Innovative aids to help the elderly stay safe and fit at home

Singapore is on the hunt for innovative devices that will help elderly citizens continue to live independently at home.

Such aids, meant to improve daily functioning in areas such as hearing or showering, should be easy to use, safe and cost-effective.

"We hope to attract multi-disciplinary research proposals that are scaleable and sustainable, and transform the way we see assistive devices today," said Senior Minister of State for Health Amy Khor as she called for proposals for such devices at a conference last week.

To date, about $8 million has been awarded to projects under the Care-at-Home Innovation Grant. Some involve having an e-marketplace to match volunteers with seniors requiring home care and a call centre service that will respond to seniors who need help.

Singapore can draw some ideas from Denmark, said Senior Minister of State in the Prime Minister's Office Heng Chee How at a dialogue held between the two countries last month to exchange views on how to design elderly-friendly societies. It was organised by the Royal Danish Embassy.

"We can learn from the Danish experience in terms of the preventive and rehabilitative part of care," said Mr Heng, especially since Singapore is moving away from a model it is traditionally strong in, such as acute care, to improve its community- and home-based care.

"Assistive technology is going to become an increasingly important part of the story. As people live longer, how are you going to enable the individual to keep his functioning up for as long as possible?" he said.

Denmark has set up "living labs" countrywide to encourage innovation. Private firms can introduce the latest technology, including eldercare products, at these spaces, allowing government officials and citizens to test them and give feedback.

The inventions include a bed that helps turn a bedridden person on his back or side automatically, and a ceiling hoist that gently lifts a senior from his bed to a wheelchair.

Seniors in Denmark are invited to move into these living labs for a week or a month to try out the technologies for themselves.

Both countries are ageing rapidly. One in four people here will be 65 or above by 2030. Denmark will face a similar situation by 2040.

In recent years, the Danes have used technology to ramp up home care and rehabilitative care.

By 2019, all patients with lung disease in Denmark will monitor and manage their condition on their own at home using electronic devices. These aids will enable them to record and track vital signs, and hold regular videoconferences with nurses and doctors. There are plans to do the same for patients with diabetes and heart disease.

Danish residents are able to use technology to manage their own health at home because they have access to the national electronic health record system.

"I can go into the portal and see all my medicines, lab results, clinical notes written by my doctors, so I am empowered as a citizen to have insight into my own health," said Mr Hans Erik Henriksen, who is chief executive of Healthcare Denmark, a non-profit organisation that is partly supported by the government.

"Now, a lot of people live for a long time with chronic disease. That means it is not just about the doctor giving you a pill or sewing you back together any more - you have to manage it yourself at home," said Ms Ninna Thomsen, Copenhagen's health and care mayor.

Some assistive technology can also be used in daycare centres or nursing homes in the community. For instance, the Vennerslund Day Centre in Copenhagen partnered the Technical University of Denmark to introduce a game that helps seniors improve their balance and reaction times. Robotic tiles controlled by a tablet light up when the user steps on them in a certain sequence.

"I can't afford to buy it but noticed the fun we had when we played it together as a group," said Mr Hans Joergen, 80, who goes to the centre three times a week. The game, which costs about $7,000, is free for use at various daycare centres.

"It's fantastic to use technology this way to keep our limbs strong and nimble indoors when the weather outside isn't good for walking in the woods."

SOURCE: Janice Tai, Straits Times

Understanding the benefits of long-term memory care

If you find yourself considering a specialized facility for a parent or loved one with Alzheimer’s disease or dementia, you should try to make sure the care is aligned with your loved one’s needs.In fact, make sure you answer some key questions before making a decision. What is your loved one’s level of mobility?  Does your loved one display behavior issues? Is he or she aggressive?  This last question forced Demetrius Folsom to consider a more secure environment for his father, James.

“I knocked on the screen door one night to check on him and nobody answered,” he told CBS4. “So I used my key to come through the back door and as I opened up the door, he pulled a gun.”

After that incident and others, James Folsom was placed in American Senior Communities’ Harrison Terrace.  It’s a secure long-term facility for clients who have Alzheimer’s and/or a form of dementia.

Demetrius has been pleased with his father’s care.  But when considering such a facility, there is a list of questions which should be asked.

Is the facility secure? Are the grounds secure? What type of training does the staff have? What is the staffing ratio at night? Is there a visiting physician?  Can the facility care for wheelchair-bound or bedridden residents?

James Folsom is in a wheelchair.  Demetrius believes his father’s dementia may have started several years ago after he forgot to take his blood pressure medication.  James Folsom did suffer some small strokes.

“I’m not a caregiver,” says Demetrius. “And to watch that was very, very, difficult.”

Janean Kinzae, who is the director of memory care for American Senior Communities, says loved ones can be assured of secure units and a level of freedom.

“Our memory units are secured,” says Kinzae. “So folks can wander, which is a really common issue when you’re living with dementia.  So they can explore, have that release of energy without putting themselves at risk.”

James Folsom isn’t one to wander, but Demetrius says his father is surrounded by people who know and care about him.

“I absolutely love it,” says Demetrius. “I wouldn’t put him anyplace else.”

Debby Knox, CBS

That's such a powerful story we cant , any of us, fail to be moved by the predicament facing so many people caring for our aging population. Imagine having to deal with such a frightening and seemingly random act, yet knowing that the dementia sufferer was simply defending himself in a worrying situation.
Many people are having to make these difficult decisions about providing care or finding excellent long term care for parents, dealing with dementia related illnesses. 

Clinicians should address needs of dementia patients’ family caregivers

Clinicians are ethically obligated to care for family caregivers of dementia patients, as well as offer helpful resources, according to an article published in December by the AMA Journal of Ethics online.

“We suggest that, in dementia care, attention to family caregivers should be mandatory as their health and well-being are a critical part of the context of providing care to a patient with dementia,” the authors wrote in the article.

The authors are Laura N. Gitlin, PhD, a professor at the Johns Hopkins University School of Nursing and School of Medicine in Baltimore, and Nancy A. Hodgson, PhD, RN, FAAN, an associate professor and the Anthony Buividas endowed term chairwoman in gerontology at the University of  Pennsylvania School of Nursing in Philadelphia.

More than 15 million people including family members care for persons living with dementia in the U.S., according to a University of Pennsylvania news release. “Yet the current healthcare environment and reimbursement models emphasize obligations toward individual patients, preventing clinicians from reaching out to these caregivers to assess their needs and provide care,” the release stated.

In the article, the authors wrote that most persons with dementia are cared for in their homes, and “that tasks associated with caregiving increase in number and complexity with disease progression.” These tasks include help with bathing, dressing, feeding, moving and managing medications.

“The caregiver must also ensure the patient’s safety, well-being, and quality of life; coordinate care and care transitions; negotiate unwieldy and disjointed health and human service systems; accompany the patient to doctor visits; and advocate, protect, support, and comfort the person with dementia, particularly in healthcare encounters,” they wrote, adding none of these tasks include other family and work responsibilities. “These care tasks accumulate with disease progression and result in significant and well-documented physical, emotional, and financial consequences for families.”

“From a family-centered care perspective, asking about how a patient’s caregiver is doing and about his or her needs during a clinical encounter is the only ethical and moral stance that a clinician can assume,” they wrote.” Clinicians can also offer referrals to the caregivers where they can get help and advocate for public health policies that include caring for the caregiver, they wrote.

SOURCE: Sallie Jimenez, Nurse.com

Senior Tory councillor apologises after 'fiasco' of County Hall home care scheme

The man in charge of adult social care in the county has apologised to vulnerable and elderly people who missed out on vital home care after Leicestershire County Council switched their providers.

County Hall Conservative cabinet member for adult social care Dave Houseman said sorry after coming under fire for the troubled start to the Help to Live at Home (HTLAH) scheme.

The project began early last month when the council transferred the care of some 1,430 adults from 150 small independent firms to nine larger companies.

One of the firms, TLC, backed out of the deal it signed in September just days before the new regime was due to go live leaving officials scrambling to arrange care for those the company was due to take responsibility for.

Opposition Lib Dem councillor Simon Galton said Coun Houseman had been the "invisible man" as the problems mounted leaving officers to make public explanations about what was going wrong.

Coun Houseman told today's council meeting: "I would like to apologise for to any of the 1,432 people who received poor care."

However he added: "This has not been a political failure. It has been a provider failure.

"We had spare capacity but we did not see a care company with 20 years experience in such contracts, who signed a contract with us in September, would let us down with just a few days before it was to start."

He said the council was seeking to recover costs associated with staff having to work weekends and evenings to plug the gaps in care left by TLC's withdrawal.

Coun Galton criticised the Tories for delegating the process of moving the contract to officers without political oversight.

Coun Houseman said the Lib Dems had had numerous chances to comment on the scheme as it was being organised.

Labour group leader Robert Sharp described what had happened at the start of HTLAH as a fiasco that had caused bed blocking in hospitals as wards could not release patients to go home without domicillary care.

He said Coun Houseman needed to "man up and face the consequences".

Lib Dem member Bill Boulter said Coun Houseman ought to reconsider his position as cabinet member prompting a stiff response for Tory council leader Nick Rushton.

Coun Rushton said: "Dave has my 100 per cent backing and I will take absolutely no notice of what you say at all."

He said the council had done as well as it could have done after the withdrawal of TLC.

He said the criticism of Coun Houseman was totally unfair.

Since November 7, 82 people have complained about missed or late home care appointments from their new providers.

SOURCE: Dan J Martin, Leicester Mercury

Study: Dementia healthcare services need to be redesigned

A new report from Alzheimer’s Disease International, authored by researchers at King’s College London and the London School of Economics and Political Science (LSE), found that the vast majority of persons with dementia have yet to receive a diagnosis and calls for a global transformation in healthcare.

It also claims that strategies need to be developed that will focus on prevention and risk assessment, while rebalancing non-specialist primary care.

The report, Improving healthcare for people living with dementia, rings the alarm about the rapid rise in dementia cases worldwide, which are projected to triple by 2050. A particular aspect of concern is the low levels of dementia diagnosis that prevent dementia patients from having access to care and treatment.

The researchers noted that around half of persons with dementia (40-50%) in high-income countries, and one in ten or less (5-10%) in low and middle-income countries have received a diagnosis.

In high-income countries, the costs of healthcare are higher for those suffering from dementia than age-matched controls, with a substantial proportion of costs arising from hospitalisation.

Gilles Pargneaux, a French Socialist MEP, recently told EurActiv that dementia costs Europe €123 billion per year, in terms of medical expenditures and social care.

According to the report, a radical change in the way healthcare is delivered to individuals living with dementia should be made, focusing more on non-specialist primary care.

“Greater involvement of non-specialist primary care staff can unlock capacity to meet increasing demand for dementia care, and could make the cost of care per person up to 40% cheaper,” the report reads.

Primary care staff are non-specialist doctors and nurses based in the community who are typically the first point of contact with the healthcare system.

Primary care

Martin Prince, the lead author of the report at King’s College London, told EurActiv that current specialist models of dementia care (where geriatricians, neurologists, and psychiatrists are providing dementia care) were unlikely to be able to scale up to care for the growing number of individuals affected by dementia – especially in low and middle-income countries.

“There is evidence that when primary care doctors take responsibility for dementia care they can achieve similar outcomes to specialists. Nurses can be case managers, and perform diagnostic assessments and reviews,” he said.

Prince  explained that training was crucial if primary care doctors are to take on an increased role in treating dementia patients. This, he said, can be achieved by defining a ‘pathway’ for dementia care with clearly defined roles for primary care doctors, specialists and others to work collaboratively.

“Specialists will need to take on a prominent role in training and supervising non-specialists in more general tasks,” Prince said. “In low-resource countries, a greater commitment is needed to strengthen primary healthcare. These are elements that should be contained in a National Plan on Dementia, with allocated funding, in every country,” he added, emphasising that more effort is needed to integrate dementia in primary healthcare.

Professor Craig Ritchie, who is the director of the University of Edinburgh Centre for Dementia Prevention, told EurActiv that primary or non-specialist care has two main roles: one linked to diagnosis and another related to prevention.

“There are still a lot of people in the world who have not been diagnosed with dementia who are living with this condition; I think there is a particular role for primary care to play in making this diagnosis,” he said.

“For instance, we need to see who does best during the whole evolution of the disease. Early disease possibly requires more specialist assessment in making a diagnosis but later in the disease primary care certainly will have a very prominent if not leading role,” he noted.

Regarding prevention, he emphasised that although efforts have rightly focused on developing new drugs, there are probably a lot of things to do in risk mitigation, like the promotion of a better diet, exercise, and healthier lifestyle.

“Clearly, there is a role for the general practitioners in this as there is in other chronic conditions like diabetes or heart disease. So the general practitioners not only have a role in making diagnoses but also a very critical role in terms of prevention and maintenance of brain health.”

What can the family do?

For Ritchie, families and close relatives have a critical role to play. Living with someone affected by dementia has a major impact on the wellbeing of family members who may need to sacrifice their professional lives to care for the patient, on top of the challenges of seeing a loved one’s illness progress.

The family could also help identify the early symptoms, Ritchie said. “So family members have to be encouraged and given the opportunity to seek assistance if they are worried about a loved one’s memory,” he pointed out, saying the first point of contact is often the general practitioner.

Family members should also be involved in the therapy process, which helps optimise treatment, Ritchie said. But families cannot bear the entire burden, he warned. “Good care must also reflect and manage the needs of family members who may have developed their own physical and mental health needs in their caring role,” he remarked.

Raising awareness in the EU

The latest survey regarding the state of dementia care in the EU showed that half the carers spent at least 10 hours a day looking after their loved one and only 17% of them consider that the level of care for the elderly in their country is good.

They also noted that the information they received at diagnosis was “inadequate”, and called for more information on drug treatments.

Four out of five said they wanted more information on help and support services and just two out of five were informed about the existence of an Alzheimer’s association.

“Perhaps of greatest concern is that more than half have no access to services such as home care, day care or residential/nursing home care, and when these services are available, many carers have to pay themselves,” the report reads.

Another report, Mapping dementia-friendly communities across Europe, commissioned by the European Foundations’ Initiative on Dementia (EFID) and carried out in 2014-2015 by the Mental Health Foundation (a UK non-governmental organisation), specified the need for dementia-friendly communities across Europe.

The report aimed at providing practical information to support good practice around sustainable, inclusive and supportive environments for persons living with dementia and their carers.

Among the findings, researchers suggested that dementia sufferers should be actively included and involved in the communities they live in. Raising awareness about dementia was also highlighted by the researchers, who warned that “unclear information can be misleading and inadvertently risk adding to stigma”.

SOURCE: Sarantis Michalopoulous

What we see on the internet or in the news about preventing or treating dementia isn't always reliable.

1. What is the difference between Alzheimer's disease and dementia?

Dementia can be caused by a number of different diseases, with Alzheimer's disease the most common. Other diseases that cause dementia include vascular dementia, dementia with Lewy bodies and frontotemporal dementia. Symptoms of the different forms of dementia can vary a great deal and can include memory loss, confusion, and mood and behaviour changes.

2. Are there more women than men with dementia?

Yes. In the UK 61% of people with dementia are female and 39% are male. This is mostly because women tend to live longer than men and as dementia becomes more common as we age, there are more women to develop the condition. Some studies have suggested that other factors may affect the number of women and men with dementia, but there is no firm evidence that women are more likely than men to develop dementia at a particular age.

3. Can aluminium affect the risk of developing Alzheimer's disease?

Despite occasional publicity, there is no convincing evidence that cooking with aluminium saucepans or foil increases the risk of developing Alzheimer's or dementia. During the 1960s and 1970s, aluminium emerged as a possible suspect in Alzheimer's but since then studies have failed to confirm a direct role for aluminium in causing Alzheimer's. Although it is difficult to research as aluminium is common in our environment, exposure to normal sources of aluminium is not thought to pose any threat.

4.Will eating particular foods help reduce my risk?

Maintaining a balanced diet is a good way to help reduce the risk. Oily fish, which contains omega-3 fatty acids, is an important part of a healthy diet. Some studies have linked higher omega-3 intake with a lower risk of dementia but current evidence does not support the use of omega-3 supplements to prevent cognitive decline.

There have been reports that turmeric, 'super foods' like berries, and particular drinks like red wine can lower the risk of dementia but there is no evidence that this is the case.

5. Does drinking alcohol decrease my risk?

Some studies suggest that moderate amounts of alcohol are associated with a lower risk but the research is not conclusive. Very heavy drinking is known to cause alcohol related dementia, also known as Wernicke-Korsakoff Syndrome.

6. Does a head injury increase the risk of dementia?

We don't yet know. Some research has suggested that a serious head injury or trauma could increase the risk of developing Alzheimer's and dementia, though other studies have not found this link. Research is ongoing in this area to help us understand more.

7. How do I find out more?

If you are worried about your health or memory, it is a good idea to discuss it with your GP who can give you advice, run tests and refer you to a specialist if necessary.

SOURCE: Alzheimers Research

Woman, 92, in hospital for year over lack of home care

A 92-year-old woman languishing in a hospital for almost a year because there no funding for a home care package shows how the system is failing older people, Alone said yesterday.

The charity that supports older people to age at home has called on the Government to increase home help hours in line with demand.

Alone chief executive, Sean Moynihan, said the number of home help hours had been cut by 1.58m since 2010, but over that time, the number of older people in the state had increased by 18%.

The elderly woman, who broke her pelvis, has been cleared by her doctors to go home but they did not want to discharge her until a home care package was in place.

advertisement

“This case is a clear example of how the system is failing our older people,” said Mr Moynihan.

The woman from South Mayo has been a patient at Mayo University Hospital for almost 300 days. Her home care package has been approved, but there is no funding available.

The HSE said the Galway, Mayo and Roscommon area had been providing home care supports “in excess of the funded levels of service.”

The health authority said it was now required to bring the level of service and expenditure back “into equilibrium” with allocated budgets.

Mr Moynihan said it made economic sense to provide the elderly woman with the home help she needed.

“A home care package would only cost around €400 a week while keeping this lady in hospital, taking up an acute bed, is costing €7,000 a week,” he said.

The HSE said all home care applications are considered by the Home Care Fora, which included representatives from older people services and nursing.

“The allocation of care is focussed on prioritised cases within available resources,” it pointed out.

The woman’s daughter, who does not want to be identified, said because she was working, she would have to get a loan to pay around €600 a week for a private nurse to care for her mother. She said her mother was receiving the best of care at the hospital, but all she wanted was to be in her home again, and was finding it difficult to keep her spirits up.

Independent councillor Michael Kilcoyne blamed “pure Leprechaun economics” for the elderly woman’s plight.

“How far are we away from the point where the hospital budget is spent, and people who are dying are left outside,” he asked.

“I am appalled that this is happening in the Taoiseach’s constituency, and there is no public outcry about it.

“This woman wants to go home. This is terrible, unbelievable. We have four TDs in Mayo and five senators. Of the four TDs, two are in government, and the other two are supporting that government. I am also saying to Fianna Fáil TDs in this constituency — have they confidence in the kind of government that is allowing this to happen?”

SOURCE:Irish Examiner, Evelyn Ring