model.

The time has come to ask why when they, the USA, should be learning from us!

As the Commonwealth Fund report states, based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries’ approaches if it wants to achieve an affordable high-performing health care system that serves all Americans.

To read more about this report and to access the full version click here