How should healthcare services to care homes be configured – results from the Optimal Study

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham. He tweets @adamgordon1978 Claire Goodman is Professor of Health Care Research at the University of Hertfordshire.  She tweets @HDEMCOP Here they describe findings from the Optimal Study, funded by the National Institute of Health Research and delivered by a collaboration of researchers from the Universities of Hertfordshire, Nottingham, Surrey, City University London, University College London, Kings College London and Brunel University.

The UK care home sector, with 425,000 beds, is just over three times the size of the acute hospital sector.  It is home to some of the oldest and most vulnerable members of UK society.  The average resident is over 85, has multiple health conditions, cognitive impairment and physical dependency.  Providing care to such older adults is recognised to be complex and challenging.

Autumn Speakers Series: The boundary between health and social care

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham.  He is currently principal investigator for the Dunhill Medical Trust funded PEACH study which considers using quality improvement collaboratives to implement Comprehensive Geriatric Assessment in care homes.  His twitter handle is @adamgordon1978.  You can follow the PEACH study @PEACHstudy. He will be speaking at the upcoming BGS Autumn Meeting in London.

Care home residents in the UK receive their healthcare predominantly through the National Health Service. Their social care – primarily focussing on enablement to support activities of daily living and supporting participation in society – is provided by staff in their care home.

Or at least that’s how it looks on paper.  In reality, the boundary between health and social care is less well defined.  Providing care to the older people who live in care homes, many of whom have multiple conditions and are approaching the end of their life, requires frequent give and take between healthcare and care home staff.

‘Water, water everywhere’; dehydration in the older population

Janet Gordon & Marie Henson both work for Birmingham Community Healthcare NHS Foundation Trust. Janet Gordon is a dietitian working in Nutrition Support and is team leader for the adult Nutrition Support Team which is part of Birmingham Community Nutrition. At the time of the study Marie Henson was a Community Nurse team leader in the Kings Heath area of Birmingham, which is where the study took place. This study was presented as a poster at BAPEN Conference 2016 and was published here.

The prevalence of dehydration in older people in the UK has not been widely studied. The UK DRIE Study found 20% of residents in UK long term care were dehydrated. The prevalence in those living at home has not been determined. Dehydration in older people is linked to associated morbidities such as increased falls, confusion, and infections and is a frequent cause of hospitalisation. Clear signs of early dehydration in older people are yet to be determined, but there is a need to identify those at risk of dehydration and intervene early. Systems for recognising those with inadequate fluid intakes, and helping them to drink more, are already in place in many UK hospitals where a red jug scheme identifies those requiring assistance to drink.

Fostering attachment in dementia care

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. He tweets @berrisfjord

One of the most useful pieces of advice I can share with a colleague working in dementia care is this: whenever confronted with what you perceive to be attention­-seeking behaviour, reframe it to yourself as attachment-seeking behaviour.

Attachment is a hard-wired evolutionary mechanism in all mammals. Simply put, in order to survive, infants must imprint upon a main carer (typically one or both parents) to ensure that their essential needs are met.

These needs are not purely physical (food, drink, protection); the relationship itself is essential. This fact is aptly demonstrated by animal experiments (Harlow’s monkeys and Skinner’s rats, for example) which consistently show that infant mammals raised in isolation – with no access to a main carer to imprint upon – age quickly and die younger.

A Warm Glow in Solihull

Maxine Burrows and Yvonne Obaidy are Collaborative Leads for Early Help 0 – 19 at Solihull Metropolitan Council.  They develop high quality sustainable services for children, young people and families.  In this blog they talk about a new intergenerational pilot that they are working on and how they are enjoying the challenges and diversity that this work is providing.  Dr Zoe Wyrko (Consultant Geriatrician. Associate Medical Director – Quality Development, University Hospitals Birmingham) is providing them with support and help as needed, including evaluation tools for the older adults. You can follow them at @EngageSolihull

We are carrying out a pilot of intergenerational working in Olton, a district of Solihull in the West Midlands, with two local partners – St Bernard’s Residential Care Home for older adults and Tender Years Day Nursery. The care home has lovely cosy rooms – which are not huge, and the nursery has transport for five children so we chose to do a small pilot involving just five older adults to start with. Our intergenerational activity takes place every Wednesday at 10.30am for one hour.

We had several preliminary individual meetings with the nursery and the care home and then all parties came together for a final planning meeting two weeks before the pilot started. The meetings were useful for clarifying roles and responsibilities and planning some of the activities.  Most importantly the final meeting enabled the care home staff and nursery staff to meet and share their reasons for taking part in the pilot.

Handmade for Dementia North West & UK

Sharon Wallace is from Chester, Cheshire. She has been a professional singer for 34 years.

I sing in care homes around Chester and North Wales and had noticed that a few of the residents were quite anxious and fidgety, which was disappointing to see. My grandma had Alzheimer’s and now my beautiful mum and her sister both have Vascular Dementia.

I was introduced to the NHS Dementia Twiddle Mitt in March 2016 when I volunteered at The Hospice of The Good Shepherd in Chester. As a non-knitter, I decided that I would try to make one. That ONE has now taken me over…

World first study reveals admitting an older relative in temporary respite care can be a deadly mistake

A world first study into deaths of Australians admitted into aged respite care – usually to provide a planned or emergency break for their carer – reveals that older people in respite care are significantly more likely to die from preventable injury causes such as falls than those who are permanent nursing home residents.

The study found that preventable deaths from choking are twice as high as for long term residential care. Other preventable deaths such as from suicide are also higher in these temporary residents.

The research – published in Age and Ageing journal, by Monash University researchers – has serious implications for the 80% of older Australians who are cared for in the community by spouses, family members and friends. Of these more than 50,000 go into temporary respite care each year.

Predicting who will be admitted to a care home from hospital?

Jenni Burton is a Clinical Research Fellow in Geriatric Medicine funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh. Here she discusses the results of two linked systematic reviews of predictors of care home admission from hospital. She tweets @JenniKBurton.

Care home admission from hospital has long been recognised as an area of significant variation in practice (Oliver D et al. 2014. Making our health and care systems fit for an ageing population) and one which remains a strategic target to reduce across the UK. However, more than half of care home admissions each year in Scotland come directly from hospital settings. It is therefore important to explore the predictors of this life-changing transition to help inform prognostication, communication with individuals and their families, service planning and the extent to which we can intervene to prevent or modify this outcome. 

Autumn Speakers Series: Under what circumstances, and in what ways, is a quality improvement collaborative likely to succeed in a care home setting?

Dr Reena Devi is a research fellow in the Division of Medical Sciences and Graduate Entry Medicine at the University of Nottingham. She is working on the PEACH (‘ProactivE heAlthcare for older people living in Care Homes) study, which is led by Dr Adam Gordon, and funded by the Dunhill Medical Trust. She will be speaking at the upcoming BGS Autumn Meeting in London. She tweets @_DrReenaDevi 

Improving healthcare services delivered to older people is high on the national agenda. Nationwide initiatives are currently focusing on this, for example, six of the Vanguard projects set up in response to the 5 year forward view are specifically devoted to delivering new models of healthcare into care homes. Smaller scale initiatives are also being carried out in local settings, such as the PEACH project.

The PEACH project is using improvement science to bridge the gap between what we know and what we do in terms of the healthcare services delivered to care homes in South Nottinghamshire. The project is working with 4 clinical commissioning groups and their associated healthcare and care home providers, and is focusing on bringing healthcare services closer in-line with the Comprehensive Geriatric Assessment (CGA) model of care.

The struggle for age-proof medical care in the Netherlands

Wilco Achterberg (1963) is an elderly care physician and a Professor of institutional care and elderly care medicine in Leiden, the Netherlands. His research focus is on the most vulnerable elderly, most of whom live in nursing homes, and is centered around two themes: pain in dementia and geriatric rehabilitation. He tweets @wilcoachterberg

The Netherlands have been very fortunate to have had a very good insurance system for long term care, which provided good funding for nursing home care. That is why in a typical Dutch Nursing home you can find, next to nurses, therapists like physiotherapists, occupational therapists, psychologists, dieticians and even physicians. In 1989, a 2 year post graduate medical training program started, and ‘nursing home physician’ became an officially recognised medical specialism.  The biggest challenge for Ageing Holland is not how to provide good care for older persons, but how to pay for that care. Therefore, for several years now government is trying to find other ways of caring for vulnerable and care dependent persons.