Dealing with Infections Often Becomes the Burden of Families After Transitioning Home

Spending time in the hospital is not on anyone’s top ‘things to do’ list, but when they finally get the chance to return home, family is often the ones providing support. While there are numerous things to worry about, one issues that can be overlooked involves infections. 

Most family caregivers have no medical experience, no background, have not studied these important issues, and while hospital administrators and doctors are often focused on an array of concerns, contending with infections may not be one of them. 

As these patients are transferred back to their home environment, focus generally shifts to either recovery or providing comfort. If this individual suddenly contracts an infection or other preventable illness, depending on their health issues, it could quickly escalate and lead them right back to the hospital. 

Home care support is one of the most vital aspects of recovery for men and women following a hospitalization and when those professional caregivers have direct experience, they often pay close attention to various signs of trouble brewing. Home care becomes the added layer of defense that too many hospitals overlook, or don’t pay enough attention to. 

According to Kaiser Health News, in their blog, As Care Shifts From Hospital To Home, Guarding Against Infection Falls to Families, written Melissa Bailey: 

“But hospitals have not done enough to help these families,[“] said Dr. Amy Billett, director of quality and safety at the cancer and blood disorders center at Dana-Farber Cancer Institute/Boston Children’s Hospital.” 

“The patient safety movement has almost fully focused all of its energy and efforts on what happens in the hospital,” she said. That’s partly because the federal government does not require anyone to monitor infections patients get at home. 

Even at the well-resourced, Harvard-affiliated cancer center, parents told Billett in a survey that they did not get enough training and did not have full confidence in their ability to care for their child at home.” 

Home care aides and visiting nurses certainly must be focused on many details when supporting clients after a hospital stay (or who may be dealing with serious health issues like cancer), including sanitizing their hands to avoid transferring bacteria to the client. If families aren’t aware of these concerns or don’t place a high enough value on these details, the risk to the patient can increase dramatically. 

Home care agencies may provide more information to those families who aren’t aware of these unseen risks and may offer one more benefits to relying on home care support. 

SOURCE: homecaredaily, Valerie VanBooven

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

EVEN TIDYING THE HOUSE CAN HELP

Practise Yoga

Studies show yoga lowers the stress hormone cortisol and helps ease depression, anxiety and create an overall sense of wellbeing. Experiment with different teachers and different types of yoga to find a class that suits your personality and your desired level of exercise and mental relaxation. Some classic yoga postures which are effective for stress relief include child’s pose, spinal twists, gentle hip openers, cat/cow pose, legs-up-the-wall and corpse pose.

Listen to music

One of the best ways to unwind, listening to music helps combat stress and lower cortisol levels. One recent study found that individuals who listened to music had lower blood pressure and experienced less stress than people with a great diet and who took regular exercise. Try to fill your day with music as much as possible, and use it at night to relax before sleep.

Tidying up

When your surroundings are chaotic it’s very easy to become distracted, stressed and anxious, even if you don’t realise it, and then focusing can be more difficult. But a clean, orderly space creates a sense of calm, making it easier to focus. By getting rid of clutter in your living room, for instance, you find you have room for an exercise bike, a yoga mat or a set of dumbbells to make regular exercise easier to sustain.

Share a hug 

Close contact with friends and loved ones naturally helps reduce stress levels. Studies have found that oxytocin, a hormone associated with decreased stress response, is released when you are being hugged, or when someone holds your hand.

Find your Ikigai

The Japanese concept of ‘having a purpose’ has been shown to lead to a longer, healthier life as well as reduced disability and mortality. Studies show keeping a strong sense of purpose after retirement and into old age protects both your mental and physical health. So consider volunteering or engaging in community service of some sort.

As we investigated further, we started to think of meditation as an antidote to modern distraction. If it could help us focus, we thought, it could also help us reduce stress, especially in the brain.

Meditation isn’t ‘doing nothing’. It’s not a passive activity. Done properly, it is all about cultivating concentration and focus, a fantastically powerful antidote to dementia as it happens in the very brain regions which are often the first to be affected by Alzheimer’s.

We are now convinced that including meditation or mindfulness of some sort in your daily routine can dramatically reduce the effects of uncontrolled stress and even expand important —and very useful — areas in the brain.

And you can rest assured that enjoying the benefits of meditation will not mean joining an Ashram or compulsory cross-legged sitting. Yes, it can mean chanting if you wish, but it can also simply be sitting quietly, walking around your neighbourhood or having a comfortable de-cluttered space you can go to that helps you unwind at the end of the day.

If you want to give it a go, find a quiet place where you won’t be disturbed for ten minutes.

Sit down, close your eyes and try to clear your mind, focusing only on the breath going in and out of your nose.

Every time your mind starts to wander, bring your focus back to your breath.

Don’t be discouraged if you find it hard — with practice you’ll see amazing benefits.

Even doing something you love — that puts you in a ‘zone’ (it could be knitting or washing up, cleaning your shoes or day-dreaming) where you simply experience the activity rather than think too much about it — can have enough of a meditative effect to provide huge mental benefits for both focus and stress management.

Ultimately, the best relaxation techniques for you are ones that interest you and bring you a sense of calm. Everyone responds differently.

But don’t think you’re too busy, or that unwinding isn’t important. Pick something from the suggestions in the boxes. Whatever method you choose should be simple, convenient for you and, most importantly, relaxing.

Medicine works best when it's PERSONAL

Although there is no cure for Alzheimer’s, our work as specialists in the very cutting-edge of this field has convinced us that you really can protect yourself and dramatically reduce your risk.

The key, we have found, is creating a personalised plan which ensures you eat a brain-boosting diet, keep active, sleep well, avoid stress, and challenge your brain — and crucially, that you then stick with these simple changes for life.

Our infinite differences profoundly impact the way medical treatments affect us, and also how effective they are

Conventional medicine’s approach has typically been to treat us as though we’re all the same, to assume somehow that one nutrient, drug or behaviour will fit all.

But now we know that our infinite differences profoundly impact the way medical treatments affect us, and also how effective they are.

Personalisation is becoming increasingly important in many areas of medicine.

This model of medical care effectively customises treatments based on individual differences in genes, proteins and environment.

STRESS MYTHS BUSTED 

Stress is most damaging to your heart: Stress damages the entire body, but the brain is especially susceptible, even more so than the heart.

You have to sit in a yoga pose when you’re meditating: You can meditate while standing, lying down or even while walking. A gentle walking meditation can be a great choice for some elderly people who aren’t comfortable sitting for too long or who find that sitting makes them tired or stiff.

You have to meditate for long periods of time to experience any benefits: Any amount of meditation or mindfulness is helpful. Even a few three-minute sessions per day are likely to reduce stress and support your brain. 

It is now emerging as the new medical paradigm for chronic disease as doctors and researchers move towards greater precision in disease treatment and prevention that takes into account an individual’s genes, environment, chronic wear- and-tear, protective factors and lifestyle.

Dementia is not a one-size-fits-all condition and we are convinced that in the future, Alzheimer’s prevention based on these individual differences will become the standard of care.

Up until now, personalised medicine has been used most successfully in the treatment of diabetes, obesity, and heart disease, where doctors have looked at the unique genetic and chemical constituents of an individual’s disease, and have suggested lifestyle changes that take into consideration the individual’s history, resources, limitations, and proclivities.

This comprehensive approach is bringing to light what we discovered years ago: chronic disease, especially neuro-degenerative disease, is highly complex and highly personal, and if given the right tools, people can change their lives and influence their health.

That’s why the approach we share in our book, The Alzheimer’s Solution, on which this series is based, is personalised medicine for the brain.

Ours is a ground-breaking model for how to understand, prevent, and treat Alzheimer’s on a personalised level. Whatever your degree of risk, no one is expecting you to make wholesale changes, but through adopting a personalised approach to your stress levels and the methods you might be able to incorporate to help mitigate them, as well as your diet and activity levels, you will be able to start moving in the right direction.

Just instituting one or two changes at a time, based on your individual resources and capacity for change is all it takes.

OVERCOMING OBSTACLES

AND RELAX... 

Starting at the top of your body and moving downwards, begin to tense up all your muscles — your forehead, eyes, jaw, neck, shoulders, back, arms, hands, abdomen, buttocks, thighs, calves and feet.

Hold this tension for at least five seconds. Then take a big inhalation, and on your exhalation release everything. Take a few more deep breaths. Feel the difference between a tensed body and a relaxed body. 

‘I’m too stressed!’: Even a three-minute-per-day meditation can significantly relieve stress.

Try not to think of mindfulness activities as a burden, but rather as a solution to the unpleasant stress you feel right now.

‘I don’t have anyone to do this with’: While it can be relaxing to meditate on your own, and in your own space, you can also join a group or class at a community centre, or find a meditation community online.

‘Impossible! I’m hyperactive!’: Not everyone has to meditate the same way or for long periods of time. Three-minute sessions are helpful for people who find it difficult to relax. Try several of these sessions per day, and gradually increase the time as you become more comfortable.

SOURCE: MailOnline, Dr Dean Sherzai and Dr Ayesha Sherzai

A WALKING BREAK FOR YOUR MIND

For ultimate cynics who can’t bear the thought of sitting cross-legged — and probably spend too much time sitting anyway — or those who are already struggling with cognitive decline, walking meditation is powerfully effective and very simple.

Just going for a walk can be a powerful meditative activity that allows the brain to rest and restore. Stick to the same route and work to minimise distractions and interruptions. 

Starting at one point and ending at another creates a sense of regimented activity — which forms the groundwork for meditative thinking. 

When you walk a familiar circuit the problem-solving part of your mind can go offline which helps you instantly feel more relaxed. Walk at an easy pace. Feel the ground beneath your feet, the tensing of your leg muscles and the swing of your arms. 

If you find your attention wandering, label your steps — one, two or left, right — to keep your head clear. 

Turn to your free magazine which was given away in Saturday’s paper (if you don’t have one, call 0808 272 0808 and we will send you one straight away), and focus on the main sources of stress in your life, and possible ways you could mitigate them.

We encourage our patients to work towards eliminating, as much as they can, any situations in life that make them feel stressed, and taking steps to avoid the difficult and awkward relationships that make them uncomfortable.

We urge them to make sure they give themselves time in each day to relax (this is very important!) and to find a way to reduce the constant distractions of mobile phones, computers and TV (you might think this is just background noise, but it can put your brain in a permanent state of unrelenting alert).

For our part, we managed stress levels by keeping a close eye on our schedules. We now cancel meetings and events at night to allow time to decompress after a busy day.

When we travel, we allow a day at home to eat well, exercise and sleep soundly before returning to our work routine.

Four times a day we practise mindful breathing (left) for five to ten minutes a time, and spend lunch hours walking the same path around the hospital where we work (exercise and relaxation combined).

When we are at home you’ll hear classical music playing at a low volume, and, when they are around, one of our children will put on a dance song every hour or so and we have a rule that we all have to get up and dance, (which is great fun and another effective form of stress relief).

THE BENEFITS OF MEDITATION

Like many people, we used to get uncomfortable when someone mentioned meditation — it hadn’t entered textbooks when we were studying medicine.

But it is such a buzzword in California, where we work, and many of our healthiest patients were such great advocates, that we set out to research its scientific benefits.

To our surprise, we found many studies that, over the years, really have convinced us of the powerful relaxation benefits of meditation.

Beyond stress reduction, meditation has been shown to either increase the brain’s volume or slow the rate at which the brain loses volume through age — particularly in the crucial parts of the brain that govern attention. This means regular meditation really could help enhance memory.

Continued tomorrow

MailOnline, Dr Dean Sherzai and Dy Ayesha Sherzai

How stress can shrink your brain, meditation isn't just for hippies and why medicine works best when its personal

All this week, a pair of eminent neurologists specialising in Alzheimer’s are sharing cutting-edge research with Mail readers and revealing how lifestyle tweaks can help fend off the disease. Today, they show how avoiding stress and learning to meditate could boost your brain . . .

 There's no doubt that many of us are more stressed than ever before. Thanks to the rise of smartphones, we’re never far from our emails — meaning too many of us take work home with us.

Then there are all the other stresses of modern life: never getting to the end of your to-do list, worrying about family, money, friends, work and so on.

It can be easy to shrug off that missed appointment or lost wallet as the inevitable consequence of having too much to do and never enough time.

But those mental blanks and foggy-headed moments could be an early warning sign that stress is damaging your brain.

Mental blanks and foggy-headed moments could be an early warning sign that stress is damaging your brain.

In fact, stress management is a critical and often misunderstood aspect of a brain-healthy lifestyle. Regardless of your degree of risk of developing dementia, stress reduction is crucial to overall health and happiness.

Together, as a neurologist husband-and-wife team, we run the prestigious Memory and Aging Center at Loma Linda University in California.

We have dedicated our careers to finding a cure for Alzheimer’s and after decades of research and clinical experience we believe we have found a scientifically-backed way to reduce your risk — and keep your brain sharper for longer.

All this week in the Mail we have been serialising this personalised lifestyle plan, based on our book, The Alzheimer’s Solution, which focuses on five key areas that can really make a difference: diet, exercise, sleep, stress and brain training.

Today, the focus is on stress, and specifically on finding ways to unwind.

Some forms of stress are, in fact, good for your brain — if the stress helps you pursue some kind of long-term goal (such as studying for a degree).

This kind of purposeful action actually bolsters brain reserves, making you stronger and more resilient. But many of us now live our lives in a state of unrelenting, uncontrolled stress.

THE DAMAGE CAN START IN CHILDHOOD 

It is possible that much of the microscopic damage to the brain which can culminate in Alzheimer’s actually starts in early childhood.

Stress, poor nutrition and lack of exercise could start damaging the arteries that supply oxygen to the body and brain from a young age. Studies show that children who have a tough time early in their lives do tend to be at greater risk of high blood pressure, diabetes and high cholesterol later in life, all of which, as we have shown, increase the risk later in life for developing Alzheimer’s.

Neglect and emotional abuse sustained at a young age have been associated with memory deficits in adulthood.

Sports-related head trauma (even repeatedly ‘heading’ a football) is another risk factor that studies show could predispose children to developing cognitive problems in adulthood.

A process called ‘myelination’ by which the neuron’s connections are coated with a protective fatty membrane called myelin (to ensure effective communication) starts before the age of five and continues into your early 20s. This is one of the natural processes which helps the brain develop resilience in the face of later traumas — so children really do need a good, strong lifestyle foundation to ensure this process happens efficiently.

Stress has been shown to significantly affect growth in developing brains, and lower cognitive resilience in childhood (i.e. myelination was inefficient or incomplete), which could leave you with a higher risk of developing dementia once you reach your 60s and 70s.

This is the worst possible kind — if you don’t own it and you didn’t choose it and you feel there’s no end to it in sight. Stress like this puts the body in overdrive and subsequently increases the level of stress hormones (such as cortisol). These affect blood sugar levels and cause damaging long-term problems such as anxiety, depression, disrupted sleep and depressed immune function, which then makes us more vulnerable to infections — and all of which increase our risk of developing Alzheimer’s.

Stress affects each of us differently, but our brains are particularly vulnerable. Studies show chronic stress decreases levels of the crucial protein responsible for the production of new brain cells.

It puts the brain in a state of high inflammation, causing structural damage and impairing its ability to clear harmful waste products. Uncontrolled stress initiates a hormonal cascade that taxes the brain on many levels. It even changes the structure of the brain, destroying cells and effectively shrinking it.

If you were to look at the brains of people with Alzheimer’s, even early on in the disease process, you’d see evidence of chronic inflammation in the form of special proteins (called cytokines and chemokines) that rush to the site to support the immune system by attacking foreign substances. You’ll also see small cells (called microglia) that rush there to help with the clearing of waste and damaged brain cells.

The problem is, under stressful conditions, these microglia can become so responsive in clearing waste that they start to harm neurons (the cells of the nervous system) and their supporting structures, resulting in both cell death and structural damage.

This is why stress, and the chronic inflammation that it induces, is widely considered to be a main factor in the development of Alzheimer’s.

Studies have also shown that chronic stress can quite literally shrink your brain.

A single stressful event is enough to destroy brain cells — very often in an area called the hippocampus, which controls memory. When the hippocampus is damaged by cortisol, the region struggles to regulate the body’s stress system.

This results in the secretion of even more cortisol, a vicious cycle that in turn damages more cells.

Everyone, whatever the state of their brain health, will benefit from unwinding and de-stressing. This factor alone could be enough to significantly reduce your risk of getting Alzheimer’s, and if you already have a dementia diagnosis, should ease your symptoms and improve your focus and memory.

To work best and have the greatest impact, the process of unwinding or de-stressing, just like the other four lifestyle factors in this series, should be personalised to you.

Continued tomorrow

SOURCE:MailOnline, Dr Dean Sherzai, DrAyesha Sherzai

Nine in ten councils will run out of care homes places within five years because they are not doing enough to cope with the ageing population

The vast majority of councils will be hit by a dramatic shortage of care home places within five years, a major audit reveals today.

The shortfall is set to be particularly acute in 14 areas, where the number of extra care home places the council is planning is at least 25 per cent lower than needed.

An incredible 87 per cent of town halls will not have enough places to meet demand by 2022 – because they are not doing enough to cope with the demands of an ageing population 

The analysis by the consumer group Which? found that by 2022, there will be an estimated shortfall of 42,000 elderly care home beds across England. In the worst-hit area – Bracknell Forest in Berkshire – there will be 161 fewer places than needed, a shortfall of 53 per cent.

Next comes Lewisham in south London, where the shortfall works out at 48 per cent, or 355 beds short. Haringey’s shortfall is projected to be 38 per cent, followed by Hartlepool (35 per cent) and Milton Keynes (33 per cent).

Devon will have the largest shortage in terms of the number of beds, with a projected 1,921.

The figures highlight the depth of the crisis facing England’s broken care system. Last month the Mail revealed that the CQC watchdog is intervening over poor standards in care firms four times every day – an increase of almost 70 per cent in just one year.

Alex Hayman, of Which?, said: ‘It’s heartbreaking that families who have no choice but to put a relative into care then have the additional stress of not knowing if they can find a space in a suitable home that’s close to loved ones.

‘It is vital that the Competition and Markets Authority looks at the potentially huge local disparities in provision, which could reach crisis point if nothing is done.’

The Which? research used population projections to look at how many care places will be needed in each local authority by 2022 to keep provision for the over-80s at the same level as it is now. It then compared that to what will be provided by 2022 if the pace of annual increases in the number of places continues.

It takes up to seven years to plan, build and open a care home – and Which? says this means that many local areas will not be able to respond quickly enough when it becomes apparent there are not enough places.

Izzi Seccombe, from the Local Government Association, said: ‘These findings reinforce our warning about the urgent need to reform adult social care and deliver a long-term sustainable solution that delivers a range of high-quality care and support for the growing numbers of people who will need it.

‘It is absolutely critical that the Government uses the Autumn Budget to bring forward its consultation for social care announced in the Queen’s Speech, and that it works with local government leaders in delivering a long-term sustainable solution for social care.

‘To tackle the problems we face tomorrow, we must start planning today.’

SOURCE: Daily Mail, Daniel Martin

Dementia sufferers get lost in care home where corridors all look the same, says health watchdog

Care Quality Commission says 'similar-looking corridors' can stop patients finding their way round

News

A Beverley care home has been told to become more "dementia friendly" following an inspection by the Care Quality Commission (CQC).

Lindum House cares for around 46 patients, nearly half of whom have dementia and other degenerative brain conditions, at its premises in Deer Park Way in the town.

The home was handed a "good" rating on three out of five criteria following a visit in July, but has been told that "the environment did not meet peoples' specific needs in all cases and had not been adapted to support their disability".

In their report, inspectors said the home had not benefited from a programme run by its management designed to improve the lives of those with dementia, and their communication with health professionals.

The report said: "The environment had very little signage and colour contrast was not used as a means of supporting people to find their way around the building.

The home was given a 'good' rating on three of the five criteria, but was still handed a 'requires improvement' overall rating.

"We heard one person frequently asking where they should go. The corridors all looked very similar and the doors, apart from different numbers, were the same.

"There were small name plates on the doors but nothing else to help identify a person's room. The environment did not meet or support people's needs."

However, Lindum House was praised on multiple points. Staff described the culture as "transparent and honest" and patients described the home's manager as "approachable".

It was noted by inspectors that the home had made improvements since their last visit in May 2016, when it was told to give staff more support and make its management of medicines safer.

The report said: "The service was safe. Peoples' medicines were managed safely in line with the service policy and procedure and national guidelines.

"People felt that staff cared and we observed many positive interactions between people and staff. Relatives echoed this view."

A statement from Barchester Healthcare Homes, which runs the home, said: "We are pleased that the latest report from the care regulator, the Care Quality Commission, reflects the improvements in the home and the high quality care we give to our residents.

"We do recognise that improvements can still be made and we are working to embed these in our home."

SOURCE: Hull Daily Mail, David Spereal

Isnt it surprising how seemingly small changes can have such a large overall impact.