Category Archives: Dementia Research & Best Practice

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.

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

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

People with Dementia cope worse in Hospitals, so why are our nursing homes in Asia designed to look like hospitals?

Hospital2.pngBelow is a great a great piece by Prof June Andrews republished free, online or in print, under Creative Commons licence.

 

Why hospitals are dangerous for people with dementia – and why it’s up to families to help

June Andrews, University of Stirling

People with dementia go into emergency hospitals more often than the rest of the population even though these hospitals are run as if every patient has perfect intellectual function. An acute hospital is like a meat grinder for people with dementia – it chews them up and spits them out – so it is worth both avoiding admission in the first place, and learning how to support someone if admission is really necessary.

Your local hospital might be prepared to welcome people with dementia but you can’t be sure. Its management would be wise to do so, as up to 50% of patients, on top of their illness or injury, may be elderly and frail and affected by either dementia or delirium. Delirium is a reversible state of confusion caused by stress and infection. If staff work to reduce delirium, it almost certainly also helps reduce problems associated with dementia.

Slippery slope

How we regard hospitals has developed over time. What was a costly amenity for our great-grandparents is now understood as a regular service. A building that was once viewed with dread because so many people died there is now seen as a desirable place to get treated. People battle against local hospital closures. They attend accident and emergency (A&E) in preference to going to see the GP, as if the hospital was superior.

But if old people with dementia can stay out of hospital, it’s much better. Of course, some things can’t be managed outside a hospital but for many, getting admitted is the top of a slippery slope. They may have been managing perfectly well at home, but during their hospital stay things happen that mean they never go home again.

Dementia patients are twice as likely to suffer preventable complications such as pressure ulcers and pneumonia in hospital. Patients with dementia and a fractured hip tend not to be given as much pain relief as other patients with fractured hip. Uncontrolled pain in dementia gives rise to delirium that is often undiagnosed and untreated in hospitals. As a result, half of these patients who develop delirium die in six months.

Patients with dementia may get missed by accident at mealtimes and have problems eating and drinking which are made worse in hospital. Some hospitals provide guidance but bad stories are more common.

Coping worse in hospital

Research shows that if you have dementia you will stay in hospital longer than other people with the same clinical problem. People frequently say that after admission it was discovered that they had not been coping at home. But in fact, it may be the opposite. A person who does not get enough to eat in hospital may have been eating adequately at home. The person coping on their own with washing and going to the toilet in a familiar home environment may not be able to negotiate the confusion of the ward and start to wet themselves and be unable to keep themselves clean.

Someone who managed to be happy and live quietly at home, sleeping at night and entertaining themselves by day, will be kept awake by noise and light at night, and bored rigid in the daytime, never even seeing daylight. Getting the lighting right can prevent major dementia symptoms such as mood swings, sleep problems, and behavioural issues.

Then when they become noisy and irritable they may be given dangerous anti-psychotic medication in the first instance to quieten them down. It is not unusual after this to have a fall or a fracture, causing a longer period in hospital during which patients can then develop depression and delirium, leading to early death.

This is a terrible human story. And it’s terrible financially too. Staying longer in hospital than others with the same condition makes for a greater tax burden and causes waiting lists. Social services are under pressure now to find care home places for people, when what they had before was a semi-independent person who mainly looked after themselves with a bit of home care. The family, if there is one, and the estate of the person now face the probability of having their assets stripped to pay for a situation that may have been avoidable or at least delayed for months and years.

Families can do more

Logically families should take more responsibility for care of elderly relatives while in a hospital. Be there to help them eat, and to help them with washing, keeping them company and making sure that they swallow their medication.

But hospital staff resist it. For political reasons the NHS has difficulty accepting a situation like this for fear of accusations that the system is failing. Just recommending help from families has in the past been misrepresented in the media or by politicians as an attack on the NHS.

This is because we have been led to believe an unreal fantasy of what hospitals can do. Recommending that families help is not a criticism but a practical response. If families support the frail person in hospital, it helps the nurses, reduces delayed discharges, saves money and maintains the dignity of the patient. Everyone wins. We must all do it out of enlightened self-interest to allow the system to focus on patients who have no-one and nothing.

The alternative is that we assume hospitals can do everything we expect for an ageing and increasingly frail patient group. That in itself is enough to lead to system failure, because we ask too much of them.

The Conversation

June Andrews, Professor of Dementia Studies, University of Stirling

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

Why we need Geriatric ERs in Asia

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CNN (Source: Geriatric ERs reduce stress, risks for older patients – CNN.com) recently touched on the need for Geriatric emergency rooms (ER) that can provide seniors with better care. According to the world bank, in 2010 there were 211 million older adults 65 years and above in East Asia and even in a little island in Singapore, by 2020, 1 in 5 Singaporean will be an older Adult. We have hospitals for children across Asia, isn’t it about time we started having at least an ER for older adults? Wouldn’t this not only be beneficial to the patient and their family but beneficial to the outputs in terms of care and the cost to the system as well. We all know that hospitals are detrimental environments for older adults and especially so for people with dementia.

  • unfamiliar alien environment
  • difficulty in orientation
  • high levels of negative stimulation from noise, smell, temperature…
  • constant interruptions to sleep well into the night
  • lack of autonomy
  • lack of natural light

We also know the benefits for the patient if we improve the acute environment and the care provided, but there are also wider benefits for society and especially for the family. With dependency ratios increasing in Asia and higher life expectancy rates, think China, with 1.3 billion people and a 4,2,1 family structure. With 4 grandparents, a couple, and their child, and now with the removal of the one-child policy, you may have 2 children in the family. If an older adult has been admitted into the emergency room the stressors on the family, especially the working adult will be incredible. Anyone who is a parent and are caring for parents will know this. This is not inclusive of the 30 million bachelors in China who will be the sole caregiver of their parents. How can we have an effective workforce if there is a constant worry that our parents are not getting adequate medical care in hospitals, on top of juggling work, kids and worrying about the health of 3 other older adults in the family? As a child you can’t not worry about your parents especially when it involves the ER, it’s only natural. A parent going to the ER is possibly one of the scariest thing a child can experience. On top of that, there are the worries about the out of pocket cost for care. The least we could get really is a decent healthcare system that can help care for older adults, and a geriatric ER will be a good start. In a Geriatric ER at least we know our parents are getting the right care from the start and in the right environment, that in itself will be a great relief from the get go.

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We’ve all heard of the Chinese proverb:

“The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness”.

A cultural change in care requires collaboration and evidence, and the success of early intervention will reduce the operational and financial strain on the health and social care system. Isn’t it time, for the hospitals in Asia that can make a change start doing something about it and adopt a salutogenic approach to care? Isn’t it time we start taking our own advice?

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Sleep, Dementia & Circadian Rhythms 

 

A simple and easy to understand video about circadian rhythms from the Oxford University. Over the years I have heard numerous discussions about the need for artificial lights and the needs for better lighting to aid the sleep process for people with dementia. However, do we actually know how, why and what light does to impacts our sleep patterns? This video provides an engaging and interactive way for us to all understand how it all comes together.

My key takeaway from the video is that natural light helps to keep us awake and maintain our sleep-wake cycle and natural light sources is by far the brightest light source around. 🙂

The transcript can be found below.

Published on 9 Nov 2015

How do you know when it’s time to wake up or go to sleep? More powerful than any alarm are your circadian rhythms. In this animation we take a look at how these rhythms work and what controls them, inspired by the TeenSleep project being carried out at the University to look at how later start times at school might affect achievement.

How does our body know when it’s time to sleep?
Humans detect light through the eye. Light enters the eye and is focused onto the retina at the back of eye. The retina contains photoreceptive cells that detect light and send this information to the brain, via the optic nerve. The most obvious outcome of this process is the ability to form images; to see. Image-forming vision depends upon rod and cone photoreceptors, which are critical for low light vision and bright light colour vision, respectively. However, it was discovered in 1999 that the circadian system of animals lacking rods and cones could still respond to light. This led to the discovery of a new class of photoreceptive cells: the photo-sensitive retinal ganglion cells (pRGCs), which express the light sensitive pigment melanopsin. These pigments undergo a chemical reaction when they absorb light, which causes the ganglion nerve cells to fire signals to the brain.

These signals from the melanopsin pRGCs feed directly into the Suprachiasmatic Nuclei (SCN). These are cells in the hypothalamus, near the base of the brain, which contains the master circadian clock (or pacemaker). The SCN orchestrates our circadian processes, to make sure that systems throughout our bodies are working together, in time. This system is also involved in controlling our sleep-wake cycle. As the level of light gradually decreases at the start of the night we produce increasing levels of a hormone called melatonin. Melatonin plays a vital role in our day-night cycles, acting as an internal signal of night time.

Why is being exposed to light at the wrong time so bad?
If we are exposed to light at the wrong time, say because we work night shifts, this confuses our system. Light supresses the production of melatonin, and promotes wakefulness. We delay our sleep and other circadian and sleep-dependent processes. We can work nightshifts for years and our circadian system will not adapt to our new sleep-wake cycle – primarily because we are exposed to natural light during the day, which is far brighter than artificial light sources. This leads to a whole host of problems. Working through the night means we are working when our bodies are craving sleep.

Is it different for teenagers?
The reason we are so interested in sleep during adolescence is because our circadian rhythms change during this period. From the age of 10 until around 21 our circadian rhythms delay. This means that as we go through adolescence and into early adulthood we are naturally more inclined to go to bed later and also to get up later. This is a biological process, and will happen to teenagers regardless of their environment.

Asking an adolescent to get up at 07:00 to start school at 09:00 is akin to asking a 55-year-old to get up at 05:00: this leads adolescence to accumulate a significant amount of sleep deprivation. The circadian drive isn’t optimised for wakefulness and engagement until around10:00.This means that adolescents are typically starting school at a time when they are feeling the effects of sleep deprivation and when their natural rhythms are not optimised for alertness, and therefore learning. There have been a whole host of studies, mostly from the US showing that a delay in the school start time improves sleep, mood, well-being, alertness and academic outcomes with one study suggesting that a delay in the school start time is more effective than improving the quality of the teaching.

Whilst timing of sleep (and activity) is important, so too is understanding what other factors might affect the quality of your sleep. Not only do adolescents have a natural biological predisposition to staying up later, but the devices they use to communicate and for entertainment may also impact sleep. TV screens, tablets and phones emit light at a level which may interfere with sleep onset, compounding the effects of the naturally occurring circadian delay. A recent study has suggested that teenagers may be particularly susceptible to the effects of light emitting deceives. Students are also dealing with the stress of exams and the pressure to perform well. The TEENSLEEP study aims to address some of these issues by looking at the effect of sleep education and delaying the start time of teaching on sleep quality and academic outcomes.