Alarming amounts of noise demand ways to silence noisy hospital environments

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Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Researchers will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country during the 174th ASA Meeting, Dec. 4-8, 2017, in New Orleans, La.

Source: Alarming amounts of noise demand ways to silence noisy hospital environments

Hospital noise is a growing concern for patients, family and staff, but many facilities are looking for new approaches to reduce the din and bring peace back to their environment.

Public Release: ACOUSTICAL SOCIETY OF AMERICA

WASHINGTON, D.C. December 6, 2017– Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Ilene Busch-Vishniac, of BeoGrin Consulting in Baltimore, Maryland, will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country.

According to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, noise is the top complaint of patients, staff and visitors. “Nearly everyone has a stay in a hospital at some point,” Busch-Vishniac said. “Noise is a universal problem in hospitals around the world.”

Busch-Vishniac will explore these concepts during the 174th Meeting of the Acoustical Society of America, being held Dec. 4-8, 2017, in New Orleans, Louisiana. Noises emanate from a variety of sources at the bedside. Airflow and the noisy machines controlling it are kept on high to prevent pathogens from lingering near patients, and overhead pages alert staff of needs or announcements. Equipment alarms are the most egregious source, and although they are designed to alert staff of changes in the patient’s medical condition, many also sound when medication needs to be changed or when battery conditions are low.

“Alarms in hospitals are being horribly abused,” Busch-Vishniac said. “Most of the time, they don’t in fact indicate urgent situations.”

Previous studies showed that alarms at a patient’s bedside sound an average 133 times per day. With so many alarms, staff often face alarm fatigue as well.

“Most alarms are being responded to eventually, but not all in a timely fashion,” said Busch-Vishniac. “Staff also may not respond quickly because they recognize that the sound is not critical and the situation will right itself.”

Besides the obvious barrier to rest, high noise levels have been associated with changes in the patient’s heart rate, respiration and blood pressure. These changes increase stress levels and may impair healing. The noise can also impair communication between patients and staff.

With noise levels on the rise, the Centers for Medicare and Medicaid Services (CMS) initiated the HCAHPS survey in 2008 to assess consumer perception of health care providers and systems. Today, more than 5,500 hospitals contribute to the report, which consists of patients’ responses on seven composite measures, including questions focused on room cleanliness and quietness.

The survey has teeth. Hospital value-based purchasing links up to 30 percent of CMS payments to hospitals across the country to the results of the survey.

“Faced with a loss of money, many hospitals are looking for ways to address noise levels in a way that patients can see as an improvement,” said Busch-Vishniac.

Hospitals have been developing and implementing noise control programs that can be broken into two categories: engineering and administrative interventions.

Engineering interventions aim to find ways to quiet the room. The solutions can be as simple as closing the door to a patient’s room or as complex as installing acoustical absorption materials along the walls and ceiling to dampen the noise level. Administrative interventions focus on changing behaviors. Many hospitals have instituted quiet hours when doors are closed and voices are kept low.

One of the big changes during the past 10 years has shifted alarms from solely sounding at the patient’s bedside to also alerting a central monitor at the nursing station. This approach improves the ability of staff to identify and respond to alarms set at a reduced volume.

According to Busch-Vishniac, it may be possible in the future to remove alarms from the bedside. A quiet hospital may not be a pipedream for much longer.

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Presentation 3pIDa: “Hospital noise: how bad is it?” by Ilene Busch-Vishniac is at 1:45-2:05 p.m. CST, Wednesday, Dec. 6, 2017, in Salon E in the New Orleans Marriott. https://asa2017fall.abstractcentral.com/s/u/M8hKSrQu66E

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Green for wellbeing – science tells us how to design urban spaces that heal us

 

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Generic plotting of ‘green space’ on an urban plan does not target mental wellbeing unless it is designed to engage us with the sights, sounds and smells of nature.
Zoe Myers, Author provided

Zoe Myers, University of Western Australia

One in five Australians will suffer from a mental health issue this year and living in a city makes it far more likely. Research shows that city dwellers have a 20% higher chance of suffering anxiety and an almost 40% greater likelihood of developing depression.

Promisingly, however, research has also found that people in urban areas who live closest to the greatest “green space” are significantly less likely to suffer poor mental health.

Urban designers thus have a significant role to play in lowering these rates of mental illness, and the data on how nature affects our brains are central to changing the ways we design. As depression is the world’s biggest cause of disability, we cannot afford to ignore the impact of public environments on mental health.

Multiple stressors associated with city living have been shown to increase activity in the parts of the brain corresponding to the “flight or fight” response.


Further reading: Vanishing Australian backyards leave us vulnerable to the stresses of city life


How does exposure to nature reduce these stresses? There are two enduring theories on how nature affects the brain. Both are based on nature having a restorative effect on cognitive and emotional function.

Hyde Park, Perth, allows for an immersive ‘escape’ from the urban world.
Zoe Myers, Author provided

It is not emptiness or quiet, however, that has the effect. Nature in its messy, wild, loud, diverse, animal-inhabited glory has the most impact on restoring a stressed mind to a calm and alert state. This provides a more complete sense of “escape” from the urban world, however brief.

This idea is not new, nor is it surprising. Many people seek out nature to restore wellbeing, and multiple disciplines have sought to measure these restorative effects.

The result is more than 40 years of research quantifying specific neurological, cognitive, emotional and physiological effects of “nature” elements. These effects include increased calm and rumination, decreased agitation and aggression, and increased cognitive functioning – such as concentration, memory and creative thought.


Further reading: Biophilic urbanism: how rooftop gardening soothes souls


A neglected resource for urban design

This wealth of data has been largely overlooked in driving good urban design.

Much of this can be attributed to the data being siloed into scientific disciplines separate from design. All use different languages and are often hidden behind academic journal paywalls.

Also significant is the complexity of mental health issues. This makes it difficult to draw conclusions on environmental effects. To use this data required first a meta-analysis of these methodologies and outcomes, and my own interpretation of how the data applied specifically to urban design.

There are some notable conclusions.

This pedestrian and bike path in Perth is unlikely to maximise the benefits of green space.
Zoe Myers, Author provided
  1. Different natural elements can induce different benefits. This means generic design plotting of “green space” on an urban plan, however aesthetically pleasing, does not specifically target mental wellbeing.
  2. Time plays a significant role. There is no point having great green spaces if these do not provide good reason or opportunity to linger long enough to experience the restorative benefits.
  3. How you engage with your environment matters. Results differ depending on whether the user is observing, listening, or exercising in the space. Taking these variables into account can produce a vast combination of design scenarios.

For example, despite the many studies on the restorative effects of forests, these are not the most accessible option for most city-dwellers. Urban parks are an alternative, but creative, natural interventions in urban spaces that encourage incidental interaction with green space can also produce much benefit.

Much has been written about how walking or exercising in green spaces seems to amplify the effects on the brain of viewing nature. Indeed, as little as five minutes of “green exercise” can produce these benefits.


Further reading: Higher-density cities need greening to stay healthy and liveable


What’s wrong with existing green spaces?

Many urban parks and green spaces – particularly in residential areas – are unimaginative, repetitive and lack basic elements to evoke these references to nature. Nor do they encourage walking or enjoying the natural elements for any length of time.

A typical reserve in Perth, Australia.
Zoe Myers, Author provided
A residential footpath and verge in Perth, Australia.
Zoe Myers, Author provided

For example, paths without shade or protection do not encourage walks long enough to achieve benefits. A lack of landscape diversity does little to activate fascination or interest, and fails to offer incentive to visit them, especially given the ways in which parks can be separated from their surroundings.

In an attempt to create spaces to serve function, such as ensuring enough turf for a game of football, much biodiversity has been removed, thus also removing the sights, sounds and smells needed for an immersive, multi-sensory experience. This applies equally to many suburban footpaths and residential streets.

A suburban residential street in Perth, Australia.
Zoe Myers, Author provided

When urban design gets it right

Septuagesimo Uno Pocket Park, Manhattan.
‘Jim Henderson, Atlas Obscura’

Compare this to urban areas that employ creative uses of incidental nature to capture attention and offer genuine interaction.

Successful parks and urban green spaces encourage us to linger, to rest, to walk for longer. That, in turn, provides the time to maximise restorative mental benefits.

Urban design’s role in shaping our cities is becoming less about the design of physical spaces and more about extracting principles that can be applied to urban spaces in ways specifically tailored to context, site, region and climate.

This means urban design can have a real impact on mental wellbeing, but we need to look outside our discipline for data to make it effective.

A Tokyo road reserve.
from Tokyo DIY Gardening

The ConversationFurther reading: Greening cities makes for safer neighbourhoods

Zoe Myers, Research Associate, Australian Urban Design Research Centre, University of Western Australia

This article was originally published on The Conversation. Read the original article.

Digital life stories spark joy in people with dementia

 

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Creating a ‘digital story’ of their memories using photos, music, text and video, can hep dementia patients open up to their fear and move into optimism.
(Shutterstock)

Elly Park, University of Alberta

I was sitting on the sofa across from Christine in her home. She offered me a cup of coffee. Each time I visited, she sat in the same spot — the place where she felt most comfortable and safe. She had shared stories from the past and decided to talk about the birth of her daughters, grandchildren and great grandchildren.

For Christine, a research participant in a multi-sited study into dementia and digital storytelling, the fear dementia brings is that she won’t be able to be a part of special moments such as the celebration of birth.

As we worked together in Edmonton, creating a multimedia story from her memory, Christina started to remember new things. She became emotional when she talked about her daughters becoming mothers themselves. She pointed out that the project was so much more powerful than looking through a photo album. Like many participants, she said she recalled stories she hadn’t thought about for years.

As a post-doctoral fellow in occupational therapy under the supervision of Dr. Lili Liu, at the University of Alberta I worked with several participants in this study. Funded by the Canadian Consortium on Neurodegeneration in Aging, one of our goals was to investigate quality of life and how technology affects the lived experiences of persons with dementia.

Technology and quality of life

In this research project we defined digital storytelling as using media technology — including photos, sound, music and videos — to create and present a story.

Most previous research on digital storytelling and dementia has focused on the use of digital media for reminiscence therapy, creating memory books, or enhancing conversation. Collaboratively creating personal digital stories with persons with dementia is an innovative approach, with only one similar study found in the United Kingdom.

During this project, I met with seven participants over eight weeks. Our weekly sessions included a preliminary interview to discuss demographics and past experiences with technology. Then we worked on sharing different meaningful stories, selecting one to focus on and building and shaping the story. This included writing a script, selecting music, images and photographs and editing the draft story.

“I was blessed with wonderful parents, and I was a mistake,” begins Myrna Caroline Jacques, 77, a grandmother of five.

Participants worked on a variety of topics. Some told stories about family and relationships, while others talked about a particular activity or event that was important to them. After all participants completed their digital stories, we had a viewing night and presented the stories to family members.

Happiness in the moment

It was an intense process. Eight sessions working one-on-one with persons with dementia required a significant amount of thinking, remembering and communicating for the participants. There were challenges, such as when participants found themselves unable to express their thoughts or remember details.

In this digital story, Christine Nelson talks of her love for her children and her fear of forgetting special moments.

Although many participants were tired after a session, they all felt that it was a beneficial and meaningful activity. Working in their homes on a personally gratifying activity with a tangible outcome seemed to keep them motivated and eager to continue. The process was also enjoyable and gave the participants something to look forward to each week.

There was a sense of happiness in the moment. And the way that participants responded to me, along with their ability to remember who I was and the purpose of our sessions, all indicated a deeper positive connection. The participants all felt a sense of accomplishment and family members were proud to see the end product at the viewing night.

Into the future

I have met with one of the research participants again recently, and she still remembers me. I would like to follow up with the others to get a sense of the long term impact of this digital storytelling project. I am also eager to see how the findings in Edmonton line up with those from the studies in Vancouver and Toronto.

The ConversationFor the participants, talking about memories helped them open up about having dementia. Getting past the fear and looking ahead with optimism was the message I heard, and one that I hope to keep hearing.

Elly Park, Assistant Clinical Lecturer in Occupational Therapy, University of Alberta

This article was originally published on The Conversation. Read the original article.

Japan offers us many lessons in embracing longevity

Japan offers us many lessons in embracing longevity

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With a quarter of the population aged over 65, Japan has had to be innovative in catering for their wants and needs.
Martyn Jones, Author provided

Marco Amati, RMIT University; Marilena Kavoura, RMIT University; Martyn Jones, RMIT University, and Robin Goodman, RMIT University

Japan is famous for the longevity of its citizens. A quarter of its population is older than 65. That is a proportion that Australia is likely to reach only by 2056. Japan’s experience makes it an interesting example to learn from in the area of aged care.

In 2000, following a decade of stagnant growth, mounting public debt and skyrocketing hospitalisation, Japan introduced the Long-Term Care Insurance Scheme (LTCIS). This universal and compulsory scheme provides support to assess and deliver care through institutional or community-based services for all people over 65. It provides sufficient funds to allow everyone to age in place – even those in public housing and with late-onset dementia.

The scheme represents one of the boldest social democratic experiments in aged care policy in the last 30 years. Yet with bold experiments come surprises.

To the chagrin of the scheme’s designers the LTCIS has been too successful. Cheaper to implement than the policy it replaced, it is still oversubscribed and contributing to Japan’s public debt (230% of GDP).

Happy Active Town in Kobe is a public housing estate where more than 50% of residents are older than 65.
Photo: Martyn Jones

The universal acceptance of the scheme contributes to a paradox: while Japan has the largest ageing population in the world, it is difficult to make a business of providing aged care, as the collapse of Watami, the food chain-cum-nursing home provider, demonstrates. So what can this experience teach Australia’s aged care sector?

Care happens within the community

The first set of lessons concerns community-based integrated care. Here, the LTCIS, following 2012 reforms, mobilises support through community general support centres.

Australia is seeking to improve integration of multi-level care. The support centre in “Happy Active Town”, Kobe, provides an example. This public housing estate houses many refugees from the 1995 Great Hanshin Awaji earthquake. Its proportion of residents over 65 is more than 50%.

The LTCIS, with the local government, provides a care hub for volunteers, social workers and health professionals to provide services and respite care free to all residents on and off the estate. Community hubs such as these are designed to support a range of needs from intense support to community and family engagement in care across the life course.

Happy Active Town in Kobe houses many aged survivors of the devastating 1995 earthquake.

Harnessing technological innovation

The second lesson comes from watching and observing the Japanese experience of integrating technology in care provision. Dense, multistorey buildings of small units are typical in Japan. New, so-called “Platinum” housing integrates universal design and new technologies to ensure safe independent living for the elderly.

Retrofitting large areas of public housing to this standard is complex and expensive. A limited number of exemplary regeneration projects where the local municipality, private providers and the LTCIS work together guide the way. One example is Toyoshikidai, a public estate built for young families in the 1950s in Kashiwa to the north of Tokyo.

Alongside these urban changes a generational change is afoot. As the digitally literate generation reaches old age, smart home devices and new security and communication technology assume increasing importance. The business opportunities alone could amount to US$1 trillion by 2035.

The Japanese government supports this shift with its “Silver ICT” agenda. This includes a raft of e-strategies to bridge the digital divide between “active and inactive” elderly populations.

Yet in the nation where the development of robotic assistive technologies enjoys vast sums of research and development support, there is little sign of this in daily life. In Japan, applying technology in aged care is fraught with ethical, personal and logistical challenges. The solution, for now, centres on the involvement of humans.

The ConversationThe Japanese experience of ageing is unique and varied, but presents a foretaste of the future for many post-industrial societies. The “Happy Active Town” of Kobe, 20 years after a major natural disaster, is one example of a place where public policy, housing and technology converge to create solutions for an ageing society. Its mechanisms to support the passion and commitment of the people working and living there can teach Australia how to age with dignity.

Marco Amati, Associate Professor of International Planning, Centre for Urban Research, RMIT University; Marilena Kavoura, Manager Industry Linkage, RMIT University; Martyn Jones, Associate Professor of Social Work, RMIT University, and Robin Goodman, Professor of Urban Planning, Deputy Dean, Sustainability and Urban Planning, RMIT University

This article was originally published on The Conversation. Read the original article.

Trishaws anyone?

A beautiful intergenerational activity to celebrate the love of cycling, a spot of reminiscence, and the great outdoors.

 

How lovely is this? As a child, my mother and I use to jump on a trishaw after our trip to the wet market. I use to watch the spokes go round and round and I still can hear the “Tak tak tak” sound the wheels make as we head home. It’s always a magical experience no matter how short the trip was. Took less than 5 minutes to reach our home from the market on a trishaw and I’ve sat in it for years and years with my mum, but it never grows old. With the wind in my face, the clicky round of the rickshaw, and just cuddled beside my mum with all our groceries at my feet, the world was our oyster.

When Cycling Without Age it just brought back all these lovely memories of my childhood. I wondered how wonderful would this be for it to be reintroduced into the community. There would be so many older adults in Asia whose main form of transport was the bicycle or the trishaw at a point of their time in their youth. As we aged and our physical abilities deteriorate, we lose our abilities to cycle and with it, our memories of freedom, that wind in your hair, the road just beneath your feet, to go wherever you wanted to go and be wherever you wanted to be.

Such an intervention can only bring generations together, a real intergenerational project of adventure and bonds. To bring people closer through the love of freedom and the outdoors.

I’m so glad to see this in Singapore and I hope that more Singaporeans will jump on board to support this movement!

If you have time, have a read of these 21 inspirational stories from Cycling without Age http://cyclingwithoutage.org/book/

Ageing in Place? Yes, we can!

Article: Why it’s good to be old in Wakabadai estate, where nearly half the residents are elderly

Read about a community that has come together to age together at the Wakabadai public housing estate.

Recently Channelnewsasia did a piece on the Wakabadai housing estate in Yokohama, Japan. It’s a really interesting estate and the means in which the estate has been configured bears many similarities to the high rise housing estates found in the big cities where we all live a wall away from our neighbours. However, despite living in the same building for 30 to 40 years a lot of us may just be acquaintances, saying the passing “hi” and “hellos” as we greet each other at the elevator or when we pass each other along the corridors.

A few years ago, I visited a couple who lived alone in a little apartment with two bedrooms, their children had moved out and the husband was caring for his wife with dementia. She is very quiet and apathetic. His greatest worry was that he may suffer a stroke or a heart attack and is unable to get help in time and both of them may pass away in their apartment despite being surrounded by hundreds or thousands of people living in the building. He cited a neighbour living a few floors below them, who had passed away without anyone noticing until a number of days later. He talked about the need for services for families like them, and many services assume that because they have children, there would be someone watching out for them. However, with the busy lives that his children lead, looking after their families and juggling work, they could only call in on the weekends and rightly so with the changing landscape of the economy.

His son offered to have them stay with him but leaving their much familiar neighbourhood might be too much for his wife. Even now she would get agitated if they left the vicinity. For them this is home, this is where they had built their lives, house their memories, thrived in their love, and they wouldn’t want to live anywhere else.

Why is it that when we grow old, we have to move away? We have to sell our home, move into a retirement village and start all over again. I want to live in a place that will evolve and age as I age, that grows old as I do.

Back to Yokohama, the Wakabadai public housing estate is just that, with slightly less than half of the residents 65 years and older, the people living in the estate are ageing in place together. To date, there is a total of 14,658 residents living in the estate in 6,304 units. To ensure that they needs are met, they have come together with organisations and council to organise a range of services.

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Map of Wakabadai

Social Engagement for Older Adults:

The Wakabadai Non-Profit Organisation enables social activities such as health, music, cultural and sporting events to be held in the vicinity. Himawari provides a space for volunteers to interact with older adults over a cuppa. Residents are also keenly aware of “kodokushi”, which refers to people who are living alone and have passed away and their deaths have gone unnoticed by the community. In Wakabadai, residents band together and keep a keen eye out for the sudden build up of mail or newspaper in the mailboxes of older residents and the mail continues to be left unattended with no notice that the resident might be away.

A paid service is also available at the Himawari Community Centre where they can have a staff to ring their phones to ensure they are alright. They can also have a spare key stored at Himawari for approximately 500 yen.

In addition, celebrations during festive periods are arranged by the organisation to encourage engagement among the residents. Sports events are also organised regularly to encourage and promote a healthy lifestyle among residents.

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Wakadabai Estate

Creating an Intergenerational Community:

To encourage engagement from children and younger adults, a facilty for mothers group known as Wakaba Family Plaza Soramame can be found in Wakadabai. A safe space for mother’s of infants and toddlers to interact, support and exchange vital parenting information with each other and older adults. Older adults with early childhood qualifications can find work as advisors, helping to support young mothers, sharing with them their years of wisdom. Coming into Wakaba Family Plaza Soramame, you may find three generations interacting and hanging out together.

Meaning Occupation:

The Wakabadai Non-Profit Organisation also helps to find jobs for older adults.

Older adults can also showcase their culinary skills at Haru Dining, a restaurant staffed by older women living in the area serving up old school, heartwarming home cooked meals.

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Assistance with Activities of Daily Living:

Residents can also tap on a home help service at the cost of 490 JPY per hour which covers everything from house chores to transport to get their food or groceries delivered. Transport is highly efficient with buses running every 3 mins to the major train station, currently, residents are campaigning for a train station to be built close to their vicinity.

Other accessible facilities in the area include a post office, supermarkets, salons, restaurants, shops, gyms and parks.

Healthcare:

When it comes to healthcare, the Community Centre run by the Yokohama City Council also provides exercise classes for older adults, a care facility for older adults during the day, and medical staff such as nurses are available to provide older adults health and medical advice.

In addition, Asagao, a district nursing service consisting of nursing and medical staff from an acute hospital in the area man an emergency hotline that is accessible for residents in the estate at all times of the day or night. On top of the hotline, staff also provide and provide home care to the residents in the community.

When it comes to high care needs, residential aged care facilities are also located in the estate for residents who are too frail to reside in their own home.

With all the facilities to encourage a positive ageing in place, it is no wonder that the rates of older adults requiring nursing care much lower than the average rates found in other estates in Yokohama. In Wakabadai, the rates of nursing care currently stand at 12 percent whereas, on average 17.5 percent of older adults in each estate is found to require nursing care at home.

Wakadabai has shown that ageing in place is possible and it is achievable in the big cities with high-density living. With key elements in place, council and community support, we all can grow old gracefully in the luxury of our homes.

A study shows that 1 truly remarkable change can improve lives and help save cost in residential care homes!

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In residential aged care, how many times have you heard the howls of frustrations as management and staff, shake their fist in the air, bicker and scratch their heads to work out how to improve dementia care at the same time balance the books. It’s a constant frustration, not just for the staff but for the residents with dementia and caregivers as well as they continue to pay for care and feel that they are unheard, unseen and their needs have gone unnoticed.

Good news, the latest study was presented at the Alzheimer’s Association International Conference from the University of Exeter and carried out in collaboration with University College London, Hull, Bangor and Alzheimer’s Society UK. The study evidently highlighted the fact that activities carried out in line with the philosophy of Person-Centred Care, coupled with a week of social activities resulted in a reduced in responsive behaviours in dementia and improve the quality of life for residents with dementia in a residential care home.

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The large scale study funded by the National Institute for Health Research was carried out in 69 residential care homes in the United Kingdom and consisted of 800 residents with dementia. Each of the 69 residential care home had two staff attend a four-day session, training them to socially engage with residents with dementia and finding out what residents would like in the areas of their care needs. When executed, this person-centred care approach coupled with an hour of social engagement found that not only was there a reported in the increase in quality of life but a reduction in responsive behaviours of dementia resulting in cost savings in dementia care to the organisation compared to care without such interventions.

“Taking a person-centred approach is about really getting to know the resident as an individual – knowing their interests and talking with them while you provide all aspects of care. It can make a massive difference to the person themselves and their carers. We’ve shown that this approach significantly improves lives, reduces agitation and actually saves money too. This training must now be rolled out nationwide so other people can benefit.”

-Dr Jane Fossey ( Oxford Health NHS Foundation Trust)

With the success of this study, the researchers are potentially aiming to have this intervention carried out in 28,000 residential care homes in the country, potentially positively impacting up to 300,000 residents with dementia.

What is ‘cognitive reserve’?

What is ‘cognitive reserve’? How we can protect our brains from memory loss and dementia

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Engaging in cognitively stimulating activities can help build your resilience to cognitive decline.
Gene Wilburn/Flickr, CC BY

Michael Ridding, University of Adelaide

As we get older we have a greater risk of developing impairments in areas of cognitive function – such as memory, reasoning and verbal ability. We also have a greater risk of dementia, which is what we call cognitive decline that interferes with daily life. The trajectory of this cognitive decline can vary considerably from one person to the next.

Despite these varying trajectories, one thing is for sure: even cognitively normal people experience pathological changes in their brain, including degeneration and atrophy, as they age. By the time a person reaches the age of 70 to 80, these changes closely resemble those seen in the brains of people with Alzheimer’s Disease.

Even so, many people are able to function normally in the presence of significant brain damage and pathology. So why do some experience symptoms of Alzheimer’s and dementia, while others remain sharp of mind?

It comes down to something called cognitive reserve. This is a concept used to explain a person’s capacity to maintain normal cognitive function in the presence of brain pathology. To put it simply, some people have better cognitive reserve than others.

Evidence shows the extent of someone’s cognitive decline doesn’t occur in line with the amount of biological damage in their brain as it ages. Rather, certain life experiences determine someone’s cognitive reserve and, therefore, their ability to avoid dementia or memory loss.

How do we know?

Being educated, having higher levels of social interaction or working in cognitively demanding occupations (managerial or professional roles, for instance) increases resilience to cognitive decline and dementia. Many studies have shown this. These studies followed people over a number of years and looked for signs of them developing cognitive decline or dementia in that period.

As we get older we have a greater risk of developing impairments in cognitive function, such as memory.
from shutterstock.com

Cognitive reserve is traditionally measured and quantified based on self reports of life experience such as education level, occupational complexity and social engagement. While these measures provide an indication of reserve, they’re only of limited use if we want to identify those at risk of cognitive decline. Genetic influences obviously play a part in our brain development and will influence resilience.

Brain plasticity

The fundamental brain mechanisms that underpin cognitive reserve are still unclear.
The brain consists of complex, richly interconnected networks that are responsible for our cognitive ability. These networks have the capacity to change and adapt to task demands or brain damage. And this capacity is essential not only for normal brain function, but also for maintaining cognitive performance in later life.

This adaptation is governed by brain plasticity. This is the brain’s ability to continuously modulate its structure and function throughout life in response to different experiences. So, plasticity and flexibility in brain networks likely contribute in a major way to cognitive reserve and these processes are influenced by both genetic profiles and life experiences.

A major focus of our research is examining how brain connectivity and plasticity relate to reserve and cognitive function. We hope this will help identify a measure of reserve that reliably identifies individuals at risk of cognitive decline.

Strengthening your brain

While there is little we can do about our genetic profile, adapting our lifestyles to include certain types of behaviours offers a significant opportunity to improve our cognitive reserve.

Activities that engage your brain, such as learning a new language and completing crosswords, as well as having high levels of social interaction, increase reserve and can reduce your risk of developing dementia.

Regular physical activity increases cognitive reserve.
Jenny Hill/Unsplash, CC BY

Regular physical activity also improves cognitive function and reduces the risk of dementia. Unfortunately, little evidence is available to suggest what type of physical activity, as well as intensity and amount, is required to best increase reserve and protect against cognitive impairment.

There is also mounting evidence that being sedentary for long periods of the day is bad for health. This might even undo any benefits gained from periods of physical activity. So, it is important to understand how the composition of physical activity across the day impacts brain health and reserve, and this is an aim of our work.

The ConversationOur ongoing studies should contribute to the development of evidence-based guidelines that provide clear advice on physical activity patterns for optimising brain health and resilience.

Michael Ridding, Professor, University of Adelaide

This article was originally published on The Conversation. Read the original article.

The Lantern Project Australia

The Lantern Project Australia, founded by Cherie Hugo, is about giving aged care residents the quality of life they deserve through good food and nutrition.

Source: The Lantern Project Australia

Stories waiting to be told

Why we need to open our hearts & listen to the people we care for

I wanted to share this beautiful video of Raelene and Soo Ren, who opened their hearts poured out their life story in this short 11-minute film. Raelene touches on the challenges in their life of being an inter-racial couple in the UK, their life settling down in Singapore in a house with 30 members of the family and later as a caregiver for her husband who is living with cognitive impairment. No matter the challenges both Raelene and Soo Ren continue to move forward in life, sharing every day together.

I also apologise for not blogging as much and not having any new articles of late. I’m currently 29 weeks pregnant and soon to start a new chapter our lives with a baby boy. In a way, Raelene and Soo Ren’s story strikes a deep chord in my heart because much like them, me and my husband are an interracial couple as well, with me being an Asian and my Husband being a Caucasian. We do face similar stigmas but possibly not those as aggressive as what Raelene and Soo Ren had experienced in the 60s and 70s. I do ponder the needs and the types of assistance that an interracial couple may require in the areas of dementia care, be it bilingual literature on dementia, or even training especially for expatriates and immigrants, hearing their stories. Most of us will become aware of the cultural differences that both will have to overcome to be together and as cognitive impairment and dementia sets in, can we say that we can we deliver care services that can meet the needs of interracial couples? Is there more that we can do?

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On top of the discussions on inter-racial couples, it is also important to recognise that everyone, everyone that you see has a story. As a nurse and a personal care assistant, I have heard of stories of women who worked in the times of war in the UK, wearing their hair in “victory rolls” and working on machines, the life of a submariner and the experiences of a WW2 Vet. There was a lady who took 7 months to sail from Australia to the UK, which to me was an incredible feat in itself. A man who knew more about the history of Singapore than I did, having visited Singapore in the 70s and 80s. A lady who thought me that when it comes to fashion quality far surpasses quantity, pulling out a teal dress she bought 20 years ago for a wedding that continued to look stunning on her at 80. A teacher who taught me all about baking and I’ll never forget five women who agreed in unison that a home cooked meal was the heart and gut of marriage. They opened their heart, they brought me smiles and laughter, sharing with me their adventures, their lives and their memories. I’m here to provide care, and yet it feels like they are providing me with the knowledge and care that I need to mature and grow, learning from their experiences and their stories, nourishing my mind and my soul, an experience that no money can ever buy.

Dementia, prevention & our children

There are 23 million people living with dementia in the Asia Pacific Region in 2015, costing the region a whopping US$185 billion. Little education exists on dementia for our children aside from countries such Australia, Japan, with some children attaining information in countries such as Korea, Singapore, Taiwan and China. However, there is nothing in the national curriculums to prepare children for Dementia or help children to fully understand  the need of dementia inclusive enabling communities or the preventative measures required for them to put in place at a young age to reduce their risk of dementia especially those brought about by lifestyle factors.

Ireland with slightly less than half the number of people living with dementia at approximately 20,000 people, and a population of 1.8 million and a land mass of 14,130 km2. Alzheimer’s Society reported that at least 30% of the young will know a person living with dementia. Last Wednesday it was announced on the Alzheimer’s Society website that Alzheimer’s Society and the Council for the Curriculum, Examinations and Assessment have included dementia in the school syllabus, making Northern Ireland the first to have a dementia friendly generation.

The resources are also available not just in English but also in the Irish language. Click here to view resources.

PRIMARY SCHOOL: The Archie Project from Reminiscence Learning has created a unique and innovative intergenerational awareness project to reduce the stigma associated with dementia. They believe that by engaging with young children they are dispelling the fear of dementia and changing the attitudes of our workforce for the future, providing education to support early diagnosis. Archie’s Story follows a scarecrow with dementia on his journey from exclusion to inclusion. The accompanying Archie workbook goes on to help children understand how Archie’s state of wellbeing improves by being understood, loved and included — a simple concept but one that both children and adults can relate to. The Archie Project provide books, workbooks, assemblies, scarecrow parades, Archie-related activities, training, drama and recognisable merchandise so that everyone can connect with the Archie character and learn how to engage with people with dementia in their families and communities. Links between schools and care homes enable children to put their new dementia awareness into practice. By increasing their knowledge of dementia, the project gives them confidence to interact with residents during visits to local care homes, where they take part in shared activities such as singing, gardening activities, coffee mornings, shared lunches, snooker, craft activities, tea dances and storytelling. Archie mascots encourage conversation and engagement with people at all stages of dementia. For more information visit www.reminiscencelearning.co.uk/archie (Source Alz Soc Youtube)

The promotion of dementia awareness not only helps us to create a better multi-generational dementia inclusive society but for our children, it will help them better understand the need for education and the impacts of negative lifestyle choices. A study based on a Comparison of the Prevalence of Dementia in the United States in 2000 and 2012 published in JAMA internal Medicine on the 21st November indicated that education appears to be a protector against dementia. Dr Kenneth Langa theorises that education “actually creates more, and more complicated, connections between the nerve cells so that you’re able to keep thinking normally later into life.”

In addition, Director of the Division of Behavioral and Social Research in the National Institute on Aging, John Haaga adds that “Education can not only change the brain, it can change your whole life… It affects what kind of work you do, of course. It also affects who your friends are, who you’re married to, whether you’re married. All aspects of life are affected by educational attainment.”

When children learn about dementia and the brain, they will also learn about the risk factors which will help them to adhere to healthier lifestyle choices. According to Dr Alina Cohen, “factors such as adhering to a healthy lifestyle including a diet that is rich in essential nutrients, regular exercise engagement, and having an adequate cardiovascular profile all seem to be effective ways by which to preserve cognitive function and delay cognitive decline.” This study by York University presented evidence that the delay of dementia is connected with healthy living which in turn aids higher brain function. On a whole, our children will understand the importance of education, strategies to building cognitive resilience and understand the need for a healthy lifestyle for a healthy brain. There are a whole lot more pros than cons in this picture and policy makers should really sit up and start using their brains to look at how this can be implemented. Students will be able to understand the effects of stress on the brain, the importance of prevention and help-seeking behaviours especially in the areas of anxiety and depression. On a systemic level, this will create not only a friendlier, integrated and healthier multi-generational society but one that in the future may potentially see a reduction in healthcare spending as a result of unhealthy lifestyle choices.

SECONDARY SCHOOL: In the summer of 2012, Stoke Damerel Community College was invited to become one of 21 Pioneer Schools as part of the Prime Minister’s Challenge on Dementia. The school took a unique approach to dementia education, placing it across the curriculum into as many subjects as possible and endeavouring to work in partnership with their community and local and national organisations. They placed emphasis on creative processes and outcomes, intergenerational contact and active learning. Subject leaders were actively engaged in determining the shape of dementia education in their own subjects. Some of the most successful projects at the school were those that involved creative ways of working and intergenerational activities. For example, as part of the PE curriculum, people with dementia visited the school to play croquet with year 7 students. For more information visit http://www.sdcc.net (Source Alz Soc Youtube)

In addition to Primary and Secondary school, Scout groups have also joined the cause On such program is A Million Hands a program that supports 4 main social issues, dementia being one of the four that have been selected by the young. The objective is to empower and enable the young and the youths to tackle these issues head on and have the courage to make a change. In the areas of dementia, Scouts may find themselves helping people with dementia to fight isolation or helping with awareness by teaching people to spot signs and symptoms of dementia.They may work to try and work to make communities more accessible and even work to campaign for a cure and improve the lives of people with dementia.

Dementia as part of the educational curriculum could well be a means to improve not just the future of our children but perhaps the society as a whole.

Death and dying, life and living in long-term care facilities in Singapore

Building a dignified system where Singaporeans can choose how we want to live and how we want to say goodbye

The loss of freedom, dignity and respect in places with 11 to 25 bedded wards, lacking in privacy, with staff being paid SGD$350 a month without food and accommodation were reported in a Channel NewsAsia program known as Talking Point. In addition, it was also mentioned by author and research Ms Radha Basu one staff member can be observed responsible for 20 to 32 residents in the night, and residents live with bare necessities such as a toothbrush, bed and a cabinet. The lifestyle was found to be highly regimented with the journalist sharing that there are were only 2 options for times for showers at 6 am or 7 am.  “it was like a hospital for the rest of your life” stated television host Anita Kapoor. She also states that “it’s not a criticism of the facilities themselves, it’s a criticism of the system. You cannot approach eldercare the way you approach hospital visits. It can’t just be a means to an end need. It is a life. You have to think in terms of life and end of life.”

I was really exhausted by the environment  

– television host, Anita Kapoor, 45 years of age.

I applaud Ms Kapoor for taking a stand and putting herself in the resident’s place, experiencing the environment literally for a fortnight first hand, living as residents lived.

Like my previous article about Singapore nursing homes, our story of the wooden bowl? I questioned how we want to care for our older adults, our parents, our grandparents, given the state of the nursing homes in Singapore. How do we care for our loved ones in Singapore with dementia without dementia enabling built environments?

My thoughts have constantly been being echoed in this programme. Pushing for better environments for people with dementia. I dare to say that I can dream for a day when Singapore will be able to have facilities that advocate for independence, dignity and respect for residents. Seeing an assisted living facility in the heart of Bukit Timah, it’s heartwarming and inspiring to see the St Bernadette Lifestyle village, assisted living facility that is just like a home.

It is with a flicker of hope that one day we can have facilities like intergenerational nursing homes inspired from our HDB designs (Taking a leaf from HDB flats for Pocket Gardens & Intergenerational Nursing Homes) which we call home.

In the meantime, I will keep working on a dementia enabling environmental audit tool for Singapore in the hope that we will be able to create dementia enabling long-term care facilities that Singaporeans can call home.

Watch the full episode here http://video.toggle.sg/en/series/talking-point-2016/ep24/458260

Poem: Do not ask me to remember

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Jikka: a beautiful & unique aged care facility in Japan

This is such a heartwarming facility, perhaps not the most dementia-friendly, but it is beautiful, enchanting and absolutely lovely. Nursing homes done differently. Food for thought, this nursing home in Japan was designed by 2 women and is known as Jikka. Created by architect Issei Suma, this facility in the mountains of Shizuoka Prefecture and brings together the community into the care facility.

Wheelchair accessible spa.

What does a person with dementia look like in Asia?

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I spoke to a few people about dementia recently and some were shocked at the fact that people with dementia are able to live in the community. I was quite surprised at the fact that they were surprised, I guess to me it’s been such a norm that I forget that people have different ideas and perceptions about people with dementia. One person even said to me that she thought people with dementia were people who have forgotten how to do anything, and that they get lost all the time, and maybe scream a lot or are angry. Or people who sat around in nursing homes and were the shell of themselves and stared into space all day. It was an incredibly painful feeling to sit and know that people with dementia are thought of that way.

However, with the media continuously labelling people with dementia as “sufferers” and movies portraying people with dementia as people with high care needs, staring into space or being highly disabled, it’s no wonder people have such negative stereotypes. In a cab ride last week, a cab driver pointed out that there’s not much point designing services for people with dementia since there will be a cure or a vaccine out in 5 to 10 years; he had seen the headline in the papers. I listed out the evidence on vaccine development and talked about the damaging impacts of the media and highly misleading headlines that are taking away the focus of providing care to people who are now living with dementia in the public eye. Again, who could blame him, he’s seen it in the papers. I left the cab feeling frustrated.

Media gurus with little understanding of dementia undermine the objective and essence of research, turning publications into another holy grail headline but it is their job to create publicity for the institution or organisation, and most of the time the rehashed facts are close but no cigar. Do these media personnel understand the devastating effect this has on people with dementia and their families, to be constantly thrown a lifeline every day that says a cure has been established only to find out it’s another sensational headline in the making.

Coming back to the person with dementia? Can the media change the way dementia is portrayed? An associate shared a good example of enablement. He talked about how he has a visual impairment and in the past without the aid of glasses, he would be severely disabled, however ,with glasses, he is enabled and can function just like everyone else. People with glasses are accepted just like everyone else. So how can we change the way the public think, accept and include people with cognitive impairment, in the same way as visual impairment? You don’t see a headline every day screaming that my vision can be cured or there’s a vaccine developed for my short-sightedness, could this be attributed to the knowledge base of media personnel having an understanding of visual impairment.

I’ve attached a 6 min trailer of the Last Laugh; here Kate Swaffer shares her experience of living with dementia and her experience after receiving a diagnosis of dementia. She’s an amazing woman, championing the rights of people with dementia, working on her Ph.D., is the inaugural Chair of the Alzheimer’s Australia Dementia Advisory Committee, author of “what the hell happened to my brain” and a founding member of the dementia alliance international.

Below is a video featuring the amazing Christine Bryden who has been living with dementia for 20 years and has been advocating for better quality of care and life for people with dementia. She was diagnosed with dementia in 1995 and when she was diagnosed with Alzheimer’s Disease at 46, doctors had prescribed that she stop working and prepare herself for the inevitable. 20 years now, Christine is an author of 2 books, lectures international, is a well-known dementia advocate in Japan, completed her post-graduate studies and is into her 15th year of marriage.

These active champions who have never given up, are true heroes in the face of dementia, and their hard work to make a change while living with dementia is truly admirable. However, looking back at my home encounters in the  last couple of weeks, it was a stark reminder that we still have a lot of work to do in the space of creating awareness about dementia in Asia, because what we think a person with dementia should look like, is not reflective of reality at all.

Taking a leaf from HDB flats for Pocket Gardens & Intergenerational​ Nursing Homes

I recently visited a friend living at Dawson and was really surprised at the gardens located on the upper floors of the housing development board (HDB) flat. There was a sky garden right up the top, but there were gardens found in between the floors as well. There isn’t a void deck in the traditional sense like the older flats would have, instead there are familiar seating areas found in these pocket gardens for the residents which are just like a void deck but with a beautiful view of Singapore filled with a range of greenery that stimulate the senses.

There’s safety and security features found in the garden as well, from lighting, to security cameras, handrails, and high vertical railings. For most parts the garden I visited was sheltered from the weather. There were even play area for kids.

I’ve got a few images of the gardens to share with everyone.

Security Cameras, Handrails & Railing 

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The image below on the left is from a separate HDB block. I added this image in because this was actually a bridge from the HDB flats to the garden. Residents have personalise the bottom of the handrails with little plants of their own on this bridge. The path is open to rain and other environmental conditions, however, the design intrigued me as the gardens are separate from the residents providing me thoughts on how we can link intergenerational services in one facility.

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The railing are really high too, approximately 1.3m in height, but enough that doesn’t have a caged in feel. I understand a lot of clinical staff would be concern about safety in nursing homes especially in the gardens. You can see behind me that an array plants have been strategically placed in front of the railing of fence. Below is the front view of the same railing behind me with the plants in the frnt. You can see that the beautiful lush greenery of the plants distract and divert attention away from the railing that appears to be muted, disappearing into the background.

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There is a number of wheelchair friendly access to the garden as seen below and handrails of different heights. The handrails were not smooth and provided some grip.

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Positive Stimulation (lighting, ceiling, temperature, sound)

The area is flushed with natural light and ventilation.Hanging lights and discreet lighting are placed strategically around the garden and sitting area. High ceiling seen in the garden according to Vartanian et al (2015) are seen to be

  • asthetically more beautiful then areas of low ceiling or closed rooms
  •  activate structures in the brain such as visuospatial exploration and visual motion processing information on objects and space
  • Non-enclosed space deactivates the cingulate region and it’s association with the amygdala

We all know that the Amygdala hijacks our rational thoughts and sends us all into a fight or flights behaviour. For designers working on environmental design for people with dementia, this may be something that we may wish to consider in the design of healing or therapeutic gardens and spaces to reduce the activation and evolutionary response to fear and anxiety brough about by the amygdala.

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Due to the lack of direct exposure to the sun, the temperature was cool and breezy, which made it quite relaxing even for a 32 degree day in Singapore. The chairs were cool to sit on, and none of the siting area was hot to touch. Despite a few older adults, and teenagers hanging around in the area, chatting in the afternoon, I could not hear their conversations until I am right beside them. The area did not appear noisy despite the moderate number of people hanging about.

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Familiar & Inclusive Environments

The garden also contained a number of familiar tables and chairs that we see at our local Kopithams (coffeeshops) found in HDB estates and food courts.

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Areas inclusive for children were also found in the garden containing a little area for hop scotch and for a game of snakes and ladders.

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Integenerational Facilties

Just looking at the garden, and thinking back on nursing home in Singapore, Nursing Homes can be integrated with other services to serve a multitude of generations and become a truely multigenerational facility such as the design below.The draft below is inspired by this garden and thoughts of an integenerational facility.

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I also notice the tables and chairs were great for students as study area but lack facilties such as powerpoints. Living in a crowded, high density city, finding study areas are getting harder by the minute. For people in the western world, this is our Asian phenomennon. We use to joke that rich kids get to study in Starbucks and fork out a ton for drinks while us poorer kids try and tough it out in the libraries or at the cloest Macdonalds or Mos buger. However, libraries may not be close to home, and if we wanted to study in a group, finding a location gets pretty tough. anyway who has to tough it out in eateries to study have to put up with the noise.

Older adults can participate in activities after they have sent their grandkids to kindergarden, or school and all come together in the mornings and return home in the evenings. Grandparents can also relax with their grandchildren in the public garden, grab a coffee and catch up with friends before meeting up with their kids and going home together. This is a dream for a place where communities and families can come together to build that kampung spirit.

If there is a multi-generation facility such as the ones found above, families can remind tigher and stronger despite hussle and bussle of our urbanised cities and dual income lives. We are already spending much time on transport and work, what we really need is some solutions to help support us with maintaining our relationships with out familiies to build a stronger, tighter, and caring Singapore, and we know it starts with family.

 

 

From ‘demented’ to ‘person with dementia’: how and why the language of disability changed

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The initial aim of political correctness, to establish non-hateful language was, and still is, admirable.
Nathan Anderson/Unsplash

Roland Sussex, The University of Queensland

In the second half of the 20th century, we came to accept that in certain cases we should avoid deliberately hurtful language. While many deride political correctness for going too far, its initial aim to establish non-hateful language was, and still is, admirable.

In the early 20th century, “moron” was a medical term for someone with a mental age of between eight and 12. “Mongol” was a person with Down syndrome, and also was indirectly a slur on people from Mongolia, some of whose features were supposed to resemble those with Down syndrome. “Retarded” described someone mentally, socially or physically less advanced than their chronological age.

We know these terms now primarily as pejoratives. “Mongol”, following the Australian tendency to form diminutives, has even given us “mong”, meaning someone who is stupid or behaves as such. Yet there is also a consensus such language is unacceptable. How did we get here?

The path to dignified language

In December 1948, the United Nations passed the Universal Declaration of Human Rights. Affirming the dignity of all humans, Article 1 of this landmark document states:

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2 goes on to specify this should apply

without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

The declaration, prompted by the dehumanising events of the second world war, soon led to concerted initiatives to avoid hurtful and denigrating language.

Race and ethnicity was the first area to be addressed in Australia, where the philosophy of respect was enshrined in the Racial Discrimination Act of 1975. This included the currently controversial section 18C, which made it an offence to offend, insult, humiliate or intimidate someone else on the basis of race or nationality.


Read more – What is Section 18C and why do some politicians want it changed?


In the 1980s the scope was expanded in Australia to include gender and sexuality, with the legitimisation of terms like “queer”, and an increasing range of different kinds of sexuality now evident in the LGBTQI designations.

Words like ‘deaf’ and ‘blind’ are commonly used in negative ways.
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The third big change involved the language for people with disabilities, whether cognitive or physical. Here the English vocabulary was full of terms that mixed description with pejorative overtones.

People first

Words like “deaf”, “blind”, “dumb” and “lame” are not only descriptions of physical ability and disability, but are commonly used in negative ways. For instance, “deaf as a post”, “blind Freddie”.

We have now moved away from such language. Especially unacceptable are nouns like “retard” or adjectives like “demented”. In their place we have the principle of people first. The person and the disability are separated.

Instead of a phrase like “demented person” we have “person with dementia” or “person living with dementia”. The New South Wales Department of Ageing, Disability and Home Care has a list of such terms.

We should avoid terms that suggest deficit in a negative way, such as “disabled”, “invalid”, “retarded”, “handicap”, “spastic” and “cripple”. We should also avoid terms that explicitly specify limitation like “confined” (say, to a wheelchair). “Suffering from” is to be eschewed for the same reason, since it suggests the person is passive and incapable.


Read more – Redefining the (able) body: disabled performers make their presence felt at the Fringe


A number of paraphrases allow us to avoid sensitive terms. Instead of “blind” we have “visually impaired”. People are not “disabled” but “differently abled”.

Some of these terms can go too far and are effectively euphemisms because they sound overdone and excessively delicate, like “intellectually challenged”.

It is preferable to use language that doesn’t exclude people with these conditions from society. A good example of such inclusive language is “ambulant toilet”, often found in airports and public places, which simply indicates the toilet is suitable for anyone able to walk.

The Disability Discrimination Act 1992 consolidated these issues in Australian legislation, which now forms part of an expanding suite of anti-discrimination legislation both here and overseas.

Ambulant toilet is a good use of inclusive language.
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Talking to someone with a disability

A general guideline for talking to someone with a certain condition is to ask that person how they wish to be described. In some cases, words like “deaf” have been reclaimed by bodies like the National Association of the Deaf in the US. The presence of the capital letter legitimises the term’s use, so long as it is done respectfully. In a similar way, various gender groups have reclaimed the word “queer”, and the fact they use it licenses others to do so too.

The requirement for respectful and considerate speech is not just a matter of good manners; it has teeth. Governments, education systems, companies, societies and other bodies often have guidelines for language use for people with disabilities.


Read more – Political correctness: its origins and the backlash against it


The US National Institutes of Health recommends “intellectually and developmentally disabled” or “IDD” for people with Down syndrome. Bodies like Dementia Australia have language recommendations.

Institutions and governments can apply a variety of sanctions to people who violate this principle in a persistent and hurtful way. These principles are now common in the English-speaking world and countries of the European Union, especially as enshrined in its Charter of Fundamental Rights.

The ConversationIn little more than a generation and half, we have become a more caring and inclusive society, and one much more aware of the importance of avoiding hurtful language. We don’t always get the expression right. But we are getting better at seeing the effect of what we say and write from the point of view of others.

Roland Sussex, Professor Emeritus, The University of Queensland

This article was originally published on The Conversation. Read the original article.

 

Bringing back memories with a bundle of love

A woman with dementia who had forgotten how to speak suddenly rediscovers her voice when paid a visit by a six-month-old baby: http://ab.co/2u3kQTV Source (ABC) 

Watch this beautiful video from the ABC news! It’s so heartwarming.

 

 

Chemical restraint in aged-care homes linked to early death

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Up to 60% of nursing home residents are on psychiatric drugs and around 30% are on powerful anti-psychotics.
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Juanita Westbury, University of Tasmania

Last night ABC’s Lateline discussed the case of 63-year-old John Burns, who died within 12 days of going into residential aged care. Burns was put into care after he started to display disinhibited sexual behaviour, and was prescribed anti-psychotics soon after.

The show reported that up to 60% of nursing home residents are on psychiatric drugs with as many as 30% on powerful anti-psychotics. It yet again draws attention to a problem that’s been recognised for over 20 years: the overuse of sedative medication in nursing homes.

And despite strong evidence that many of these drugs are not only often ineffective but may also cause substantial harm (in the worst case, strokes, pneumonia and death), their use appears to be increasing in Australia.

A case study

Lilian moved into the aged care home several weeks ago. She is 84 years old, recently widowed and, two years ago, she was diagnosed with Alzheimer’s disease. Lilian displays certain behaviours that are annoying other residents and some of the nursing staff. The main issue is that she goes into neighbouring rooms and sorts through cupboards, taking out other resident’s toiletries and underwear.

This is a real case that was described to me by nurses who were interviewed for a study looking at sedative medication use in aged care. To address Lilian’s behaviour, a nurse contacted her doctor to discuss the issue and they decided to give her a small dose of diazepam to see if it would help.

Diazepam, better known by its trade name of Valium®, is a long-acting benzodiazepine prescribed mainly for anxiety. There’s limited evidence that it’s effective for managing behaviours associated with dementia. So was it appropriate to prescribe this medication to manage Lilian’s behaviour, or is she being chemically restrained?

Chemical restraint

Medications such as anti-psychotics are often inappropriately prescribed to manage behavioural symptoms of dementia.
Ashley Rose

A variety of medications are prescribed in aged-care homes for their sedative properties. Some are used to manage the behavioural symptoms of dementia, and include anti-psychotics and benzodiazepines. And the use of these agents appears to be increasing. A recent study conducted in 44 Sydney aged-care homes found that over 28% of residents were taking anti-psychotic medications. The researchers noted that six years earlier, drug use in the same group was 24%.

So what exactly does the term “chemical restraint” mean? The definition used by the Federal Government is the “intentional use of medication to control a resident’s behaviour when no medically identified condition is being treated, where the treatment is not necessary for the condition or amounts to over-treatment of the condition.”

It may seem obvious to readers that, according to this definition, Lilian is being chemically restrained but many health practitioners working at aged-care homes wouldn’t agree. One director of nursing I interviewed said, “We don’t chemically restrain our residents….anyone that is prescribed a sedative medication has a medical condition; be it dementia, anxiety or a problem getting to sleep.”

Others feel that someone is only chemically restrained when the sedative dose is too high. This broad interpretation of what chemical restraint constitutes, or rather, does not constitute, validates the use of sedative medications for a substantial proportion of aged-care residents.

A growing problem

The prevalence of mental health conditions in the residential aged-care is increasing as the population ages and long-term psychiatric beds remain closed.

According to the latest Australian Institute of Health and Welfare (AIHW) report on aged care, over half of aged-care home residents have dementia. The majority of these residents will have symptoms such as aggressive behaviour, calling out and wandering. Over a third will have anxiety disorders and over half will have disturbed sleep. These statistics indicate that the majority of residents are likely to display mental health symptoms.

Among residents with serious mental illness, such as schizophrenia, major depression and severe aggression, the benefits of using sedatives outweigh harms. But for less serious mental health conditions, using such medication is not ideal.

Giving sedatives to older residents can result in significant harm, including confusion, falls, increased rates of pneumonia and even death, especially in the case of antipsychotics.

For less serious mental health conditions, using sedatives is not ideal.
Pedro Ribeiro Simoes/Flickr

Many of these medications only have modest effectiveness in treating difficult behaviours, anxiety and sleep disturbance. And there’s a mounting body of evidence that non-drug strategies can be effective for treating these symptoms. At the very least, non-drug measures should be trialled before sedative medication is prescribed.

Better alternatives

Behavioural symptoms of dementia, anxiety and sleep problems are not always caused by the dementia itself, but can be caused by other underlying medical conditions, such as infections or pain. So it’s important to rule out such causes first before starting treatment. But according to nursing staff, there’s often inadequate assessment of residents.

Non-drug strategies that are effective in managing symptoms include relaxation therapy, personalised music, video tapes of family members, one-on-one time and providing basic counselling and sleep hygiene measures. But many aged-care homes don’t have the staff, training or resources to provide these strategies. As one relative told me, “I just wished that the staff had the time to just be with her and calm her, talk with her and settle her down.”

The ConversationExcessive sedative use in aged-care homes is thought by many to be symptomatic of problems in funding adequate staffing, training and medical services in this sector. Little progress in reducing reliance on sedative use or chemical restraint can be made until this under-resourcing is addressed.

Juanita Westbury, Lecturer in Pharmacy Practice and Research Fellow, University of Tasmania

This article was originally published on The Conversation. Read the original article.

 

Personality changes do not begin in the onset of dementia or MCI

Latest findings from a study of 2,046 participants over 36 years from the Florida State University found that there is no evidence to support preclinical personality changes occur prior to the onset of dementia or even in mild cognitive impairment.

 

Associate Professor Antonio Terracciano, at the College of Medicine stated that “We further found that personality remained stable even within the last few years before the onset of mild cognitive impairment”.

 

Therefore, it is important to note that personality change may not be an early sign or symptom of dementia, however personality changes should not be ignore by caregivers or clinicians. These changes can have a large inpact on the quality of care and life of the person living with dementia and their caregivers.

 

Original article http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2653004

Replacing care staff with robots… is this really the solution?

To be honest, I would not want to stay in a care home like this. I wouldn’t have a robot care for my child, why would I have a robot care for the elderly. Especially when we know that the human elements of social engagement and familiarity are an essential for cognitive function. How confusing would it be for a person living with dementia to be residing in a home fully run by artificial intelligence? Wouldn’t it be like being trapped in a Dr Who episode where the world is run by Cybermen?

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