Unchain me: how our approach to safety leads to harm

Professor Joseph Ibrahim is Head, Health Law and Ageing Research Unit at Monash University’s Department of Forensic Medicine and the Clinical Director of Geriatric, Rehabilitation and Palliative Care Medicine, at a large regional health service in Australia. Joseph has a keen interest in promoting better care for older people and edits the Communiqués printed educational material designed for health professionals to learn from cases investigated by the Coroners Court. Learn more about Joseph on his personal website.

Joseph and the team recently completed a landmark Australian study published in Age and Ageing, examining deaths due to physical restraint of people living in nursing homes. The study found that five deaths were recorded in nursing home residents due to physical restraint over the 13-year period. The median age of the residents who died was 83 years; all residents had impaired mobility and had restraints applied for falls prevention; four had diagnosed dementia. The mechanism of harm and cause of death were ascertained by a forensic pathologist following autopsy and in all cases, were formulated as ‘neck compression and entrapment by the restraints’. Continue reading

‘A journey of a thousand miles begins with a single step’: raising the status of care home nursing

Dr Miriam Stanyon is a Research Fellow on the Achieving Quality and Effectiveness for Dementia Using Crisis Teams (AQUEDUCT) research programme at the University of Nottingham. She also worked, until very recently, for a number of years as a care assistant in care homes.  Here she talks about work to establish agreed competencies for Registered Nurses working in care homes.

nursing-home-residentIt is no secret that care home nurses get a bad press. If you type ‘care home’ into the BBC news website, the result is a series of stories about neglect and elder abuse, care homes put in special measures by the CQC or having to close due to lack of funding.  Among nurses themselves, care home nursing has a lower status than working in the NHS. It has traditionally been seen as a job to do when you’re close to retirement or can’t get a job in a hospital. I remember speaking to a colleague after she had attended some CPD training (which she had to self-fund and attend in her own time) and she expressed how she felt embarrassed to ‘only work in a care home’. Continue reading

Every older person in a care home needs access to high quality healthcare

chg-v2The British Geriatrics Society (BGS) calls for everyone who commissions or provides healthcare in care homes to follow the principles of good practice set out in the guidance we are publishing today, so that every older person who lives in a care home in the UK has access to high quality healthcare which fully meets their needs. Based on the clinical expertise of our members our updated guidance sets out clinical and service priorities for how best practice can be achieved, and provides clear indicators of what successful delivery looks like for older people, their families and carers.

In the UK 405,000 people over the age of 65 years old currently live in care homes. This represents 16% of older people over the age of 85. Their healthcare needs are complex and the average care home resident has multiple long-term conditions, and frailty. They are likely to have better health outcomes if health services reflect these needs, and they have access to comprehensive, multidisciplinary assessment, with input from healthcare specialists trained in the care of complex medical problems in later life. Continue reading

Choosing the right care for people from nursing homes: Hobson’s Choice, Morton’s Fork or Buridan’s Ass?

Glenn Arendts is Associate Professor in Emergency Medicine at the University of Western Australia and Chair of the Geriatric Special Interest Group of the Australasian College for Emergency Medicine. He writes about his Age & Age paper. 

donkeyHobson’s Choice: A choice where there is really only one option
Morton’s fork: A choice between two equally unpleasant alternatives
Buridan’s Ass: A hungry donkey placed equal distance from two identical bales of hay cannot use reason to choose between them, and so dies of hunger

Take a straw poll of hospital emergency department (ED) staff and you will find majority support for the following statement: “too many people from nursing homes are sent to the ED”. That your poll results may say something about the views of some hospital staff toward nursing home (NH) residents is immaterial. Acute medical care of dependent people with life limiting illness is an area of legitimate concern, and the prevailing orthodoxy is that ED is a less than ideal place to deliver it. For decades, health services have invested in a variety of programs and interventions to reduce the transfer from NH to ED. Continue reading

‘Distraction’ techniques as first-line treatments to manage dementia-related behaviours in care homes

Tamara Backhouse is a senior research associate at the University of East Anglia. In this blog, she discusses her recent co-authored Age and Ageing paper on the use of non-pharmacological interventions for dementia-related behaviours in care homes.

aaDementia-related behaviours such as, aggression, agitation, anxiety, wandering and delusions are common. They can be distressing for individuals with dementia and create challenges for those caring for them. Many care-home residents with dementia experience these behaviours frequently. Non-pharmacological interventions (such as, music therapy, animal-assisted therapy, massage and aromatherapy) have been recommended as first-line treatments for dementia-related behaviours. However little is known about the day-to-day use of these interventions in care homes. We explored if, and how, non-pharmacological interventions were being used in care homes to manage dementia-related behaviours. Continue reading

Delirium research in care homes: Trojan Horses and Holy Grails!

Najma Siddiqi is a Clinical Senior Lecturer in Psychiatry who works at the University of York & Hull York Medical School; and Bradford District Care NHS Foundation Trust. She discusses her Age & Ageing paper ‘The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people’.

aaDelirium (often called ‘Acute Confusional State’) is a common and serious illness among older people. It can be very distressing for patients, their families, and for healthcare staff; and can lead to worsening dementia, hospitalisation and death.

There is relatively little research on delirium in general, but this is particularly true of delirium in the care home setting. Continue reading

‘Help yourself’; Supporting older people towards independence

Rudi GJ Westendorp, is Professor of Medicine at Old Age at the Department of Public Health and Centre for Healthy Ageing, University of Copenhagen. In this blog he discusses his recent Age and Ageing paper New horizons: Reablement – supporting older people towards independence.

cottage

The majority of older people wish to remain independent and live in their own homes for as long as possible. Instead maintaining a cruising altitude however, the process of ageing forces many to descend towards dependency and long-term care.

It’s never too late to learn new ways for coping by yourself and to make preparations for independent living in older age. But it is a shame that too often these good intentions are superseded by doubts and avoidance. Continue reading

Adding meaningful to activities

Wendy Perry has been working with older adults for over 25 years, and has been specifically involved in the development, staff training and management of memory support services in both the US and the UK over the last 15 years. In the past she has worked for RSAS AgeCare as a Dementia Training Specialist and for the Association for Dementia Studies at the University of Worcester as a Dementia Practice Development Coach.  After moving to Scotland in 2013, she began work for Balhousie Care Group as the Dementia Services Development Lead. Of particular interest to her are the improvement of services for people with advanced dementia, understanding and responding to stress and distress in people living with dementia, and empowering care staff to make positive changes in their work culture. @dementiacentre

All of us at times do meaningless activities. We flip through channels on the TV or play silly games on our mobile phones.  Sometimes these activities serve as “breaks” from more intensive activity or time fillers when waiting for a person or an appointment. But rarely do we finish doing an activity like that and feel as though we have accomplished something, nor do we usually feel like we have contributed to the world in a positive way.  Not that we should be constantly out to change the world with our actions, but let’s face it, Candy Crush rarely made anyone feel better about themselves. Continue reading

‘A welcome with tea and cake’: Making the most of your care home GP

Aileen Jackson is a senior project manager for the dementia and diabetes programmes at the Health Innovation Network (HIN), the Academic Health Science Network for South London @hinsouthlondon

AJ BLOG PICThe Health Innovation Network (HIN) for South London like the BGS has an active programme to work with care homes to learn about, share and spread and adopt good practice in South London. During our last biannual care home forum we held a quick fire Q&A session led by two South London GPs Dr Nwakuru Nwaogwugwu and Dr Charles Gostling asking the question ’How do you get the best out of your care home GP?’ Everyone agreed that a good common denominator was to ensure that the GP was welcomed with tea and cake hopefully prepared and baked by the care home residents.  The forum then set to work on developing the basis for really useful HIN guide for care and nursing homes to get the most out of their GP. It was acknowledged by all that sometimes the GP care home relationship can be quite fractured due to genuine pressures on both GPs and the care home sector and the lively and interactive discussion provided a platform to discuss problems for GPs and care homes such as time constraints, a lack of confidence, training issues, external pressures and staff retention. Continue reading

Better medicine reviews in care homes – a no brainer?

fotolia-8532456-m(7)Wasim Baqir is a Research & Development Pharmacist at Northumbria Healthcare NHS Foundation Trust.

There are currently 405,000 care home residents in the UK aged over 65 taking an average of seven medicines, with some taking double or treble this amount. Research shows at any one time 70% of them have an error with their medication which can occur during prescribing, dispensing or administration. That’s a lot of errors.

I’m a clinical pharmacist working in Northumbria and although these figures are quite well known, they are still pretty shocking.

Medicines use in care homes is problematic: over-prescribing, lack of structured review and little or no resident involvement in decisions are common themes. Despite the evidence (think CHUMS report) and guidance (think NICE guidelines) medicines use in care homes remains generally poor. That’s why I’m backing a new campaign from the Royal Pharmaceutical Society to improve the situation.

Continue reading