Robots could soon care for dementia patients but experts warn it's 'not a replacement for human contact'

Robots could soon be caring for dementia patients, a report suggested.

Technological advancements mean gadgets and apps are already being introduced into dementia care.

Devices like GPS trackers are used to ensure patients do not get lost, while monitors in the home can detect falls and tell if the phone or television is being used, sending information back to family and carers.

Some dementia patients wear smartwatches, which collect data on their sleep and eating patterns, blood pressure and sugar levels for analysis by doctors, researcher and carers.

Technological advancements mean gadgets and apps are already being introduced into dementia care - but robots could be next

And interactive technology, including virtual reality and specialised apps and computer games have been introduced to care homes to help calm patients with dementia.

Electronic calendars and speaking reminders can also help patients tell the time or remind them to do simple tasks like washing hands.

Some care homes are also using robot animals which interact with patients to help them feel at ease – and it will not be long before robots are used to help with feeding, washing and mobility. 

The summary of technology available to patients is published today as part of a Lancet Commission report on dementia prevention, treatment and care.

It warned that while technology could be useful, it was 'not a replacement for human contact.'

Robots are just as effective at removing prostate cancer as humans, research showed in July.

The first-ever study into a type of operation performed by three-armed machines also found they cause patients far less pain.

It involves a highly-trained surgeon controlling a small robot from the back of the operating theatre and guiding it to remove the infected cells.

The section of the robot which removes the tumour is very small and experts claim it causes less bleeding, scarring and pain than the standard operation.

There were also concerns some devices could fringe on privacy rights and that most had not been tested to see if they had any negative effects.

It said: 'Advances in the use and application of technological innovations might help people with dementia to live in safe, stimulating, and functionally enabling environments, and support and assist carers and professionals in improving quality of care.

'However, evidence on the effectiveness for most devices is not available. Caution is therefore needed to protect people with dementia from overselling of ineffective and potentially unsafe devices.

Study co-author Professor Clive Ballard, of Exeter University, said: 'There might be some potential in robots but my worry would be if people started using that as a substitute for face-to-face care.

'Personal interaction is a human need and advancements in technology won't work unless you also have that human element.'

SOURCE: MailOnline, Rosie Taylor
Food for thought indeed, is this really where we are headed?

Make a playlist for someone with dementia: the results will astonish you

Music is neurologically special. If your brain were to be scanned while you listened to your favourite music, the screen would light up like a fireworks display. Not just the auditory cortex, but areas involved in emotion and memory, language and decision-making, movement and reactions.

Even if dementia erodes one part of your brain, music can still reach those other parts to tap into emotions, memories and even abilities thought lost.

The results can be astonishing – and profoundly moving. People who cannot speak can sing. People who struggle to walk can dance. People who have withdrawn into themselves take an interest in others again.

These effects explain the growing number of musical activities for people with dementia. Formal music therapy is wonderful but out of reach to many. The Alzheimer’s Society runs Singing for the Brain groups. There are fabulous outreach programmes by arts companies such as Opera Holland Park and the Royal Scottish National Orchestra, bringing live music into care homes.

Through music, these schemes bring people with dementia out of themselves to connect with others. But they rely on specialist expertise or a group setting that cannot be available when someone is having difficulty dressing, or lying on a trolley in A&E, or despairing at night.

We all know that flashback feeling when a song comes on the radio and takes you back to another time, person or place

There is a growing movement to democratise the power of music, including teaching families and care staff how to use something we all possess – the soundtrack to our own lives.

We all know that flashback feeling when a song comes on the radio and takes you back to another time, person or place. That is personally meaningful music – and research shows it has the most powerful effect.

At Playlist for Life, we teach skills to help family members and care staff find the right music for someone with dementia, and how to harness its effects. Playlist for Life has partnered with The Centre for Dementia Prevention at the University of Edinburgh to help further the research.

Psychologists have found that we lay down more memories between the ages of 10 to 25 than at any other time of life. So people can start by looking at what musical memories may be lurking in that “memory bump”. Once you have found the right music for an individual, research shows that listening for half an hour before difficult activities or times of stress should lead to a reduced need for psychotropic medication, reduced falls, and reduced stress and distress.

We recently visited a care home where a woman with severe dementia had been receiving a particular sedative 60 times every month. Since the introduction of a tailored playlist of music for her, she had not taken it at all, in 24 days.

Such music makes the job of caring easier and more rewarding. The very act of building a playlist brings carers closer to the individual they care for. And for families, listening can be a joyful experience that brings a loved one back for a while.

We are still only scratching the surface of what music can do, but the evidence is growing. Until then, be it with a playlist or Radio 3’s upcoming dementia programming, we can all spread the word: music can help people living with dementia.

SOURCE: The Guardian, Sarah Metcalfe

Its interesting isnt it how something like listening to music, something we all do subconsciously at times in our every day lives, can impact so dramatically on dementia sufferers. 

Small steps could reduce dementia risk

Joining a book club or signing up to learn a new language may well give your brain the mental stimulation it needs to ward off dementia.

A new study has found that having to engage in such activities in later life can help protect against cognitive decline, which in turn may reduce the risk of someone developing dementia.

Everything from playing chess to pottering around the garden can prove beneficial, but learning new skills or launching yourself into a brand-new hobby is arguably the most effective way to get a mental workout.

The Engage Your Brain report said: “It is never too late to benefit from cognitively stimulating activities, and you can learn new things at any age.

“In the same way that you need to maintain exercise for physical strength, you need to participate in mental activities to support the health of your brain.”

However, the study is more sceptical about the relative benefits of the many “brain training” apps and computer games which have grown in popularity.

The suggestion is that while these programmes may well improve a specific skill, be it vocabulary or memory, there is less evidence that they boost overall performance.

By contrast, going to Spanish classes or learning to paint appears to pay dividends.

James Goodwin, chief scientist at the charity Age UK, said: “Many people think that all thinking skills decline with age, and we know there is certainly a lot of fear around this happening.

“But decline is not inevitable, and there are plenty of activities that we can start today that can provide benefits for brain health.

“If they are new to you and require your concentrated attention they may even be activities that you do regularly in your life, such as playing with grandchildren, gardening or playing cards.”

SOURCE: care@home
The overriding impression seems to be that any kind of stimulus that engage the brain and our imagination can bring only benefits in the long run. 

Ask the Expert: My dad has dementia - how can I protect his money from £1,000-a-week care fees?

My dad has dementia and his condition has deteriorated recently. Sadly it’s probably time he had full time care in a care home. My mum died about five years ago, so we will probably have to sell the house to pay for his care – I think it’s worth about £180,000. He has £20,000 in other savings and a small pension that brings in about £5,000 a year on top of his state pension (he’s aged 72). I’ve heard care costs around £1,000 a week so his money will not last long. He was proud that he would be leaving something behind for my brother and me after his death: what can I do to prevent it all disappearing? I have Power of Attorney over his money so can I give some of the money to myself and my brother now?

I’m so sorry to hear about your dad. Deciding to move him into care can’t be an easy decision and money worries won’t help. Let me deal with your second question first: it isn’t advisable to give money away to avoid paying care fees. When assessing your father’s finances to see if he’s eligible for financial support, your local authority may well consider any gifts made now to be “deliberate deprivation of assets” and may count the amount given away as part of his overall wealth.

You can make gifts on his behalf as his attorney, but they must follow the kind of gifting pattern that he has established in the past.

The reported fees of £1,000 a week you have heard are the average across the UK for nursing and residential care combined. If your dad doesn’t need nursing care, average fees are around £700 a week – so not quite so bad, but your dad’s current assets may be significantly depleted. You can ringfence the amount that will go to pay care fees by purchasing a care fees annuity that will provide a top-up to his income to meet the cost of care. This is usually tax-efficient as it is normally paid direct to the care home rather than your dad, so not taxed as income. It will require a substantial sum to purchase the plan, but it will limit the total spent on his care. Talk to a financial adviser.

If you’re not ready to sell his house yet, local authorities are now obliged to offer what is known as a deferred payment agreement, whereby the council pay your dad’s care fees until either the property is sold, or until he dies – whichever is soonest – when the amount will have to be repaid, along with associated charges.

SOURCE: Eastern Daily Press, Mark Shields

Home care crisis stopping patients leaving hospital

A north MSP says it is “critical” that the Scottish Government provides health boards with the proper resources to stop bed blocking in the Highlands.

Stornoway-born Lewis Macdonald also maintains there must be better packages to attract home care staff.

In the NHS Highlands area, 58 of the 117 patients ready to be discharged are waiting for home care packages. Across Scotland, the figure is 433.

Two elderly patients at the Lorn and Islands Hospital in Oban have been waiting for weeks to go home.

Tommy Wood, 70, and Neil MacLeure, 77, both received home care from the provider, Mears Group.

Mr Wood said: “The doctor told me I could go home but there is no care package for me. I think Mears just don’t have the staff.”

Mr MacLeure added: “I keep getting told I can go home tomorrow, but it never happens. I understand there’s not enough carers.”

A spokeswoman for the Argyll and Bute Health and Social Care Partnership said: “Recruitment and retention of all staff in the health and social care field is very challenging, but there is a significant amount of service delivered in the local area. The care at home service is a priority for us.”

A spokeswoman for the Mears Group said: “We are following the agreed standard procedure that, after being admitted to hospital for three weeks, the service user will have to be re-assessed by social services as their condition may have changed. We have contacted social services to undertake re-assessment. We are awaiting their response and all being well, we look forward to recommencing their care package.”

Mr Macdonald added: “This issue occurs in hospitals across Scotland and patients must have somewhere to go when they leave. It’s critical that the proper resources are provided as well as more attractive packages for staff.”

Health Secretary Shona Robison said: “We are continuing to make progress and the number of bed days lost to all delays are 11% lower than January this year. The number of people delayed over three days due to delays in health and social care also fell by 14% between January and June of this year.

“The recently announced extra £9million to improve patient flow through hospitals will help us continue to reduce delays even further and we are investing further in social care to eradicate this issue.

“This year, almost half a billion pounds of additional investment will go into social care and integration while the health revenue budget will increase by almost £2billion by 2021.”

SOURCE: Press & Journal, Ann Mack

Is it time to rethink the drugs prescribed to dementia patients?

Marie Wynne cares for her husband, Denis, who has dementia, in their home in Stillorgan, Co Dublin. Overall, she manages pretty well and pays particular attention to his medication.

So when Denis was prescribed anti-psychotic medication last December, she waited until their adult children had returned to their homes after Christmas to start him on the medication.

“The doctor said he was agitated,” she says. “Now, I called it restless but I started him on the medication anyway.”

Three days later, while the Wynnes were out with a “Living Well with Dementia” group, Denis collapsed and was taken by ambulance to St James’s Hospital. Tests at the hospital could find no reason for the collapse.

Marie Wynne is convinced that the anti-psychotic medication caused his collapse.

“Denis has vascular dementia and atrial fibrillation [irregular heartbeat, which can increase the risk of stroke or heart failure] and I discovered that these anti-psychotic medications are contra-indicated for that. I also discovered that they are very powerful drugs that can be of value if someone becomes violent and aggressive. But Denis wasn’t a suitable candidate.”

She says Denis has the occasional aggressive outburst, which she’s not surprised about as when he was younger he was very active: “He played rugby. He was a sales director in a company. He was always building or making something at home or working in the garden.” She is concerned that these anti-psychotic medications are prescribed too quickly for people with dementia who become agitated.

Paddy Sheridan has been the full-time carer of his partner with dementia for five years. His partner was also prescribed an anti-psychotic medication to help reduce agitated behaviour.

“I found that it led to more sleepiness and lack of co-ordination during the day,” Sheridan says. “So I stopped the daytime tablet and continued with the night-time one so we could both get a better night’s sleep.”

Jacqueline Keane, whose husband is now in a nursing home, believes that the use of anti-psychotic medications led to serious deterioration in his condition.

“When my husband, John, was still at home, he was put on anti-psychotic medication because he became aggressive sometimes. But when I saw how they impacted on his ability to walk, talk and feed himself, I took him off this medication.”

However, when John Keane was taken to hospital, following an episode of extremely agitated behaviour, he was again prescribed the same anti-psychotic medication.

“I begged them not to put him back on these drugs,” his wife says. “I know he was difficult to manage, but again after 1½ days on these drugs, he couldn’t walk, talk or feed himself again. Yet they continued to give them to him for seven weeks.”

John was transferred directly to a nursing home from hospital and “now totally incapacitated a result of these medications”.

These three carers are keen to speak out about the use of anti-psychotic medication for their spouses and partners so that other family carers can become aware of the potentially negative effects. Marie Wynne, Paddy Sheridan and Jacqueline Keane also also took part in De-Stress, a study to access the health and wellbeing of spousal carers of people with dementia in Ireland.

At the June launch of the study in Trinity College Dublin, one woman spoke about her battle with medical staff regarding the use of similar anti-psychotic medication for her husband.

“It was the most severe aspect of the whole disease. I felt like I was fighting a fog and a wall of medication, which was isolating my husband more and reducing his physical capacities as well.  There were so many medications that we fought against, but we felt like we were interfering. The doctors will admit that none of them are specifically for Alzheimer’s, but they are believed to keep him safe.”

Sabina Brennan, director of the Neil Memory Research Unit at Trinity and lead researcher of the De-Stress study, strongly believes that there are other ways to minimise agitated behaviour other than putting people in chemical straightjackets. “Giving people with dementia anti-psychotic medication is a violation of their human rights,” she says.

Brennan herself had personal experience of the use of these medications when her mother, who had dementia, was in hospital.

“I used to ask the medical staff to call me if my mother was confused and walking the corridors,” she says. “I would go there as soon as I could and calm her down. But sometimes, the medication had already been administered by the time I’d arrive.”

At the study launch, family carers called on the Alzheimer Society of Ireland to campaign against the use of anti-psychotic drugs for people with dementia.

Tina Leonard, head of advocacy and public affairs at the Alzheimer Society, says the use of such medications should be a very last resort.

“It is crucial that local GPs, pharmacists and medical professionals regularly consult with people with dementia and their family members and carers over any medical treatment for their loved ones,” Leonard says. “We would encourage any family member and carers who are concerned over medical treatments for their loved ones to voice their concerns immediately.”

Adds Ann Twomey, the Alzheimer Society’s advocate for carers: “You are in charge of their medications. It’s very important for the carer to inform healthcare professionals about the tablets that agree with their spouse and the ones that don’t. It’s a good idea to keep a log of medications and show this to the doctors.”

Prof Brian Lawlor, old-age psychiatrist at St James’s Hospital in Dublin: believes there is inappropriate and excessive usage of anti-psychotic medications for patients with dementia in nursing homes and acute hospitals

Dr Shaun O’Keeffe, a consultant geriatrician at University Hospital Galway, has spoken out about the “unnecessary use of potentially hazardous anti-psychotic drugs” in nursing homes.

Treatment of dementia patients with anti-psychotic medication over a three-month period can lead to death in one in 100 cases, according to O’Keeffe. “One in 60 people will have a stroke if regularly prescribed these drugs. Chemical restraint and the misuse of psychoactive drugs is a violation of personal and bodily integrity and a breach of article three of the European Convention on Human Rights.”

To further complicate the picture, many anti-psychotic medications are not licensed for use with people with dementia but are still administered. “They are unfortunately being used a first rather than a last resort in too many cases – particularly in hospitals which don’t have specialists in dementia care,” adds O’Keeffe. 

Prof Brian Lawlor, old-age psychiatrist at St James’s Hospital in Dublin, agrees that the use of anti-psychotic medication for people with dementia is widespread and needs to be curbed, although he says the medication is beneficial for a small proportion of patients with dementia who might harm themselves or others. 

“The message is to start low [dose] and go slow and review the medication every four to six weeks,” he says. “If there are side effects such as problems with sedation, swallow and mobility, then the person should be taken off it.”

Lawlor believes there continues to be inappropriate and excessive use of anti-psychotic medications for patients with dementia in nursing homes and acute hospitals. 

“It’s a question of education and training,” he says. “Sometimes a person with dementia can be in pain or distressed about being in a strange environment and he/she isn’t able to verbalise what’s wrong. Even for cases of delirium, the cause can be an infection, pain or constipation.”

Studies find that hospital staff were often focused on the acute medical or surgical reason that led to hospitalisation of the person, rather than the overall care of the person with dementia.

Most healthcare professionals agree that dementia awareness training would go some way to dealing with overuse of anti-psychotic medication for people with dementia who seem agitated. And if everyone was more aware of looking after the basic needs of a person with dementia first, perhaps the medical profession wouldn’t be so quick as to prescribe anti-psychotic medication.

A wider focus on the ongoing care of people with dementia can reduce the use of anti-psychotic medication prescribed for agitated behaviour. And the active engagement of carers of people with dementia in their hospital care is extremely important, according to the Irish National Audit of Dementia, which was published in 2014.

Firstly, medical staff are often more focused on the acute medical or surgical reason that led to hospitalisation rather than the overall care of the person with dementia.  Secondly, people with dementia can experience difficulty having their needs understood and met in acute hospitals, so a family member is often more familiar with their personal needs.

Dementia awareness training for all hospital staff is also considered to be crucial for the holistic care of patients with dementia. 

“Three years ago we introduced dementia awareness training for everyone from porters to doctors and nurses,” says Prof Brian Lawlor of St James’s Hospital. “There is still a need for more education and training to manage and support people with dementia. We need to be able to put ourselves in their shoes and have an empathic understanding of what is going on for them.”

Specific training for care attendants would also help ensure the needs of people with dementia are not neglected in the busy environment of an acute hospital.

In the absence of family members, care attendants can also ensure patients with dementia are kept away from chaotic or stressful zones and check that their basic needs for food, water, going to the toilet and pain relief are always considered before, during and after receiving treatment.

SOURCE: The Irish Times, Sylvia Thompson

Clearing the fog of dementia with song

Music’s ability to trigger our deepest memories and emotions could help improve quality of life for people with dementia

Anyone who’s known a loved one with dementia can testify to its cruelty – the frustration, anger and sadness that comes from watching someone you love slip away.

Dementia, the umbrella term for conditions with a severe decline in mental function, can be an incredibly painful experience, marked by confusion, distress and a profound sense of loss. It’s also increasingly common. Dementia is now the second leading cause of death in Australia.

There is no cure, but researchers, including Professor Felicity Baker, co-director of the University of Melbourne’s National Music Therapy Research Unit, are looking for new ways to help people cope.

Professor Baker studies how music, especially singing and songwriting, can be used to treat people with a range of conditions – from young people with traumatic brain injuries to adults with substance abuse issues. She says music therapy can be a way for people living with dementia  and their carers – to deal with its symptoms.

 “We know that managing dementia with medication actually can make people more confused,” she says. “We need to be creative in finding ways that people with dementia can manage the challenges they face, and to address distressing symptoms such as agitation and depression.”

Professor Baker recently developed a songwriting program for people living with dementia and their carers at Caladenia, a care centre based in Melbourne’s eastern suburbs. Participants worked together in small groups to write and compose songs with a music therapist.

In one 10-week session, participants wrote seven songs. They sang about family, cruise ship holidays and staying out until the sun comes up. They thought about, talked about and even argued about songs they created, from the lyrics to the musical direction.

Even participants who normally struggle with conversation and interaction were able to work together on a music project.

“With music, they’re really engaged in a way that they’re not in other activities,” says Professor Baker. “They’re offering their ideas and perspectives. They’re happy to argue with each other about what they think the lyrics should be and whether the lyric fits the melody.”

But what really struck Professor Baker was that participants remembered the music they created.

“There’s this assumption that people with dementia can’t learn, that they’re just losing memories,” says Professor Baker. “But what we found is that they were actually remembering lyrics from week to week.”

Professor Baker’s findings will be used to inform her next project, a large-scale study funded by a grant from the National Health and Medical Research Council. She hopes to find out more about how collaborative music therapy, such as group music therapy or choir groups, might affect the cognitive function, depression, neurological symptoms and quality of life of people with the condition.

The project will include a major randomised control trial, comparing standard dementia care practices with three music-based interventions – group music therapy, larger choir groups and a combination of both.

There’s no doubt that music is a huge part of our lives. The simple act of listening to a song can evoke memories and emotions of heartbreak, love affairs, places or people in our past. And scientists, too, have long known that music has a powerful effect on brain function.

Unlike other stimulants, Professor Baker says, music engages all parts of our brain.

“When we engage in some activities, specific neural networks are activated. But when we listen to music, we actually engage quite a distributed network of neuronal activity.”

Studies have also shown that the act of creating music – songwriting, singing or playing an instrument – is more effective in stimulating our brain than just listening to music. In other words, it’s more stimulating to write and sing a song than listen to your favourite album.

“When we sing, we’re stimulating our auditory system, we’re stimulating our physical system,” she says. “When we use language in song, it’s tapping into our emotions and it’s tapping into physiological processes like our heart rate and our breathing.”

Since music is an emotional and physical stimulant, Professor Baker wants to see how much it can trigger memory function for people living with dementia.

“The theory is that pairing music and lyrics with an emotional experience can reach the threshold for memory,” she says. “It connects people and helps them to remember.”

A 2009 study by the University of California, Davis, for example, found that the area of the brain that holds our memories and links music to emotions is also the last part of the brain to atrophy during Alzheimer’s disease, the most common form of dementia.

Professor Baker’s research project is the Australian arm of a much larger study into the effects of music therapy on people living with dementia. Work in Australia will involve 500 participants, but academic colleagues in Norway are leading similar and even larger initiatives.

“It’s going to be the biggest music therapy study in dementia care ever and it’s certainly a game-changer for the dementia field,” she says.

Previous literary reviews about the effects of music therapy have been promising but inconclusive, citing the need for larger studies and more evidence.

“Worldwide, we have amassed a lot of small scale studies that show it’s effective but nothing big that will help us be taken more seriously when healthcare policies are being made.”

The NHMRC grant used to fund Professor Baker’s research is part of the Boosting Dementia Research Initiative, which gives $200 million to dementia research projects, including several other studies based at the University of Melbourne. Nearly 1 million Australians are expected to have dementia by 2050, and health policymakers are wondering how the system will deal with it.

“Dementia is going to be a challenge for this country,” says Professor Baker. “And they want to invest extra funding into projects that will help us with this massive problem that’s ahead of us.”

SOURCE: Kate Stanton, University of Melbourne

With studies and research already proving the benefits of such initiatives, how great would it be if this was properly funded? Considering we know that dementia is going to be an increasing challenge for all in the future isnt it time these projects were given greater importance?