Lack of exercise might invite dementia

Parking yourself in front of the TV may make you as likely to develop dementia as people genetically predisposed to the condition, a Canadian study suggests.

In a study of more than 1,600 adults aged 65 and older, those who led a sedentary life seemed to have the same risk of developing dementia as those who carried the apolipoprotein E (APOE) gene mutation, which increases the chances of developing dementia.

Conversely, people who exercised appeared to have lower odds of developing dementia than those who didn't, the five-year study found.

"Being inactive may completely negate the protective effects of a healthy set of genes," said lead researcher Jennifer Heisz, an assistant professor in the department of kinesiology at McMaster University in Hamilton, Ontario.

However, the study didn't prove that lack of exercise caused dementia risk to increase. It only found an association between the two.

The APOE mutation is the strongest genetic risk factor for vascular dementia, Lewy body dementia, Parkinson's disease and, especially, Alzheimer's disease, the researchers said.

People with a single APOE "allele" may have a three to four times increased risk of dementia than non-carriers, the study authors said.

How exercise may reduce the risk for dementia isn't known, Heisz said.

These study results, however, suggest that your physical activity level can influence your dementia risk as much as your genetics, Heisz said. "You can't change your genes, but you can change your lifestyle," she added.

The kind of exercise that's best isn't known, although the people who were physically active in the study reported walking three times a week, Heisz said.

"Which means you don't have to train like an Olympian to get the brain health benefits of being physically active," she said.

The report was published Jan. 10 in the Journal of Alzheimer's Disease.

Dr. Sam Gandy directs the Center for Cognitive Health at Mount Sinai Hospital in New York City. He said the study findings aren't "really a surprise, but it is good to see it proven."

Other scientists showed some years ago that people with the APOE mutation could virtually erase the risk of developing amyloid plaques in the brain if they became regular runners, Gandy said. Amyloid plaques are one of the hallmark signs of Alzheimer's.

"That was an amazing report that, I believe, has been underpublicized," Gandy said.

However, this new study suggests that if you are blessed with genes that lower your risk for Alzheimer's, you could lose that benefit if you don't exercise, he said.

"I cannot understand why the fear of dementia is not sufficient to induce everyone to adopt a regular exercise program," Gandy said.

"I tell all my patients that if they leave with one, and only one, piece of advice, that the one thing that they can do to reduce their risk of dementia or slow the progression of dementia is to exercise," he said.

About 47.5 million people around the world are living with dementia, the researchers said, and that number is expected to surge to 115 million by 2050. With no known cure, there's an urgent need to explore, identify and change lifestyle factors that can reduce dementia risk, the study authors said.

SOURCE: Steven Reinberg, wflx.com

These seven steps will keep your brain healthy from childhood to old age, say researchers

LIVING A HEALTHY lifestyle could help your brain as much as the rest of your body, according to a new advisory from the American Heart Association (AHA).

Taking care of our bodies in the right way could also lessen the risk of cognitive decline – which can lead to diseases such as Alzheimer’s and dementia – in later years, researchers said.

Vascular neurologist Philip Gorelick said: “Research summarised in this advisory convincingly demonstrates that the same risk factors that cause atherosclerosis [a hardening of the arteries that can cause stroke or heart attack], are also major contributors to late-life cognitive impairment and Alzheimer’s disease.”

In order to ensure that our brain stays healthy into old age, the AHA recommends following its Life’s Simple 7. This is a set of health factors designed to make our bodies, particularly our heart, in good condition throughout our lives.

They are:

·         Manage blood pressure

·         Control cholesterol

·         Keep blood sugar normal

·         Get physically active

·         Eat a healthy diet

·         Lose extra weight

·         Don’t start smoking or quit

And what exactly is a healthy brain? The researchers define it as “one that can pay attention, recognise information from our senses, learn and remember, communicate, solve problems and make decisions, support mobility and regulate emotions”.

Previously, experts had not linked the problems that cause Alzheimer’s with stroke but now believe that they are related.

Gorelick said that elevations of blood pressure, cholesterol and blood sugar can cause impairment of large and smaller blood vessels, “launching a cascade of complications that reduce brain blood flow”.

Gorelick said: “At some point in our lives, a ‘switch’ may be getting ready to ‘flip’, or activate, that sets us in a future direction whereby we become at-risk for cognitive impairment and dementia.”

In Ireland, over 50,000 people live with some form of dementia. According to research from NUI Galway, that number could more than double to 132,000 by 2041.

According to the government’s national dementia strategy, the average annual cost of care per person with dementia in Ireland is €40,500.

It added: “The value of informal care for those with dementia is estimated to be €807 million per annum.”

The American researchers hope that their advisory will help to inform how doctors and physicians treat brain health by linking it to these important lifestyle factors. They added that it could also be a starting point to build a broader definition of brain health.

Gorelick said that monitoring rates of dementia in places where public health efforts are improving the health of people’s heart “could provide important information about the success of such an approach and the future need for healthcare resources for the elderly”.

SOURCE: The Journal

Definitely worth bearing these points in mind, not just in relation to dementia but in our general health and well being longterm.

Half a million frail over-80s who can't wash, dress or eat by themselves are being 'abandoned by the care system'

Nearly half a million frail over-80s who cannot carry out routine functions like washing, dressing or eating get no help from the care system, a report said yesterday.

Another 300,000 get some assistance to carry out their basic everyday tasks, but not enough to cover everything they need, it said.

The report, by the Age UK charity, said that a total of almost 800,000 elderly people do not get enough help to live their lives at a decent level.

Nearly half a million frail over-80s who cannot carry out routine functions like washing, dressing, eating, getting out of bed, going to the bathroom, dressing or walking unaided

Its findings underline deepening fears for vulnerable old people struggling to survive at a time when the social care system, operated by local councils, appears to be breaking down.

The charity, who timed its report to coincide with election manifestos, called for the next government to inject urgent cash to shore up the care system and develop a new long-term plan. 

Director Caroline Abrahams said: ‘These figures do not so much reflect a social care system which is sometimes performing less well than we would like, but instead, a complete breakdown in the way we care for our growing older population, with even some of our oldest being left to manage with help that is grossly inadequate or sometimes offers no help at all.’ 

The report, based on findings from the large-scale English Longitudinal Study of Ageing, counted numbers of people of 80 or older who are unable to carry out at least one task described as an ‘activity of daily living’. 

These include washing, eating, getting out of bed, going to the bathroom, dressing or walking unaided.

It said more than a third of over-80s, 926,000, have difficulty with at least one of these, and 794,000 of them get too little help from carers or no help at all. Among those with at least one difficulty, more than half, 491,000, get no help at all.

More than 250,000 people over 80 are said to have three difficulties – one in ten of all over-80s. A third, 86,000, get no help, and another 145,000 get some but not enough, Age UK said.

Labour’s manifesto promised £8billion extra cash for care over the next parliament, £1billion to be spent in the first year, and the establishment of a National Care Service costing £3billion a year. Lib Dems suggest proceeds of a 1p income tax hike will free up more for social care.

Meanwhile Theresa May has hinted at bringing forward David Cameron’s pledge of a £72,000 cap on the amount anyone would have to spend on their own care. 

Miss Abrahams said: ‘Older people in their 80s and beyond have spent many decades contributing to our society ... But too many who are in declining health and who need help are now being expected to fend for themselves amidst the unprecedented challenges facing our care services.’

SOURCE: MailOnline, Steve Doughty

'I thought I was bulletproof' says headteacher diagnosed with Alzheimer's aged 55

Keith Oliver, a successful and respected head teacher, is one of 42,000 people in the UK living with early onset dementia. On New Year's Eve in 2010, aged just 55, his life was turned upside down when doctors confirmed 'the unknown'.

Since then, Mr Oliver has campaigned tirelessly for Alzheimer’s Society, and has published a book called 'Walk the Walk, Talk the Talk'; the story of his life before, during and after the diagnosis.

By keeping busy, Mr Oliver believes it is the only way to face the disease that brought his 35-year teaching career to an abrupt end.

He told homecare.co.uk: "For the past seven years, I have been sharing my brain with an unwelcome and unwanted guest; Dr. Alzheimer. It stays with me 24/7. Sometimes in the background, watching and waiting for an opportunity to make mischief and sometimes leading me up a pathway where I do not seek to go.

"I am reminded of Princess Diana who said there were 'three in her marriage'. My wife Rosemary and I, and the many thousands of other people with young onset dementia know who this third insidious member of the triad is; Dr Alzheimer."

When doctors gave the diagnosis, the father-of-three, who had a distinguished teaching career and was in the process of studying for an MA in education, was forced to accept he could no longer lead Canterbury’s biggest primary school.

Mr Oliver began experiencing a series of unexplained falls, suffered with fatigue and had a general feeling of being unwell. He also experienced numerous challenges at work with regards to meeting deadlines, answering the telephone and retrieving and retaining information.

"We thought maybe it was an ear infection at first, and although a GP examined my ears and said there was no sign of an infection, he gave me some antibiotics just in case."

After no improvement, Mr Oliver went back to the doctor who carried out further investigations.

Following an MRI scan and a neurologist appointment to rule out a brain tumour, Mr Oliver was referred to a memory clinic for what turned out to be an in-depth six-month assessment period which culminated with a confirmed diagnosis of Alzheimer’s disease.

"It just wasn’t on our radar," he revealed. "We came away completely shaken. I thought I was bulletproof. No one, especially someone in their 50s wants to be diagnosed with dementia but because of the impact the disease was having on me by way of my ability to undertake my work, there was some peace of mind in knowing what the cause of these problems was."

During the diagnosis period, Mr Oliver was supported by a professional team who explained the results of the tests, which at best he was performing at average and at his worst at the lower fifth centile.

"I wanted information and I needed to understand what I was living with, and subsequently this served to allow me to come to terms with moving from a suggested diagnosis to a confirmed one, and then to begin to live as well as possible with dementia," he said.

Determined to see things through, Mr Oliver chose to confide in only a couple of his closest colleagues, while his wife would collect him at lunchtimes so he could have a quick nap in the car.

But on 1 April 2011, his teaching career came to an end and he took early retirement from Blean Primary School.

Mr Oliver may be a natural optimist, but there is no disguising the realities of living with what he calls the "wretched condition."

He needs care from his wife, who is supported by an Admiral Nurse, when the 'fog' of dementia descends upon his mind.

"There are certain 'sunny' days when I feel I am coping and there are 'foggy' days when I tend to withdraw into myself," he said. "It is extremely frustrating and it makes me angry that I am not better able to deal with it."

In 2014, Alzheimer’s Society estimated that 42,325 people in the UK are living with a diagnosis of early onset dementia.

It is a degeneration of the brain that causes a progressive decline in people’s ability to think, reason, communicate and remember. Personality, behaviour and mood can also be affected.

"I had the typical impression that dementia was solely the domain of the elderly," revealed Mr Oliver. "My mother developed Alzheimer's in her mid-70s and she was typical of how I imagined people with the condition.

"Alzheimer’s made my mother totally immobile. She lost her memory of how to move even though cognitively some of her memory wasn’t too bad. I know that for me is a problem by the way of balance and by way of mobility."

He added: "Something I have also noticed particularly in the last five or six months is that there has been a heightening of my emotions when engaged in either a book, film or TV programme which previously I would have had an emotional attachment too and enjoyed, but now I am in floods of tears.

"Your emotional intelligence becomes more fundamental than your actual cognitive intelligence. It’s partly remembering, but it’s more significant, it’s what you take away from that experience or that conversation or that person even. The content of the conversation is simply gone; but the way one has felt in that moment has been retained."

In April 2016, Mr Oliver began writing his book 'Walk the Walk, Talk the Talk'.

It covers the story of his life before, during and since receiving his diagnosis, told also by those who know him best, including health professionals, friends and family.

He hopes his story will help others who find themselves in the same situation as him, as well as raise awareness of the condition.

"I feel I have a window of opportunity to speak to people about dementia and to feel as though I can make a contribution to raising public awareness," he said.

"One of the reasons my health has maintained a reasonably good level is my determination to try and live life positively, to do things which I enjoy and find interesting and to live life to the full.

"Dementia's best friend is apathy, because if you give in to it and think 'it's got the better of me,' you cannot live life as fully as possible. Then it does get the better of you."

SOURCE: homecare.co.uk, Melissa McAlees

Taking part in academic research empowers residents with dementia and 'gives them a sense of purpose'

The role of dementia research and how it is borne out in reality can be a contentious issue, with some experts believing that it does little to benefit people currently living with dementia. But participating in projects can actually enhance the wellbeing of care home residents.

Professor Mary Marshall, a senior consultant with HammondCare, writes and lectures in dementia care and is dubious of exactly how effective dementia research is at present.

Expressing the issues she has around the topic at the UK Dementia Congress in November, she told congress attendees that she is “a bit depressed about it,” adding: “I’ve become really unhappy about the rhetoric of evidence-based and the reality of expediency.

“There’s got to be more than research, there’s got to be a campaign or something as well.”

Yet there are ongoing partnerships between care homes and academic institutions where those affected by dementia are directly involved in research and contribute by providing first-hand evidence and experiences.

These partnerships provide a wealth of benefits for residents and care teams alike. Getting involved in research can provide additional stimulation for residents as they take part in new activities and talk to new people.

It also gives residents a sense of purpose and self-worth, helping them to feel like they are contributing to their future as well as the next generation, while staff gain additional training and an increase in job satisfaction, thereby creating an encouraging atmosphere of excellence and improvement.

‘Their experiences are what really matters’

The University of Worcester’s Association of Dementia Studies (ADS) carries out research to improve the lives of those with dementia by involving people with dementia, care workers and families directly in their projects.

Isabelle Latham, a PhD student and senior lecturer at ADS, explained: “Their experiences are what really matters when we wish to discover what affects people’s experiences, quality of life and care in care settings.”

Despite complex and in-depth ethical processes, ADS makes every effort to involve people living with advanced dementia, particularly if they are unable to be involved in more conventional research projects.

Ms Latham added: “We do this because it is important that their perspective is also considered in any findings.

“[Previous projects] have used observations of people’s daily lives and care experience to try and capture their point of view even though a person may have limited verbal communication.”

‘Outsiders’ help care home staff reflect better

While contributing to research, care home staff reap the benefits of participating in often ground-breaking projects, allowing them to provide better care for residents living with dementia.

Ms Latham said: “In our experience, care homes, staff, families and people living in care homes are very positive about the impact of taking part in research, reflecting that it can feel empowering to be able to share experiences and opinions with others and know it may make a difference in the future.

“They often report that it increases their reflective abilities about the care they provide and that having ‘outside’ researchers coming into the home or discussing an aspect of care can help them think about changes they can make.”

Care homes, researchers and families can find information about ongoing and upcoming projects via Enabling Research In Care Homes (ENRICH), a National Institute for Health Research (NIHR) toolkit which provides information and networks for those involved or who wish to be involved in research.

The Orders of St John Care Trust (OSJCT) has been part of the ENRICH Research Ready Care Homes Network for three years. The network brings together care home staff, residents and researchers to facilitate the design and delivery of research, with the hope of improving the quality of life for residents.

Victoria Elliot, principal care consultant for OSJCT, said the group became part of the network because they are passionate about research and helping their residents and thought it would be a “positive experience” for them.

While the research they are involved in doesn’t always directly impact residents’ lives, it certainly enhances their general well-being.

‘For the greater good’

Ms Elliot explained: “They feel like they’re helping someone else, future generations, and it gives them a sense of purpose.

“They know that they’re doing some good that will benefit people in the future. They’re doing it for the greater good.”

She also noted that participating in research projects helps to counteract negative press that the social care sector often receives by improving staff morale.

She added: “They’re proud of the work they do and being involved in the research helps to reinforce this pride.”

Anna Hicks, a roaming home manager for OSJCT, took part in a five-year programme, WHELD (Improving Wellbeing for Health for People with Dementia), which assessed the most effective therapies to reduce the prescription of antipsychotic drugs and improve mental health and quality of life for people with dementia.

Taking part in this research not only benefitted staff and residents, but also inspired her to initiate new projects and innovations in the home to help those living with dementia.

She told ENRICH: “It was so successful that I started a dementia café, a knock-on benefit from the project. I also developed a ‘getting to know you’ process where every single member of staff now spends 10 to 15 minutes, once a week with a different resident – that includes the cooks, domestics and me.

“I felt my staff got a lot out of it – because now they understand much more about dementia and look at residents’ reactions in a different light.”

‘As academics, keep shouting’

Despite the positive outcomes for care homes collaborating with academic institutions, there remains the issue of disseminating findings and spreading awareness of the results to other care homes which have not participated in research.

This is an important issue at the Association for Dementia Studies because they “aim to make a difference to the lives of people living with dementia and their carers.”

Ms Latham explained: “We ensure that our research reports are available to the public via our website, we run free events to share the findings from our different projects and we integrate our latest evidence from research into the teaching and education programmes we offer.

“However, care homes, their staff and visitors are very busy and as such, I think we always need to work hard to make sure research findings are easy and simple to find out about and apply to practice.”

Dave Bell, an Admiral Nurse who works for Admiral Nursing Direct, the national dementia helpline, highlighted the importance of spreading awareness of dementia research.

He said: “People do want to be involved in research. We get questions: ‘How can I get into a drugs trial?’ or something like that.

“Evidence-based for us as nurses is really important but it often gets presented at conferences and we say ‘oh that’s interesting’ and then we carry on doing what we’re doing.

“So keep shouting, as academics, keep shouting because it’s really important to get through to us as nurses and other practitioners.”

SOURCE: carehome.co.uk, Charley Walker

'NHS must cut beds for better care' - Chief Nurse

THE NHS should spend more money looking after patients in their own homes instead of paying for hospital beds, the country's chief nursing officer warns today.

Jane Cummings, chief nursing officer at NHS England, said patients were being denied care at home because too much cash was devoted to paying for "old and expensive buildings".

Writing in The Daily Telegraph, she said the absence of adequate home care was trapping people in extended hospital stays which made them more ill.

She also called on health bosses to use a round of regional reorganisations to shake up "outdated" care methods and prevent patients "falling into the cracks" between different parts of the system.

She acknowledged, however, that refocusing the health service would be "controversial". The NHS is battling record levels of bed-blocking in hospitals due to the crisis in elderly care, which regulators have said has reached a "tipping point" because of the closure of residential homes and shortage of domestic carers.

Delays in the transfer of care are estimated to cost the health service around £900 million a year, with the cost of keeping an elderly person in hospital for a week about £3,000.

"With more care provided at home, the NHS can spend more cash on patients rather than maintaining old and expensive buildings," she said.

"More people can be better looked after with care personalised to their needs," she added.

On a local level, she said, the NHS "wants to invest in home-based care, but it struggles because resources are currently tied up in hospital beds".

Hospitals and other providers in England overspent by at least £2.45 billion in the last financial year, prompting the NHS to divide the country into 44 areas, ordering local managers and councils to come up with restructuring plans to improve efficiency.

A number of the schemes, called "Sustainability and Transformation Plans", have been criticised as heralding closures of A&E units and cuts to hospital beds.

But Prof Cummings said the restructurings provide a chance to make services smarter.

"As life expectancy increases, so do the ailments of old age and there are now more people with chronic conditions like heart failure and arthritis," she said.

"There are also big opportunities to improve care by making commonsense changes to how the NHS historically works, improvements that matter like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health."

Other commentators, however, have noted that the crisis in social careand the resulting bed blocking will only be solved if a significant chunk of the NHS budget, which is around £126 billion, is transferred to the £17 billion social care pot, which is administered by local authorities.

The chief nursing officer said that, as well as enabling more patients to be treated at home, restructuring should embrace smaller numbers of specialist centres, where appropriately trained staff are "available round the clock".

She cited stroke services in London, where the number of stroke wards was controversially reduced in favour of a small handful of "hyper-acute" units, which the NHS claims has saved the lives of 100 patients a year.

Proposals for each part of the country have now been made and are being scrutinised by NHS executives. They involve a £30 million scheme in Surrey to take pressure off hospitals by giving people more access to GPs. In south-east London, plans involve a scheme for 16,000 extra radiotherapy appointments and 4,600 more chemotherapy treatments a year from early 2017.

"While there will always be debate about how much money the nation invests in the NHS and social care, that does not change our responsibility to patients, which is to squeeze the maximum value from every penny available," said Prof Cummings.

The head of the King's Fund think tank, Prof Chris Ham, said treatment at home was the "right thing to do" but needed greater overall spending.

"It's been part of the conventional wisdom in the NHS for some time now," he said. "But it will need investment outside hospital services - GPs, social care, district nurses - before you can realistically cut back on hospital beds.

"At the moment we know hospitals are running very hot at capacity and over capacity and the only way we can help that is to stop people turning up.

"That requires money on staff. [Now] it's all going on deficit reduction."

SOURCE: Telegraph, Henry Bodkin

Eight minute target for life or death ambulance calls is relaxed: Report also urges services to hire more call handlers to advise patients over the phone

The eight-minute target for ambulances to reach life-threatening emergencies is being relaxed in a trial that simply lets paramedics arrive as quickly as they can.

It means patients having heart attacks, strokes or seizures will not be guaranteed an ambulance within eight minutes.

Amid a record number of 999 calls and a severe shortage of paramedics, a report also urges ambulance services to hire more call-centre handlers to advise more patients over the phone, rather than dispatching emergency vehicles.

The eight-minute target for ambulances to reach life-threatening emergencies is being relaxed in a trial that simply lets paramedics arrive as quickly as they can.

The response time trial is under way in three of the country's ten ambulance services – South West, West Midlands and Yorkshire, which serve a total of 16million patients – and could be extended nationally. But most of the public are unaware of it and it has only been highlighted today in a report by the National Audit Office.

It was gradually introduced in the three regions last year with no announcements, fuelling concerns that the public have been deliberately kept in the dark.

The report reveals that more than 10.7million calls were made to ambulance services in 2015/16, a 30 per cent rise in four years.

On top of this, ambulance services are facing a recruitment crisis, with as many as one in ten paramedic roles vacant.

This is having a severe impact on ambulance response times, and many severely ill patients have been left waiting more than an hour for an ambulance to arrive. The most serious calls – including cardiac arrests, breathing difficulties, heart attacks or strokes – are meant to get an ambulance within eight minutes.

In the trial, this is relaxed for the slightly less critical cases – known as Red 2 – which include heart attacks, strokes and seizures. These have been reclassified as Amber cases and there is no fixed time limit – paramedics are urged to respond as quickly as they can.

All Red 1 calls are sent an ambulance in eight minutes, including cardiac arrests – in which the heart stops, or for people who are struggling to breathe.

The trial will be assessed in spring and if deemed a success, will be introduced nationally. The report warns the eight-minute target encourages 999 operators to send 'multiple' ambulances or response cars to the same emergency, just to 'stop the clock'.

Amid a record number of 999 calls and a severe shortage of paramedics, a report also urges ambulance services to hire more call-centre handlers (stock image)

Ambulance services are fined if paramedics fail to reach 75 per cent of the most serious calls within eight minutes.

On average, around a quarter of ambulances are 'stood down' before they reach the scene because another crew has already arrived.

The report says it would be better to dispatch one ambulance in 15 minutes, for example, leaving other crews free to respond to the most serious cases.

But Lib Dem leader Tim Farron said: 'How can the NHS trial this without patient knowledge? When people call an ambulance they expect it to come quickly.

'How can they downgrade a heart attack to an amber call? It's life and death.'

Only one of the ten ambulance trusts meets the response-time target of reaching 75 per cent of serious calls in eight minutes, the report shows.

It also highlights how ambulances are increasingly held up in queues outside A&E units that are too busy to accept patients.

Last year, ambulance services lost a total of 500,000 hours waiting outside A&E instead of responding to other emergencies. 

Professor Keith Willett, NHS England's Medical Director for Acute Care, said: 'The ambulance service is facing significant pressures partly because too many ambulances are dispatched to simply hit targets rather than attend to those patients most in need – with 25 per cent of dispatched blue light vehicles being stood down before they reach the scene.

'That is why we're carefully testing a change to the way in which ambulance services can respond. 

'It's an idea that has come from doctors and paramedics, giving them much more control to do the best thing for patients. 

'These trials are designed to make sure ambulances focus on the right priority – getting to the most urgent patients in the quickest possible time, and improving the service to all patients who dial 999.

'All ambulance and A&E staff are working hard to keep handover delays to a minimum, with a view to eliminating them altogether. 

'These delays have many contributory causes, and often reflect pressure on beds within the hospital as a whole and a system that is struggling to discharge patients to community settings.' 

SOURCE: Sophie Borland, Daily Mail