Blood-thinning drugs 'can reduce risk of dementia by up to 48%'

Research ‘strongly suggests’ that patients taking anticoagulants for irregular heartbeat could be protected against dementia and stroke

Blood-thinning drugs could protect against dementia and stroke in people with an irregular heartbeat, research suggests.

A study found that patients being treated for atrial fibrillation (AF) were less likely to develop dementia if they were taking anticoagulants. Their risk was reduced by up to 48% compared with others with the same condition who were not prescribed the drugs.

Scientists analysed health record data from more than 444,000 Swedish AF patients.

While the findings could not prove cause and effect, they “strongly suggested” blood-thinning pills protect against dementia in patients with the condition, the team said.

Atrial fibrillation increases the risk of stroke and blood clots, which some experts think may appear in the brain and help trigger dementia.

Dr Leif Friberg from the Karolinska Institute in Stockholm, Sweden, who co-led the study, said: “As a clinician I know there are AF patients who have a fatalistic view on stroke. Either it happens or it does not. Few patients are fatalistic about dementia, which gradually makes you lose your mind.

A new study shows that doctors are actually quite bad at estimating the benefit and harm associated with treatments they prescribe. It’s a wake-up call for doctors, but patients can also play a role in getting better treatment

 “No brain can withstand a constant bombardment of microscopic clots in the long run. Patients probably want to hang on to as many of their little grey cells for as long as they can.

“In order to preserve what you’ve got, you should take care to use anticoagulants if you are diagnosed with AF, as they have been proved to protect against stroke and, which this study indicates, also appear to protect against dementia.”

The researchers identified everyone in Sweden who had been given a diagnosis of AF between 2006 and 2014. Monitoring each person’s progress provided 1.5m years of follow-up during which 26,210 patients were diagnosed with dementia.

Prescribed blood thinners include the drugs warfarin, apixaban, dabigatran, edoxaban and rivaroxaban. Their protective effect was greater the earlier treatment started after a diagnosis of AF, the scientists found.

Friberg said patients should begin taking the drugs as soon as possible and continue using them.

He added: “Doctors should not tell their patients to stop using oral anticoagulants without a really good reason. To patients, I would say don’t stop unless your doctor says so.”

The study, published in the European Heart Journal, found no difference in dementia prevention between the older blood-thinning drug warfarin and newer anticoagulants.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “Strokes caused by a clot blocking the blood vessels in the brain are a major cause of dementia, and atrial fibrillation is an important risk factor as it increases the chances of these clots forming.

“By treating AF patients with blood-thinning drugs, you reduce the risk of both stroke and dementia.”
Dr Carol Routledge, head of science at Alzheimer’s Research UK, said: “The findings highlight a need to investigate this link further, but the nature of the study prevents us from firmly concluding that anticoagulants reduce the risk of dementia.
“It will be important to see the results of other ongoing studies in this area, as well as teasing apart the exact relationship between anticoagulants and the risk of different types of dementia.”

SOURCE: The Guardian
This was a really interesting read for me because Ive recently been reading about some research that looked at the correlation between worsening mental health and dementia related illness and the incidence of stroke, heart disease and cancers. In particular they were looking for links with a raised level of cortisol in the blood, stress hormones and heart problems. 
It would appear that from the study printed above the doctors in this instance are advocating long term use of anti coagulants in patients with AF. They are finding as a result that this also protects against the risk of dementia.

Half of care homes failing in parts of England

 Which? investigation of care home inspections data reveals postcode lottery of care home quality across England

 More than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’, according to analysis carried out by Which? of data released by the Care Quality Commission (CQC).

In six local authority areas, good quality care home places are so limited that 50% or more of local beds are in homes rated by CQC inspectors as requiring improvement or inadequate, making it less likely that people looking to move into a care home will able to find a good place close to home. 

The lack of good quality care is particularly acute in the London borough of Westminster, where seven in ten (69%) beds were found in care homes rated poor or inadequate. In Manchester and Wakefield, three in five beds (58%) are in care homes rated as poor or inadequate, closely followed by Kirklees (57%), Portsmouth (56%) and Tameside (55%). With demand for beds set to rise, the time for action is now.

Poor quality care homes

In 45 local authority areas a third or more care places are in poor quality care homes. Nine of these councils are in the capital and include Westminster (69% of beds are in failing homes), Tower Hamlets (48%), Islington (47%), Kensington and Chelsea (46%), Newham (41%), Haringey (41%), Barnet (40%), Ealing (35%) and Harrow (33%). While the research, which compared the quality of local provision in 151 council areas that provide adult social care, provides some worrying figures, there are a small number of areas where at least nine in 10 care home beds are in homes rated as good or outstanding. 

These include the Isles of Scilly (100%), Richmond upon Thames (94%), Rutland (91%) and Blackburn with Darwen (90%). Overall, the analysis highlights the huge regional variation in the provision of quality local care across the country that exists in the current care market.

Care provision ‘could get worse’

Which? has already heard from hundreds of relatives of care home residents, who have highlighted existing problems in the current care system. Some have had to wait years to find a suitable care home or have had to place their relative far away, as there was no suitable place available locally. Which? is warning that this picture could get worse, as the demand for places starts to outstrip supply in an increasing number of local areas.

 

Previous Which? research shows that almost nine in 10 council areas across England could see a shortfall in care home places by 2022. The research also raises questions around whether some councils will be able to continue to meet their statutory duty to offer local authority-funded individuals at least one suitable care home place that will meet the prospective resident’s needs.

SOURCE: Which, Joanna Pearl

Dukinfield care home 'bathed residents once a month'

Dementia sufferers living at a care home were only bathed once a month and lived in "disgusting" conditions.

A Care Quality Commission (CQC) inspection in July at Yew Trees in Dukinfield, Greater Manchester, said it was "not safe".

Inspectors found nine breaches of health and safety at the home, which has been placed in special measures.

The owners said it has made immediate changes to address the issues.

The CQC said some residents "looked unkempt" and records showed some people were only given baths or showers once a month, twice at the most, even those who were incontinent.

One relative of a resident asked inspectors if they could have more baths "because I have to wash my relative down".

Meals 'chaotic'

A woman who said her late mother lived there for 18 months said it was "absolutely disgusting" and she "kept a diary of incidents but it made no difference".

Inspectors found the home was not safe, effective, caring, responsive or well led.

Claire Ingham said her mother, who had dementia and died earlier this year, was physically attacked by other residents.

Inspectors also said mealtimes were "chaotic" and had been told by a relative a resident lost four stone in weight since being at the home.

The relative told the CQC: "We shouldn't have to come in and help out as we are paying for the support."

The inspection also highlighted:

  Care was not safe because of insufficient suitably trained staff

  People were not always safeguarded from abuse

  Risks of harm was not always properly assessed or monitored

  There was no stimulation or activities

  Complaints had not been acted upon

At the time of the unannounced inspection, Yew Trees had 41 residents, the majority of whom have dementia.

A spokesman said residents' health, safety and wellbeing were its "utmost priority" and it "immediately put in place a detailed action plan" to address the issues highlighted by the CQC.

SOURCE: BBC

Family carer is 'frightened for the future' over plans to close dementia ward

A FAMILY carer has said he is “frightened about the future” if plans to close a dementia ward at Chepstow Community Hospital go ahead.

Armand Watts, 49, of Chepstow, cares for his mother, Pauline, who was diagnosed with dementia last October.

His mother, 77, is an outpatient at the community hospital and is visited by doctors once a week.

Mr Watts, who is also a town and county councillor, fears his family and hundreds of others would be hit under plans set out by the Aneurin Bevan University Health Board to close the St Pierre Ward.

Patients such as Ms Watts would be treated at St Woolos Hospital in Newport, or Ysbyty Tri Chwm in Ebbw Vale, depending on where in Monmouthshire they live.

Mr Watts said his mother is currently at the “beginning stages” of dementia, but that she may need to be treated at the ward in the future.

“What it means for our family is that we would potentially have to go to St Woolos and that will affect hundreds of families across the county,” said Mr Watts, whose dad was also treated for dementia at the ward. “Sadly we have experienced this before with my father a couple of years ago so we know what’s coming, therefore I can tell you how important it is to retain that local service.”

Mr Watts fears closing the ward would lead to a “demise” in dementia care in Monmouthshire, with families being forced to travel elsewhere. The town councillor for Thornwell believes the move will particularly hit patients who do not have family to support them.

He added: “My view is the Trust should be ashamed of themselves for even contemplating it and I think Aneurin Bevan would turn in his grave if he knew what they were attempting to do.”

Ms Watts, a former councillor, also said she disagreed with the plans.

Aneurin Bevan University Health Board’s proposals would leave three dementia units - at Ysbyty Tri Chwm in Ebbw Vale, St Woolos Hospital in Newport, and Ysbyty Ystrad Fawr in Ystrad Mynach - and a single functional mental illness unit at County Hospital, Griffithstown.

This would leave 67 beds, five fewer than at present, but requiring11 fewer nurses. Difficulties in recruiting nurses for older adult mental health inpatient units are a factor, but reorganisation of services is also a means of creating more community-based services, the board says.

A spokesman for the health board said: “In order to deliver the highest standard of services to older adults with mental health needs we have worked with our staff, patients and their families, and our partner organisations to develop a preferred option for the future of these services.

“We believe that this preferred option will enable our us to strengthen our local community-based services for older people with mental health needs in all areas of the health board. For those who need inpatient care, we would develop three centres of excellence which would offer the very best care for people with dementia. We now want to share our ideas with the public and will listen to their feedback before any decision is made.”

SOURCE: South Wales Argus, Saul Cooke Black

One in 10 care home staff has been forced to turn away an obese person due to their care home not having bariatric facilities, according to a new survey.

The research carried out by leading care home reviews site, carehome.co.uk, found that only 39 per cent of owners, managers and staff said their care home had bariatric facilities, with 13 per cent having to turn away obese people looking for a home.

The term ‘bariatric’ is used for people who weigh over 25 stone. One in four of the UK adult population is obese and this is expected to rise to one in three in the next 10 years.
The increase has led to a growing number of care homes in the UK building bariatric rooms, so they can care for severely overweight people. However the cost of providing these specialist rooms equipped with appropriate bathing and toilet facilities and of having extra care workers for moving and handling seems to be deterring many from going down this route.

Davina Ludlow, chair of carehome.co.uk, said: “The number of severely overweight older people is rising in the UK, and while some care homes have started building bariatric rooms to accommodate residents who are obese, over half are unprepared for this and have no specialist facilities.
“With obesity on the increase, it is vital that the care sector is able to cater to the needs of bariatric residents. Care home developers need to become more inclusive and start building specialist bariatric suites in new care home developments.”

She also called on the Government to acknowledge that care homes face higher costs if they care for bariatric residents due to installing specialist equipment and requiring more care workers for moving and handling. “It is much more expensive caring for morbidly obese people and care homes should receive more funding from the local authority for residents over a certain weight,” she said.
Severely obese people are more likely to suffer from complex conditions such as cardiac disease, hypertension, respiratory disease and diabetics. In addition, they often require specialist management of their skin as severely obese people have an increased risk of pressure ulcers, wounds and reduced prognosis for wound healing due to their immobility.
Zara Ross, head of care at St Monica Trust, which has a specialist bariatric suite in its Sherwood Nursing Home points out that it is not just about the physical care, as a person who is severely obese will often have emotional and psychological needs as people often feel very unhappy with their personal image.

She said: “They have to cope with the comments from people who are not obese and who can be quite intolerant and often do not understand why other people are overweight. They can also be viewed as a drain on resources such as the NHS.
“Obesity – whether associated with medical conditions, or for other reasons – is a major concern for health and social care providers currently, and over the next ten years.”
The figures were sourced from a survey completed by 1,154 care home owners, managers and staff as part of the carehome.co.uk Summer Survey.

SOURCE: carehome.co.uk, Sue Learner

Heartwarming: This couple have their 'first dance' 60 years after their wedding

A surprise celebration was organised for John and Dorothy Thexton to mark their 60th anniversary and the couple enjoyed their 'first dance' there.

A loving couple have had their ‘first dance’ 60 years after their wedding day.

When John and Dorothy Thexton tied the knot in 1957, it was a small family affair and the occasion did not involve a traditional first dance.

John, now 84, says he is not much of a dancer and the couple never really danced together over the years.

However, to mark their diamond anniversary, a surprise party was organised for them where the couple did dance and celebrated 60 years of togetherness.

The special tea dance was held at the Great Park Community Centre by Silverline Memories, a National Lottery-funded group that supports older people with mild to moderate dementia.

Dorothy, 83, was diagnosed with dementia in 2003 and John has been caring for his wife ever since.

John said: “We were married at St Cuthberts in Blyth. It was very much a small family affair. We never danced together - my experience with dancing has been absolutely zero.

“But the 60th anniversary celebration they organised was absolutely amazing. It was a breathtaking experience.

“We knew something was afoot and they were planning something but we didn’t know what it was. When we got there, they had set out the tables, banners and flowers, and our family members were there and it was great. We were not expecting anything on this scale.

 “Dorothy attends tea dances regularly and she loves music - it lights her up. I saw how much Dorothy enjoys dancing and on our celebration day, I joined in.

“They made it very special for us and we thoroughly enjoyed it. It was an unforgettable occasion for our family.”

The couple, of Brunton Park, Newcastle, have known each other since they were children as their families were close friends.

When they got married, John was studying architecture at King’s College in Newcastle and Dorothy was studying social studies.

John went on to work overseas for years, in places including Libya and Saudi Arabia.

The couple, who have two daughters and three grandchildren, met mostly during their holidays. John later became a volunteer at a care home.

And after Dorothy was diagnosed with dementia, John became her carer. He helps to pick out her clothes, get her dressed and also does her make-up.

He said: “Caring for Dorothy is not a problem for me. I volunteered at a care home for eight years so I have some experience.

“Dorothy goes to a dementia cafe and tea dances regularly. She looks forward to that. When she’s listening to music, she is always smiling.

“I’m determined to provide care for her for as long as I physically can.

“We get a lot of support from Silverline Memories - they transformed our lives. All their volunteers are gems and they help to solve any problems we may have, whether it’s to find a hairdresser or dentist or for anything else.

“We owe them an awful lot.”

SOURCE: Chronicle Live, Sonia Sharma

What a lovely heartwarming story, its good to hear how a little effort can make such a big difference and enrich peoples lives.

Hospital to home: people's needs must be central to transfers of care

When moving between hospitals, home and care homes, it can be harmful to those receiving care if the process is poorly managed. Quite simply, time is muscle. In as little as 12 hours, an older person admitted to hospital can lose the ability and confidence to stand unaided. Once lost, that muscle and confidence is hard to recover.

Following a 2015 review by NHS Providers into transfers of care, which I chaired, it was concluded that “there is no simple solution to delays in transfers of care: no one individual to blame nor a magic bullet that will solve everything”.

Getting these moves – these transfers of care – right can make a huge difference. When it comes to moving someone between a hospital and home, especially a care home, their needs should be paramount. That might sound daunting but often it’s the small details that make a difference.

One solution is intermediate care and there is good evidence that it could play a bigger part in helping people regain their strength. After it was identified that delayed transfers of care were causing older people to stay in a hospital bed longer than necessary, a “stabilise and make safe” scheme in Trafford, Greater Manchester, has seen 70% of people achieving full independence and a £7.78 return on investment for every £1 spent.

Andrea Sutcliffe, chief inspector for social care at the Care Quality Commission, says that small, practical solutions can be important. She suggests matching people with members of staff who share a common interest, giving the example of attending a pub quiz together. This can make life more interesting for everyone, rather than merely concentrating on individual tasks.

But small things can be complex to get right; registered managers of care homes and homecare services play a key role and can be the difference between a good or poor transfer.

So much has been written on transfers of care that it is sometimes hard to see the wood for the trees. This is why the Social Care Institute for Excellence (Scie) and the National Institute for Health and Care Excellence (Nice) have produced a quick guide for registered managers, based on detailed Nice guidelines.

The guide offers a practical overview of what registered managers and their teams need to do before, during and after a hospital stay. When someone has to go to hospital, managers and their teams can make sure the hospital has their care plans, details of any preferred routines or communication and accessibility needs, and any medication the patient is taking.

The key question they should be asking themselves is: how do we help this person get back to where they want to be?

One good answer to that question is NHS Sutton’s Red Bag Scheme; a simple innovation that makes sure someone takes and brings back everything they need when admitted to hospital, from their medication to details of current care. Developed by Sutton Homes of Care Vanguard in Surrey, the scheme allows ambulance and hospital staff to determine the treatment a resident needs more effectively. When patients are ready to go home, a copy of their discharge summary is placed in the red bag so that care home staff have access to this important and updated information when their residents return.

Moving to and from hospitals and the community is one of a series of quick guides to meet the needs of busy frontline health and social care professionals, while others address such issues as recognising and preventing delirium, and planning for children and young people transitioning to adult services.

It’s easy to assume that hospital transfers are solely about avoiding unnecessary admissions. This is an important component, but it’s crucial to remember the whole journey – from a community setting, to hospital, and back again. Registered managers and their teams have an important role to play and if time is muscle, much can be done in an efficient manner to make sure people’s experiences and outcomes are improved.

SOURCE: The Guardian, Paul Burstow

Shame of care homes that just don't care: Watchdog probes four serious failures EVERY DAY as charities warn of 'frightening crisis'

The ‘frightening’ extent of the crisis in the elderly care system was laid bare last night.

A shocking report reveals that inspectors are called in to deal with four complaints every day.

The Care Quality Commission launched 1,512 enforcement actions against care homes and home helps in 2016/17 – 68 per cent up on the previous 12 months. 

The watchdog dealt with complaints about unsafe care, residents not being treated with dignity and poor staffing levels. Other issues included lack of food or water and ‘abuse and improper treatment’.

+4

The Care Quality Commission launched 1,512 enforcement actions against care homes and home helps in 2016/17 (file image)

In its report the commission said:

Fifty care firms were fined and four were taken to court;

More than 100 operators were struck off the register – forcing them to close down;

Dozens were warned to improve or face the prospect of being stripped of their licence;

Hundreds of enforcement actions were taken against hospitals, clinics and GP surgeries.

The revelations will increase calls for extra cash to prop up England’s care system. Last year ministers took urgent action to allow town halls to raise council tax to avert a meltdown.

A Mail investigation found the system was in such crisis that four in ten care homes fail inspections. Of the 5,300 sites the CQC has reported on this year, around 2,000 were found to be inadequate or in need of improvement.

Caroline Abrahams of the charity Age UK said: ‘Our social care system is struggling to cope and older people desperately need the Government to follow through on its commitment to develop proposals for strengthening it.

‘These statistics are frightening for older people and their loved ones because they show that good quality, affordable care is far from guaranteed.

·          

 ‘In a civilised society we ought to be able to take it for granted that if we come to need this support it will be there for us, no ifs, no buts.’

Anyone with savings must meet the full cost of their care home place. The Tories have failed to honour a 2015 manifesto promise to cap the maximum bill at £75,000 and during the last election campaign Theresa May indicated the pledge could be scrapped.

The CQC report reveals that, for all the money that families pay out, loved ones often receive substandard and, in some cases unsafe, service.

It said the sharp increases in complaints were partly due to improved enforcement procedures. But it could also indicate that severe problems had gone under the radar.

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, said most providers were offering high quality care. But she added: ‘There is still too much poor care, some providers are failing to improve, and we are seeing some services deteriorate.

+4

The CQC also took action 135 times in hospitals – up from 58 the year before (file image)

‘Undoubtedly there are pressures on adult social care services, but it is not acceptable for people in vulnerable situations to bear the brunt of poor care.

‘We will continue to use our enforcement powers in people’s best interests and take action where necessary.’

Regulators prosecuted four care providers, including one nursing home where a 62-year-old man had broken his neck in a fall from a shower chair.

The CQC’s annual report said the number of enforcement actions taken in 2016/17 across all health and social care settings was 1,910 – up 75 per cent on the previous year.

In 2016/17, there were 263 interventions in the primary care sector – double the previous year.

This includes GP practices, dentists and NHS 111. The CQC also took action 135 times in hospitals – up from 58 the year before.

Some of the interventions were made following routine inspections; others followed complaints.

The watchdog’s annual report was published in July just before Parliament went on its summer recess – but had gone unreported until now.


SOURCE: MailOnline, Daniel Martin

Dementia files help find missing patients

Police are gathering the personal details and former addresses of new dementia patients as part of a pilot to help find them if they go missing.

Officers are working with nursing homes, GPs and families to find out the favourite haunts and walking spots of people diagnosed with dementia.

They will also gather where the person went to school and got married and where they used to live.

They hope this pre-emptive action will allow them to respond more quickly.

There are estimated to be about 90,000 people in Scotland living with dementia.

Research suggests that at some point 40% of them will go missing.

It is estimated that the numbers of people with dementia will double by 2030.

The file on dementia patients will not be kept by police but will be held by family or a nursing home in an agreed place.

The pilot protocol - which currently covers seven local authority areas - also involves looking at ways to prevent the person going missing in the first place by identifying triggers which might unsettle them and result in them trying to leave their home.

Police Scotland now plans to roll the pilot out across the country.

Supt Jim Royan, who is in charge of the pilot protocol, told BBC Scotland: "The most important thing is that it's not about preventing someone enjoying the same freedoms of life as they've always enjoyed.

"But if we can do something, if we can collect information that allows us to respond more quickly that's a good help.

"It also increases the care-providers level of vigilance through early identification and risk assessment."

Jim Pearson, of Alzheimers Scotland, said he welcomed the move but that it needed to be used with the consent of patients.

He said: "It's an opportunity for family members or staff who work in care homes to put together a picture of that person and gather some information about that person, the places they lived before, the places they might go if they go missing.

"It means that information is already there and exists so if that person does go missing, the police aren't wasting precious time."

He added: "We know that the nature of the illness means they are potentially more at risk of going missing.

"They are more likely, perhaps, to become disorientated or stressed or anxious when out of doors.

"Maybe they had intended to go somewhere - an address they had lived at before or a workplace - and actually find the environment has changed and they become disorientated and lost.

"People with dementia are more at risk of going missing and because they are vulnerable are more at risk of coming to some harm."

---

Hannah McKay's husband went missing several times after he was diagnosed with Parkinson's and dementia. He went into care partly as a result.

"On the first occasion we went to bed and I put my hand over and realised he wasn't there," she said.

"I thought where is he? And it dawned on me that he's got the key from where it was high up on the hook.

"He'd never shown any intention of leaving. The police arrived because a gentleman had found him at the back of the rugby pitch on the ground and it was raining.

"Another time he went over the main A6 and that was the deciding factor that he needed to go somewhere secure."

Now Hannah, who is 79, has been diagnosed with dementia and she has moved to a nursing home in Hawick in the Borders.

As part of the pilot all of her details and past addresses have been collected in the format set out by the police protocol.

Hannah, a retired nurse, thinks it is a good idea.

"It's better to have the knowledge before it needs to happen," she said.

"We need to prepare for the problems before they start, so it is in place.

"I see the point of having a form with as much information on that form as you can give so that it gives you a good start.”

SOURCE: BBC News, Lucy Adams