GrumbleSmiles

“A pill for everything”

Posted on September 7, 2010 by john graham

Since the formation of the NHS, we have become a nation of pill poppers. We have developed an expectation that there is a tablet for every ailment. If we visit our GP we feel shortchanged if we come away without a prescription. Indeed, how many of us ever do?

Since working with older people, I have always been struck by how many pills and potions they take. Elderly people’s bathroom cabinets are overflowing. It is almost a badge of pride to be taking more pills than your friends. Or is it a subtle cry for attention?

The medication round in nursing homes is a major event several times a day. Trolleys are laden with a multitude of drugs which have to be carefully controlled, individually accounted for and recorded on medication charts. Registration officers and pharmacists regularly check up on audit trails to underline the importance of these processes, and mistakes can carry severe penalties.

So how does this work for the majority of elderly people who live alone, often without any support ? How do you cope taking several different pills a day when your sight is impaired ? Worse still when your short-term memory is failing ? It’s not difficult to imagine that the administration of drugs in the community done by people on their own must be much more haphazard ?

According to the Association of the British Pharmicutical Industry:- More than 912 million prescriptions were dispensed in 2007, at an average cost of £10.37 each.

– This is a cost to the nation of 47 pence per person per day.

– Medicines account for 10% of total NHS costs which is over £10 billion spent on all NHS medicines.

– Prescriptions have doubled in number since 1990 and now on average we each have 15 prescriptions per person per year.

In the meantime, let’s start our own little audit:-

How many tablets and potions do we have in our house? (This includes over the counter medication)

The answer (not including odd boxes around the house and in our cars):-

51 Packets of tablets – around 1,200 pills in all

12 Potions (excludes cosmetics and suntan lotions)

At least 60% of these have not been used in the last 6 months

30% are out of date! But we are keeping them just in case

I dread to think of the wasted cost of that lot !

Maybe eventually we can start a national audit. Without breaking any clinical confidentialities.

Posted in HEALTH | Tagged "Pills", NHS | 2 Comments

Breakfast Exercise

Posted on September 6, 2010 by john graham

I am trying to lead a healthy life now I am retired. So I start most days with Tai Chi in the back garden. Half an hour of light stretching and gentle exercise improves breathing and balance as well as lifting your mood for the day ahead.

My next step in this virtuous new life is something healthy and today I have a new brand of luxury toasted cereal – Lizi’s Organic Granola. The package notes are a joy to read – I am saving the world!

The ingredients are 100% organic (all certified)

Even better – Lizi Shaw used to live in West Wales and I am helping support organic farming there!

Its slow energy release food from the good carb company in Llanelli – Yacki Da!

I am told how much to eat per serving – where are those b***** scales?

The product is “blood sugar friendly” – the glycaemic load has been measured by the world’s experts at the University of Otago in New Zealand – fancy sending my cereal half the way round the world (and back presumably) just to measure GL which I have never heard of and don’t understand. But still the Welsh always liked the All Blacks.

By now I am feeling really good about this product – great healthy food picture on the front of the packet – even a nice photo of Lizi smiling in her kitchen on the back – and such a great story too.

Now for the challenge – opening the packet – this must be the physical and mental exercise before breakfast. The foil bag must have been designed for Fort Knox. There’s no obvious point of entry, no key, no clue among all the other copious notes on the packet. This luxury cereal must be more valuable than gold!

By now all my Tai Chi composure has disappeared and my mood has turned to one of total frustration. Surely I can’t be incapable of opening a cereal packet. Has retirement dragged me down so soon?

In desperation I eventually find a pair of scissors – perhaps they should include a pair with every packet – although not inside the bag!

I slice off the top corner and spill a few seeds on the floor – better get the dust pan and brush before the wife sees them. What do I do with the re-sealable packet that I can’t re-seal? I could try and find an elastic band – but there aren’t that many hours in the day!

At last I get to the golden goods. Grumpy, irritable and about to spoil my lunch.

P.s. Lizi, next time you write such a wonderful story about your new organic cereal, don’t forget to put the note on the top corner of the bag in BIG ENOUGH PRINT FOR ME TO READ. I really would like to have known in advance that it’s “easy to open and re-sealable”.

Posted in GRUMBLES | Tagged "Breakfast", Exercise, packaging, Small Print | 3 Comments

“Mice on the move”

Posted on August 25, 2010 by john graham

Since first writing about the problems mice are having these days – see “Mouse traps become bridges” dated 1 April 2010 – it seems that the issue is much more widespread that I thought. Today the Daily Mail reports that another 3 mouse bridges have been built near Pontypridd at a cost of £190,000 !

That is not far from where I grew up, but I don’t remember mouse travel being such a problem when I was young. Indeed, the traps we had were designed to stop mice traveling quite so far. Thank goodness we now have environmental consultants who, for a small fee, can advise us about mouse rights.

Since the previous article was about mouse bridges in Somerset, it occurs to me that mice may wish to cross the Severn Bridge. I wonder what the mouse toll should be ? Maybe half a pound of cheddar.

If more and more mice are being killed on the roads each year, perhaps we should have a Department of Mouse Transport or a Mouse Czar.

Posted in GRUMBLES | Tagged Daily Mail | 3 Comments

A Confused Policy

Posted on July 28, 2010 by john graham

A recent Department of Health report places the UK eleventh out of 14 developed nations in prescribing four drugs used to help alleviate the symptoms of Alzheimer’s.

It’s not easy to get a diagnosis to start with, but when you do, you may well be told that you’re not yet demented enough to be given any drugs. According to the report, over 100,000 people in the UK are denied the drugs each year. This would seem to be a financial decision not a medical one. The National Institute for Health and Clinical Excellence says the drugs are not cost effective at £2.50 per day.

I have written already about the high cost of prescribed drugs and I am all for reducing costs in the NHS and not using drugs unnecessarily but surely this approach to dementia is both short sighted and distressing.

Now I’m confused.

Firstly, because I always thought that the earlier you start taking preventative drugs, the more effective they could be.

Secondly, at £17.50 per week to reduce levels of confusion, the cost would seem to be very good value compared to the likelihood of accidents related to dementia.

Falls are common amongst confused older people and the cost of a fractured hip to the NHS would dwarf the £17.50 a week which might prevent them happening.

Posted in HEALTH | Tagged alzheimer's | 2 Comments

Confusion about Confusion

Posted on July 20, 2010 by john graham

I have hesitated before writing anything on the subject of dementia because it is such a complex medical area with widely different levels of knowledge among clinicians and health care professionals. In terms of the numbers of people affected, it is probably the greatest challenge facing our ageing population, not just because of the huge scale of the issue, but also because of the lack of strategies for addressing the problem which vary from a degree of enlightenment to groping in the dark. For the sufferer dementia brings a baffling decline into an unknown and unknowing world. For their relatives it brings an often devastating and stressful period of bereavement before death, as a cherished personality deteriorates before their eyes.

This is not an easy subject and there are certainly no simple solutions. The field is full of uncertainties and in some cases miss-diagnosis. This in turn can lead to miss-information and in many cases mistreatment. I write not at all as an expert but as someone with some experience.

In 1986 I was involved in commissioning a nursing home which specialised in dementia. What an eye opener that was. I had no idea how devastating dementia could be on the individual and their family. That might sound naive but patients suffering from the later stages of this condition are either locked away in an institutional environment or left alone and isolated in the protective custody of a loving relative.

This first nursing home – Newfield House in Coventry – was held in the embrace of our early ideals of individualised support. We had a strong, highly committed and newly enthusiastic staff team, most of whom were liberated from a much more institutional NHS mental hospital regime. I don’t say this to be critical of the NHS; they were sponsoring partners with us in looking for new ways to care for people with memory loss. The staff brought with them years of experience – one third of them were qualified mental health nurses. One of the first things they did was to significantly reduce many of the drugs residents had been prescribed, particularly sedatives which were more used for containment rather than treatment. This often made caring for residents more demanding but importantly it released people to be themselves. It gave staff the opportunity to find out about the residents and often explained why they behaved the way they did.

To do this job, good staff have to have patience beyond belief, to constantly answer the same questions over and over and to creatively divert anxiety into a new and positive interest. We have come a long way since those early days and idealistic ambition, and some 30 years and much experience later, at least given us insights into more hopeful ways of caring for people with memory loss.

A cure still remains elusive and positive therapies are unaffordable for the majority of sufferers. Sadly, many people still sit in the same chair every day isolated in their own lost world.

What prompted me to write this blog was an article in the press last week that “walnuts can cure dementia”. Then this week I learned that “stopping eating cake can beat dementia”. No doubt behind these overly simplistic headlines lies some serious research, but newspaper sub-editors do a cruel dis-service to sufferers and their relatives by trivialising the research and by raising false hopes in this most serious of issues for older people and society as a whole.

I must thank Professor Brian Lomax, a Psycho Geriatrician from Leicester for first giving me an insight into this subject. The heading of this blog is the lecture title he gave 30 years ago and yet it would still be appropriate today.

I will write more on my experience of this subject in the months ahead but first I would like to hear from both professionals, carers and sufferers. Perhaps together we can build a more constructive way forward ?

Posted in Dementia | Tagged alzheimer's | Leave a comment

“Bus Pass bust up”

Posted on July 16, 2010 by john graham

The Government budget cuts are now under discussion and in a classic piece of political toe-in-the-water “sounding out” the Department of Transport has leaked that free bus passes for the elderly may be scrapped. The trouble with this approach is that it scares lots of pensioners and immediately polarises discussion, before any sensible consultation has taken place.

Let’s start with some free bus pass facts:-

60 is the age men and women qualify

11 million disabled and old people qualify

£1 billion is the cost of the scheme

What are the options ? :-

1. Scrap altogether (save £1 billion) –

Strands many at home and increases social isolation.

2. Only keep for poorest –

How do you and where is limit – £10,000; £20,000; £50,000

3. Only keep for registered disabled –

A system exists already

4. No change –

Leaves open argument of favourable to elderly

“Free bus passes for millionaires” – “silver bus surfers”

Questions which need to be answered:-

? What is actual usage

? Do wealthy pensioners use bus anyway

? Gets cars off the road – greener (Green Party)

? Is it just a way of subsidising public transport

? How much would fares rise if no subsidy for elderly

? How many pensioners would stop low paid work if no free bus pass

? How many pensioners would stop volunteering if no free bus pass

? Pensioners mainly travel off peak so is there a “real saving”

Posted in ELDERLY UK POLICY | Tagged bus pass | 1 Comment

Breakfast in America

Posted on July 6, 2010 by john graham

It doesn’t take long to remind me of one of the reasons I like America. You just have to go out for breakfast and you’re immediately given a comprehensive experience of what the “Land of the Free” is all about.

Politeness – straight away a friendly greeting. Next come endless choices – sit at the counter and talk to another diner, sit in the window with a view of the sidewalk, sit at the back wall quietly out of view, or sit at the centre tables and watch everyone entering – you decide – decisions this early in the morning are never easy.

No sooner do you get sat down than you have a glass of iced water and the offer of coffee – regular or decaf? There are lots of other options but coffee is the assumed default choice.

In the USA, it’s hot, it’s there straight away and you are offered a refill almost as soon as you have taken your first sip. More refills will follow at five minute intervals throughout your stay.

Now you come to the supreme challenge – choosing your meal from the 1,000 items on the menu. An alphabet of fruit juices – apple, blackcurrant, cranberry, damson, elderberry – I am sure it goes up to Zebraberry juice.

Then we go to the corn flakes, bran flakes, oat flakes, rice crispies of my childhood, and granola of my Disney visits with hot milk, cold milk, low fat milk, semi-skimmed milk, skimmed milk – it’s amazing what cows can produce these days. Now we come to chickens and eggs – one egg, two eggs or three eggs – boiled, poached, scrambled, fried – sunny side up or easy over. P.S. – all the yolks are perfectly cooked and runny, not like the rubbery, greasy hard yolked eggs we only seem to be able to make in UK motorway service stations. Bacon – American thin and crispy – English just the way we are used to – Canadian more like gammon. They don’t usually have Indonesian bacon but I’d bet they would get it for you if you are prepared to wait.

Fifteen varieties of sausage, mushrooms and beans all follow. Then there are the “sides” – upsides, down sides, insides and outsides – onion rings, corn, hash browns, corned beef hash – it never stops. This is like third-degree interrogation – everything you say is written down and used in evidence later.

Forget the rest – we haven’t even got to the omelets nor the pancakes. Pancakes for breakfast ! Next thing you know they will be offering me maple syrup. How on earth do they eat this sweet and savoury combination – maybe they just get mixed up with all the questions, and don’t remember what they have ordered? You have to be a quiz champion to order breakfast in America, but when it arrives it is uniquely yours – no two customers can conceivably ever make the same choice.

I forgot to mention the bread, white or brown is the most difficult choice you’re faced with in the UK. No, here you get white bread, wholemeal, rye, sour dough, granary, whole grain, croissants – you need to come back another day to hear the rest of the list.

Meanwhile, check out the upside down sauce (ketchup) bottle an obvious way of avoiding all that shaking and splashes on your shirt – so why didn’t we think of it ?

So what has this got to do with Grumblesmiles?

Well this was just a small diner in New York – one of many. The food was excellent, the service first class and it all cost less than £10 a head to set you up for the day. The diner had enough tables for about 100 people but only 20 or so were there – although it was a public holiday. This small restaurant employed at least 8 people – 3 waiters all turned out in black trousers, white shirts, pads and pens in their pockets – one guy at the counter and four more I can see in the kitchen. Most are no doubt on minimum wage and depend on tips to make up their pay but this one little operation creates a lot of employment, and by the way at least half the staff were over 60. Maybe this is a portent of the future pattern of employment in England. A low wage economy and people working well beyond current pension age.

One of my first jobs when I as young was as a part-time waiter in a pub restaurant. Wages were low but the tips were good if you were polite and attentive to customers’ needs. I learned a lot from meeting and talking to all sorts of people and gained a lot of confidence. Confidence building and reassurance that they are still able to make a valued contribution is something many retired people need as well as the opportunity to phase themselves gradually into not working full-time. The pin-money to top up small pensions is an added bonus.

I think the Government should look at how it could stimulate significant growth in the service sector by removing tax and beaurocratic barriers to low paid part-time work.

Who out there has had experience in this sector ?

Is it a good idea or is it demeaning to older people?

Posted in ELDERLY UK POLICY | Tagged "America" | Leave a comment

Magic of New York’s Central Park

Posted on July 5, 2010 by john graham

On the 19 May I was writing about Westminster City Council’s attempt at trying to enhance Hyde Park in London for older people with exercise equipment. Perhaps they could take some pensioners to New York and do some park benchmarking, there is a lot they could learn.

Today, I had a walker’s map given to me by my hotel just off Central Park. It’s 843 acres according to a plaque on a seat. Most of the seats have inscriptions with wonderful memories of people who have loved this place over the years. All the walks are specified precisely to the nearest one hundredth of a mile – always assuming you stick to the route and don’t get lost ! A footnote on the map says that the paths are “maintained by the Road Runners Club of New York. Oops I wonder if I am letting them down by walking? Anyway, why should I care, their map is no b***** good anyway. It’s comprehensive and incomprehensible ! After less than 5 minutes walking I am already lost . Perhaps the hotel didn’t want me back ? I have found there are far more paths in the park than on the map. Perhaps the Road Runners are paying to maintain more paths than they think !

For a while I try to get back on the beaten track, but I quickly give up and accept that it’s a voyage of discovery to not know where you are heading or where you will end up.

It’s 98º and very, very hot in the sun so it’s not long before I need to rest on a bench in the shade. Nearby is a sign which greets you at all the gates with the PARK RULES. You would need an hour to read them all. The children I am watching obviously haven’t read all the rules. Then again they are all under 5. Bikes and pushchairs cast aside like yesterday’s toys; they are running around like a ring-a-ring-a-roses game under the elusive shower of a rotating sprinkler; totally soaked; inhibited screams of enjoyment; an occasional tear when someone falls over; mum steps into the shower to give un-needed comfort to a child whose tears are quickly washed away by the excitement of the returning rain.

Meanwhile free entertainment is being provided to the Amphitheatre of on-looking parents basking in the sun and their pride in their offspring. The grassy ground is saturated now and puddles are waiting to be jumped in. A NEW JOY !

I wonder if all the rules stopped all the adults running around in the sprinklers in the park ? What a pity we all stop being children and have to grow up. Perhaps Hyde Park could have a water play area for grannies, granddads and children?

Time for another walk and in no time at all what’s this? It’s Alice sitting on a large bronze mushroom surrounded by the White Rabbit, the Cheshire Cat and the Mad Hatter, complete with oversized Top Hat. The hat I used to wear at so many ExtraCare events. I liked that hat and dressing up. Maybe sometimes – the best times – I am still a child after all.

Queues of children waiting to sit on a mushroom and have their photos taken by mum or dad. I remember that too, only they were grannies and granddads waiting to have their photo taken with me and my top hat. Maybe they can still be children too.

Just around the corner another new adventure. A boating lake full of radio controlled yachts navigating the Atlantic, the Pacific and the Indian Ocean. Not many children here, I guess they know the water is too calm to be an ocean. The sea-faring dads are all sailing round the world of their lost youth. Admiral Nelson winning Trafalgar again, Captain Bligh fighting off the mutineers, Black Beard finally finding lost treasure or a courageous Captain Ahab at last catching and killing Moby Dick. No lost galleons here. All success and happy-ever-after endings. Perhaps there are lots of children here after all.

Up and off rambling again I come across a stroller folded up and dumped in a little bin. Was this the occasion of a child suddenly learning to walk? And then realising they will not need another pushchair for at least 70 years!

The next strange scene I pass is a young girl who walks by talking to herself – an imaginary friend? Schizophrenia? Early onset of dementia? The plug in her ear (providing she is not deaf) means she is on the mobile phone to someone else, somewhere else. Is this what they mean by “you’ll never walk alone”?

From one Liverpool song to another, I have now arrived at Strawberry Fields. I can see why John Lennon liked this area. His New York exile ended here in Dakota mansions overlooking this magical place. Strawberry Fields “where nothing is real” was right outside his apartment. His songs still echo around New York. Only yesterday he was singing “twist and shout” on a dinner cruise boat on the Hudson River to celebrate Independence Day. What a shame he was not able to celebrate his own independence here for longer.

As my walk nears its end I find myself looking at another beautiful larger than life figure sitting on a bench with an open book in hand and yet another top hat. A duckling at his feet wistfully looking up for hope and inspiration ………… Hans Christian Anderson. I honestly could not make this up!

It’s a fairy-tale storytelling area where every Saturday someone comes and reads to an assembled throne of children. Tales of our childhood:- Thumbalina – the Red Shoes – The Princess – The Tinderbox – The Snow Queen – The Little Tin Solider – The Emporers Clothes and everyone favourite happy ending story – The Ugly Duckling. What a great job for grannies and granddads. I’d love to do it myself – all these eager and excited listeners.

I hope I succeeded in getting some of that children’s wonderment across to my staff when I was working with so many interesting older people. There is a world of living history in the lifetime stories of elderly people which would intrigue the young of today.

So come on Westminster City Council, maybe Hyde Park could become a living history experience with older people sharing their experiences with London’s children.

Wouldn’t that be better than 6 exercise bikes ? Children and older people playing together ?

Posted in SMILES | Tagged "America", smiles | Leave a comment

Cleanliness is next to Godliness – Follow up to “No Gumption”

Posted on July 2, 2010 by john graham

6.45 am – looking out of my sixth floor window of the Carlyle Hotel on Madison Avenue in New York – still not yet adjusted to American time. The city is just waking up. A few taxis racing by but no people walking, which is why one elderly man has all the time in the world to jet wash the pavement. Like most little boys I love playing with water, especially with a hose.

An elderly man looks like he is taking great pride in cleaning the pavement outside of a hotel restaurant where shortly tables and chairs will be laid out for a business breakfast on the side street.

Yesterday I saw another younger man walking the same street pushing a bin on wheels and emptying all the static bins at every street corner. In spite of 9/11, in the city that lost 3,000 people in the collapse of the Twin Towers, they still have rubbish bins everywhere, which is one reason why New York feels cleaner than London. Observing the street cleaning from my privileged lofty perch, I can see he is taking real care with dust pan and brush to collect up every cigarette end and all the discarded scraps of paper. A much more effective job than the privatised street cleaning lorry with its battery of rotating brushes that occasionally attempts to clean just one foot of the roadside kerb around most UK streets.

Now come the “professional” window cleaners pulling up in their white van, roof adorned with every type of lightweight steps, telescopic ladders and even sections of tower scaffolding. As well as 57 varieties of brush, squeegee mop and extending pole. The two specialists emerge from the van with rags and sponges hanging from every pocket. Aerosols attached to their belts like six guns and knee pads. They look like skateboarding scarecrow cowboys, ready for a showdown at the shop front window.

No George Formbys here. No time for cheeky eyes to peer at ladies through the glass panes. It’s all over in a few seconds – if you know what I mean. Quicker than you can say “draw”. Showdown on Madison Avenue.

Makes me think back to another holiday – 40 years ago cycling on the English South Coast with 3 school friends. All the way from South Wales via the Aust Ferry across the River Severn – no bikes strapped on the roof of cars in those days. When we arrived at the seaside town of Lyme Regis, we were fascinated to see the rubbish collection cart with a team of bin men all wearing top hats. I am sure I didn’t imagine it.

So what’s this all about? To suggest that old people are consigned to cleaning the streets would hardly be greeted with enthusiasm even if they were paid a minimum wage for doing it. Neither would it be very politically correct to require all the young graffiti artists, chewing gum chewers, street corner hoodies, long term unemployed and petty criminals on community service to wear high visibility clothing and spend 8 hours of every day very publicly spring cleaning our towns and cities.

There is the germ of good idea in there somewhere; if only we stopped long enough to think it through and extract the good things:-

Pride in doing a good job

Giving back something positive to society

Flexible hours working

? a tax free paid service to the Community

The old and the young working together

A pristine Britain in Bloom. The flowers are the next step.

Posted in SMILES | Tagged smiles | Leave a comment

Walking the Dog

Posted on July 1, 2010 by john graham

At 7am in New York, the street walkers come out – not the late night variety.

First are the power walkers – trainers, shorts and one, two or three unwashed, unpressed, faded, baggy tee-shirts. Bottle of water in hand, rushing to nowhere in particular.

Next come the dog walkers. Most being dragged along by over eager pets with sleepy reluctantly-exercising owners. The dogs’ path dictated by the next corner. Rest breaks determined by the location of the next lamp-post. Then there is the sudden pull on the lead and a head long diversive rush in the arbitrary direction of a new foe or little friend passing by.

Dapper little dogs trotting like a horse in a dressage event hoping to be awarded a rosette by a Cruft’s judge who happens to be traveling the same path. An elegant grey Weimarinar evenly paced, oblivious to its owner and everyone else but aware that it’s being admired. Then come 5 dogs – 5 leads all attached to one owner who appears to have left behind his sledge. It’s only a matter of time before he his hung, drawn and quartered!

The next early morning group are the delivery men. Their truck awkwardly parked further up the street than they would like. Out of the back doors comes their two wheeled trolley on to which they proceed to load box after box after box after box. Finally they add an extra bag just so that they won’t be able to see where they are going. That’s not necessary because they assume as important delivery people they have an automatic right of way on all roads and pavements. Approaching cars have to stop suddenly and pedestrians are expected to scatter. No time for pleasantries – there is a job to be done and the next delivery to be rushed to like a white rabbit in Alice in Wonderland – no time to say hello – goodye – I’m late, I’m late, I’m late.

Finally in this early morning pre-rush hour come the office receptionists and other early impress-the-boss starters. Coffee in one hand, latest mobile telephone in the other ringing up all the friends they can think of to tell them they are already on their way to work. Knapsack on their back but no time for wandering – they are always in a hurry.

If they all started out 10 minutes earlier, they would have time to say “good morning” and city life would be less frenetic.

Maybe we should have elderly people on street corners as “meeters” and “greeters” just to start everyone’s day off with a smile; an army of lollipop ladies and gentlemen ?

Posted in SMILES | Tagged smiles | 1 Comment