“Confusion Still Reigns”

Posted on November 9, 2011 by john graham

My very first post on this blog was about dementia – in February 2010 I wrote”Lest We Forget” which spoke about the vast scale of this disease both worldwide and in the UK. The comments related to a report published by Oxford University which highlighted the fact that two thirds of the suffers in Britain, 400,000 people were left untreated by the NHS.

For this and all my other posts on dementia ‘click’ on “dementia” in the Topics list.

Well it appears we did forget, because the Department of Health has just completed another survey which tells us the same thing !   They seemed surprised to find that only a third of adults aged over fourty understood the signs of dementia. What they did confirm was that only 250,000 patients are registered with a diagnosis of dementia by GP’s, even though there are thought to be 634,000 suffers in the UK.  This is hardly news, but perhaps it is a sign that the  DOH is accepting that the situation cannot be hidden away and ignored for much longer.

    What are the issues behind this ?  :-

  • Firstly, there is still no clear test to diagnose dementia .
  • Secondly, until relatively recently GP’s were denied access to drugs to treat early stage dementia by the N.I.C.E. guidelines .
  • Thirdly,  a confirmed diagnosis leaves most suffers and their carers with no community support and only the prospect of living out their life in poor quality residental care .
  • Finally, faced with the above, it is no wonder that suffers and their carers do not seek early treatment, and it is quite understandable that GP’s do not rush to pass on bad news about such a daunting future.

A £2 million television advertising campaign is about to be launched to raise awareness of the early signs of dementia.  This is good news but it needs to be accompanied by more action by the DOH :-

  • To improve the standards of Residential Care by increasing staff training and increase fee levels .
  • To encourage more innovative forms of support for the majority suffers and their carers who still live in the community.

The never-miss-an-opportunity-for-a-headline, or to state the obvious, —- Care Services Minister — Paul Burstow,  said   “Being diagnosed with dementia won’t make the  condition worse but leaving it untreated will. We can’t cure dementia, but we can keep the person we love for longer”

                          Yes Mr Burstow, but what future are you holding out for them  ?

                                   Action not words,  Mr. Burstow.

Posted in Dementia | 8 Comments

“Lift your Spirits” 1

Posted on November 8, 2011 by john graham

A recent survey of 3000 adults looked at what made people happy and found that it was the simple things in life which could trigger a positive change of mood.

The research was conducted for Three Barrels Brandy which is rather ironic given the title of this blog and the fact that drinking alcohol didn’t figure in the results.

Many of the things people said cost nothing at all:-

  • Waking up on a sunny day
  • A cuddle
  • A kind word
  • A favourite song being played
  • Looking at old photos
  • Hearing a baby laugh
  • A message from a loved one

Some things cost a little money or effort:-

  • Chocolate
  • Receiving a surprise gift or flowers
  • A holiday
  • Seeing an old friend
  • A walk in the country

Loneliness is an issue that affects 1,000’s of older people and left unaddressed can lead to social isolation and ultimately ill-health is often only a short step further away.

What this survey tells us, is that it is possible to turn loneliness into happiness with just a few small and inexpensive steps.  Anyone can start the process.

Posted in SMILES | Tagged | 3 Comments

“Grumble Post” 1

Posted on November 6, 2011 by john graham

It is not long ago – 4th October 2011 – I was nostalgically writing about “The Penny Post”.  No question, this was a grumbling blog lamenting the fact that things are not as good as they used to be in the past:-

  • The post doesn’t arrive now till lunchtime
  • A letter ANYTHING bigger than a postage stamp costs more
  • ALL letters cost more – one penny in my imagination, thrupence in my childhood, 19p in 2000 (4 bob), 36p today (7 shillings and tuppence in real money for second class)
  • Nearly 10 bob for first class!

Posted in GRUMBLES, SMILES | Tagged | 3 Comments

“Music has Charms to Soothe”

Posted on November 3, 2011 by john graham

Some recently reported news from San Fransisco on the virtues of music in the treatment of dementia,  showed that music therapy can significantly reduce depression and agitation in patients with dementia.  Music affects parts of the brain which may not have been affected by the illness and make it possible to connect with good emotional memories.

In the ExtraCare Charitable Trust, we had several nursing homes that specialised in high dependency dementia and yet by tapping into familiar music, it was possible to reach back into happier times.  Residents who had lost most of their communication skills could sing along with familiar tunes from the past.

This was not piped music to create an appearance of calm but properly researched memories of former times.  Nor was it all wartime songs which often held sadder recollections.

The ballads of the forties and fifties, still could be conjured up from most people’s minds and Elvis Presley songs could get everyone  up and dancing or at least singing along.

These are not new revelations, but they are certainly worth repeating.  Music has great potential to enhance the lives of many people with dementia and relieve the boredom of everyday forgetfulness.  Too often activity like this is regarded only as entertainment rather than therapy. It is seen as a luxury which cannot be afforded in stringent financial times.  Often it is substituted by the palliative of daytime TV.

Proper individualised care of older people is a mark of human decency, our current treatment of people with dementia rarely achieves this.  Music therapy is one way to bring a smile back to lost faces.

P.S.       Just after writing this blog, I found a reference to a concert in New York being given by a choir of residents with dementia and their relatives.  They are called “The Unforgettables”.

What a great name and a fantastic idea !  That’s what caring for people with dementia should be about.

Posted in Dementia, HEALTH | 5 Comments

“Physio – no – Therapy”

Posted on November 1, 2011 by john graham

A recent audit of physiotherapy services by the Chartered Institute of Physiotherapists, found that patients in the NHS are having to wait more than six months for the service.

The report adds that delays mean patients’ conditions deteriorate, leading to re-admission to hospital and higher long-term costs for the NHS and Social Services.  This is typical short-term thinking which is self-defeating as well as poor quality care.

There is nothing new in these findings as far as elderly people are concerned.  Twenty years ago when I was involved in nursing homes in partnership with the NHS, physiotherapists were never available to older people who were considered ‘low priority’ – actually NO priority – because they were ‘economically inactive’.  This short-sighted thinking meant that many elderly people spent longer in hospital and when they were discharged they were often unable to return home and had to go into a residential home.

Even more appallingly they often came out unable to walk and were confined to a wheelchair for the rest of their lives   !

In the ExtraCare Charitable Trust we employed physiotherapists at our own expense and were often able to improve people’s mobility.  Later, when we started to build retirement villages, we incorporated a small fitness centre, and with appropriate gym equipment and professional support, residents were able to improve significantly.  Many to the point where they could walk again.  In a follow-up research study in one village alone, we were able to show savings to the NHS of £500,000 over a three-year period from shorter hospital stays and reduced re-admissions.

In a health service focussed on long-term health outcomes rather than short-term targets, physiotherapy services need to be a vital ingredient in rehabilitative health care.

Footnote :-

The same situation applies with shortage of speech therapists, who are essential in helping recover speech and swallowing after strokes.  Without them, many elderly stroke victims are left unable to communicate and often have to eat mashed up food for the rest of their lives.

Posted in HEALTH | Tagged | 1 Comment

“Smile for the Camera”

Posted on October 30, 2011 by john graham

In preparing to write this blog, I started collecting research studies on ageing.  Worldwide there are 1,000’s of studies going on all the time – mainly medically related – a lot about the demographics of ageing – more and more around the commercial value of the ‘grey’ market.

They don’t all make fascinating reading, although they are never short of words.  Academics can make an awful lot out of very little, view things from every possible angle, focus on minute detail and come to most obscure insights.  Unsurprisingly perhaps, the commonest conclusion of many studies is that more research is needed :-).

Just occasionally you come across something that is fun and resonates with your own common sense.  Here is one report from last year that I have just got around to reading.  It comes from nowhere I have heard of – Wayne State University in Michigan, USA and is a study of 1952 major league baseball players which is not a subject that keeps me awake for long.  Americans are renowned for keeping sports statistics on every aspect of the game and also for collecting cards with pictures of all the major league players, so I suppose it was only natural to extend that curiosity into the longevity of the players.

Rather than looking at obvious measures of success, they focussed on the smiles on players’ faces.  It must have made for an interesting conversation when the research student first proposed the idea:-

“so to start with you have collected an album of 1952 baseball cards?”

“and you’re not interested in who hit the most home runs?”

“nor who took most catches in the season?”

“nor who was the best pitcher?”

“you just want to study the smiles on their faces ??????????????”

The players’ smiles were analysed from their photographs and grouped in terms of “no smile”, “partial smile” and “toothy grin”.  The lifespan of each player was then correlated with their smile – with some interesting results:-

  • The “no smile” group lived on average for 72.9 years
  • The “partial smile” group lived for 75 years
  • The “toothy grin” group lived for 79.9 years

Posted in SMILES | Tagged | 9 Comments

“Depression and Dementia”

Posted on October 27, 2011 by john graham

In the confusion around the diagnosis of dementia, it is not always easy to separate the symptoms of depression and dementia.  Certainly to the lay person it can be difficult to distinguish between the two issues.  In older people it is easy to imagine how someone who is clinically depressed can be thought to have dementia.  Among people over the age of 65, one in eight has Alzheimer’s disease, while one in eleven adults suffer from depression.  For the elderly it is important to distinguish between the two, because drugs can successfully treat depression.

Now some recently reported research in America suggests that the drugs used to treat depression may also improve memory loss in people with dementia.  It is very early days and more research is needed but it is possible that whilst depression may push you towards dementia, the anti-depressant treatment may protect you from further development of dementia.

Posted in Dementia, HEALTH | 2 Comments

“Southern Cross Double Cross”

Posted on October 25, 2011 by john graham

It is 10 months since I first forecast the collapse of Southern Cross Healthcare (see “Houses Built on Sand” dated 16th January 2011).  Later, the news hit the headlines and I wrote about it under the title of “Southern Cross Poker Game” dated 5th April 2011 (click on “SOUTHERN CROSS” in the TAG cloud for other related posts).

The key players in the game have ridden out the storm of publicity and condemnation, but what have all their assurances to the 31,000 residents amounted to:-

THE SOUTHERN CROSS MANAGEMENT TEAM failed to secure the £100m of new investment they were vainlessly hoping to find and their shares on the stock exchange have now been suspended and are effectively worth nothing.

THE LANDLORDS (bankers and vulture capitalists) were forced to swallow a 30% rent reduction but some took their revenge by grabbing back operational control of the homes they own.  This doesn’t solve the problem, just passes the buck to other operators – one – Bondcare – who is already in administration, and another – Four Seasons – who look to be in financial difficulties themselves.   So this part of the story is far from over.

Meanwhile, there are still several hundred homes and thousands of residents left with an uncertain future.

  • The important CARE QUALITY COMMISSION has sought sticking plaster solutions to quality issues in some individual homes, but completely failed to grasp the big issue of corporate melt down.  Their definition of vulnerable adults obviously doesn’t include the 31,000 Southern Cross residents !
  • The GOVERNMENT, in spite of all the politicians feigned concern about the residents, have continued to sit on their hands.  So far the break-up of Southern Cross has suited them well, by allowing them to stand back, keep out of the limelight and not have to cough up any bail-out money.  Provided they are prepared to ignore residents’ worries, this short-term solution will hold for a while – maybe even until the next election.

In the long-term however, there has to be a more strategic review of the whole residential care sector.  Underfunding is endemic in the industry and Southern Cross is just the tip of a very big iceberg.

In my very first blog on this back in January 2011, I suggested the Government consider closing all the expensive Local Authority residential care provision and  move elderly long-term care out of the NHS into the private / charity sector.  Macro economics will force this to happen eventually, far better if the Department of Health were to step in with a positive pro-active plan to reconfigure the whole of long-term care provision for the elderly on a sounder financial foundation.

This is the only way residential care quality will improve and vulnerable adults will be better protected.

Posted in Residential Care | Tagged | 1 Comment

“Rail Rage”

Posted on October 23, 2011 by john graham

I came back home from a meeting in London recently and just managed to catch the train.  It was about to leave when I got to the platform, so I had to leap into the end carriage and then as the train moved off, I drunkenly walked through the six, almost empty, first class carriages and made my way to the entirely full second class section at the front of the train.  By the time I found an empty seat I must have nearly walked all the way to Milton Keynes!

I wanted to do some notes after my meeting so I advanced up the train in search of an empty table seat in one of the two ‘quiet’ carriages in the 15 carriage train :-(, tripping over sticking-out feet and nudging elbows out of the gangway as I made my way past seat after occupied seat.  The ‘quiet’ carriage was chock-a-block and many of the seats elsewhere were ‘reserved’.  Eventually I found an table seat occupied by a coat without a ticket, although the coat did appear to have a reservation.  When I enquired, the adjacent passenger grudgingly removed the coat and I, not unreasonably, assumed that unless the reservee was about to parachute onto the train, I was safe to sit down at last.  I squeezed a space on the table for my papers among the i-Pads, laptop computers, kindles, blackberries, Costa coffee take-away latte and Pret-a-Manger crumbs-everywhere crusty baguette – an internet cafe come foodhall on rails!

It was then when Harry started his phone call.  I had never met Harry before and he was two seats away from me, but I felt I knew him quite well by the end of my journey.  He obviously thought that his phone didn’t work very well so he shouted down it.  The person he was calling must have had to hold the phone well away from the ear.  Sadly, I and the other ‘noisy carriage’ passengers had no such option.  We heard all about Harry’s day at work – he was an electrician and spent the journey talking to his boss about the problems he had been having with a circuit board.  By the end of the journey, most of the passengers could probably have passed a B.TEC in Electrical Engineering, given the training course 🙂 we had all received.

Fortunately for Harry, we pulled into Rugby Station just as I was about to beat him over the head with a baguette.

 

Posted in GRUMBLES | 6 Comments

“Be Bolder Mr Burstow”

Posted on October 20, 2011 by john graham

On the very same day that I was writing one of my series of blogs on dementia and suggesting more money spent on the disease – a remarkable coincidence.  I surfed the net for news of dementia and low and behold I found a press release from the DoH announcing £10m for memory clinics.

Great minds think alike?

Is the Government reading my blog?

Nah! That can’t be true and in any case £10m won’t solve the problem.  It is money to be spread across PCT’s all over the country which means half of it will be lost in administration.  What is more, I thought PCT’s were being abolished.

Be bold! be bold!

Get connected with the scale of the problem:-

  • Probably nearly 1m people with dementia
  • 100,000’s mis-diagnosed with wrong drugs (see my blog “Left in the Dark” dated 22 September 2011)
  • 100,000’s with no diagnosis at all
  • 100,000’s carers left in desperation with no support at all
  • £10m won’t even scratch the surface of the problem

30 years ago, I first started working with dementia residents at Newfield House, Coventry; it was scary.  I had not come close to a lot of residents in one place and certainly not in the later stages of dementia.  Lost in a dark world, endlessly wandering, repeating the same questions over and over, spouses locked in an everyday embrace of despair.

Staff struggling to cope with the side effects – difficulties of incontinence and over medication.  You have to be bold and committed to do the job, fortunately our staff were.

As time went on I learned to be less scared.  Some things could be done to improve the care.  Reduce medication, especially sedation.  Treat people as individuals – find out who they were in the past and talk to them on their own terms.  Give them positive things to do.  It was tough.  There was no quick fix.  We were blessed with some great staff with endless patience.

Years later we took our first residents on an outward bound course (see my blog “Swimming with Sharks” – Southern Cross 4 dated 30 May 2011)  We had taken physically frail residents for a long time, and seen the confidence building the experience had given residents.  We only did it with dementia residents at the insistence of my dementia home staff.  I wasn’t bold enough, but when we took the first step, what a revelation.  The residents could walk and talk and eat like we had never seen before.  But they could also climb and abseil and ride and canoe and sail.  It took a lot of encouragement, one to one support and skilled coaching.  It was hopelessly expensive but it was worth every penny to see people brought back to life again for a while.

The revelation was that there was a way forward and it didn’t require drugs or medication, just common sense and individual and personalised attention.

Roll the story several years on and ExtraCare Charitable Trust was emboldened to underwrite three quarters of a million pounds on a research study called The Enriched Opportunities Programme.  The key to this work was the role of a “locksmith” whose job it was to unlock the muddled up mind of demented residents by developing individualised activity programmes for residents.  Our bold action was repaid by charities who, in the end, fully covered the cost of the research by Bradford University.

The problem is certainly not solved but there is a way forward.  It needs continued bold action to challenge the way things are currently done.

Posted in Dementia, HEALTH | 1 Comment