Elderly patients are more likely to die if their doctor is over 60 because their knowledge is likely to be 'outdated'

Elderly patients are more likely to die if they are looked after by an older doctor, research suggests.

Scientists found that pensioners seen by a doctor over 60 had a higher chance of dying within the next 30 days than if they were treated by a doctor under 40.

The Harvard University researchers worked out that if 77 patients were seen by an older doctor there would be one extra death than if they were all treated by a younger doctor.

The study suggests older doctors' medical knowledge may be outdated.

Doctors over 60 tend to do more research or teaching and devote less of their time to treating patients.

Interestingly, the study found that doctors over 60 who saw high numbers of patients were no less safe than younger ones. But overall, elderly patients were more likely to die within 30 days if treated by an older doctor.

Although the research was carried out in the US, statistics from the UK suggest trends are very similar.

The latest data from the General Medical Council shows doctors over 50 are much more likely to be complained about.

Some 19 per cent of male specialist doctors over 50 have a complaint lodged against them compared to just 12 per cent of those under 50.

The statistics are similar for female specialist doctors with 11 per cent of over-50s being complained about compared to 7 per cent of younger colleagues.

The Harvard study looked at the records of 736,537 elderly hospital patients in the US treated by 18,854 doctors of all ages.

It found that 10.8 per cent of patients treated by a doctor under 40 died within 30 days. 

This rose to 11.1 per cent if they were cared for by a doctor aged 40 to 49 and 11.3 per cent for a doctor aged 50 to 59. Some 12.1 per cent of patients died within 30 days if treated by a doctor aged 60 or over, the British Medical Journal reports.

The researchers concluded that 'within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients.'

All doctors have to prove they are still fit to practise every five years, a process known as revalidation. But some experts say older doctors should go through this process more frequently

Study leader Dr Yusuke Tsugawa said: 'Scientific knowledge, technology, and clinical guidelines in medicine change regularly, and it may be overwhelming for older doctors to keep up with those changes and incorporate those in their clinical practice.'

Patients who research their ailments online can improve their healthcare, a study shows. 

Researchers from the University of Leuven in Belgium surveyed 718 patients aged 18 to 75 who frequently looked up symptoms online, often referred to as 'Dr Google'. More than half (57 per cent) said the knowledge they gained from the internet gave them more confidence in their GP.

The study also questioned nine GPs about patients who looked up symptoms online. Eight of them said it had a positive impact on the patients' healthcare

SOURCE: MailOnline, Sophie Borland

Does this concern you? Are we more likely to have confidence in a younger doctor with more recent medical knowledge over a doctor with years of experience? Does it make a difference what your complaint is?

How is dementia treated?

The vast majority of causes of dementia cannot be cured, although research is continuing into developing drugs, vaccines and other medical treatments. There is also a lot that can be done to enable someone with dementia to live well with the condition. Care and support should be 'person-centred', valuing the person as a unique individual.

Non-drug treatments and support

A range of support, therapies and activities that don't require medication can help someone to live well with dementia. The GP, memory service or local Alzheimer's Society should be able to advise on what is available.

Support for the person and their carer after a diagnosis should give them a chance to talk things over with a specialist, ask questions about the diagnosis, and think about the future. Information should be given on where to get help if needed in the future and how to stay physically and mentally well.

Talking therapies, such as counselling, can help someone come to terms with their diagnosis. Another treatment called cognitive behavioural therapy (CBT) may be offered to help with depression or anxiety.

Cognitive rehabilitation can enable an individual to retain mental skills and raise their confidence. There is also lots that can be done at home to help someone with dementia remain independent and live well with memory loss. Support ranges from devices such as pill boxes or calendar clocks to practical tips on how to develop routines or break tasks into simpler steps.

Activities that help to keep the mind active, such as cognitive stimulation, are popular. As the condition progresses, many people with dementia enjoy reminiscence and life story work (in which the person is encouraged to share their life experiences and memories). Such activities may help improve someone's mental abilities, mood and wellbeing.

It is vital that people with dementia stay as active as they can - physically, mentally and socially. Everyone needs meaningful activities that they enjoy doing and which bring confidence and self-esteem.

Drug treatments

There are drugs that can help to improve the symptoms of dementia or that, in some cases, may stop them progressing for a while.

A person with mild to moderate Alzheimer's disease or mixed dementia may be prescribed donepezil (often known by the brand name Aricept), rivastigmine (eg Exelon) or galantamine (eg Reminyl). These may temporarily relieve memory problems and improve alertness, level of interest and daily living. In the moderate or severe stages of Alzheimer's disease someone may be offered memantine (eg Ebixa). This may help with mental abilities and daily living, and ease distressing or challenging behaviours and delusions.

Donepezil, rivastigmine and galantamine can be helpful for someone with dementia with Lewy bodies who has distressing hallucinations or delusions, or who has behaviours that challenge.

For a person with vascular dementia, drugs will be offered to treat the underlying conditions. These conditions often include high blood pressure, high cholesterol, diabetes or heart problems. Controlling these may help slow the progression of dementia.

A wide range of other drugs may be prescribed at different times for a person with dementia. These include drugs for depression or anxiety, sleeping tablets or antipsychotics. Note that some of these drugs can have severe side effects. Not all are recommended for all types of dementia. Health professionals will generally advise that a non-drug approach is tried first before prescribing medication.

Can dementia be prevented?

It is not usually possible to say for sure why a particular person has developed dementia. It is known that high blood pressure, lack of physical exercise and smoking - all of which lead to narrowing of the arteries - increase the risk of developing Alzheimer's disease and vascular dementia. There is evidence that a healthy lifestyle, especially in mid-life, can help reduce the risk of dementia. Regular physical exercise (eg cycling, brisk walking), maintaining a healthy weight, not smoking, and drinking only in moderation are all linked to a reduced risk of dementia.

It is important that conditions such as diabetes, heart problems, high blood pressure and high cholesterol are all kept under control. Getting depression treated early is also important.

A balanced diet may help to reduce risk. A balanced diet is one which is low in saturated fat, does not have too much salt, dairy or meat, and includes plenty of fish and fresh fruit and vegetables.

All these healthy lifestyle choices will also reduce the risk of other serious conditions such as stroke, heart disease and cancer.

It also seems that keeping socially and mentally active into later life may help lower the risk of dementia. Being socially active could include visiting friends or going to a place of worship, while being mentally active could include doing puzzles or reading.

SOURCE: Alzheimers Society

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

'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 care and 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

Dementia patients 'get second class healthcare': Warning sufferers are given poor treatment for other illnesses because of the 'stigma' around the condition

Dementia patients are often condemned to poor care for other illnesses, doctors warned last night.

They said the ‘stigma’ around the condition meant they were given less attention than patients who were similarly ill.

They also said sufferers in their 90s or older were likely to be written off when they could receive treatment.

An estimated 850,000 people in the UK suffer from Alzheimer's and other forms of dementia

Charities said the warnings – issued at the Dementias 2017 conference – showed the need for fair treatment. ‘People with dementia have a right to equal access to treatment, support and care irrespective of their condition,’ said Rachel Thompson of Dementia UK.

‘Dementia affects everyone – the person with the condition and their family and friends. It is critical that the correct support and care systems are in place to ensure the well-being of everyone involved.’

The conference – held last week at the Royal College of GPs in London – was told dementia patients and their families were too often sidelined.

Dr Liz Sampson, a palliative care specialist at University College London, told the conference about an 80-year-old woman she saw last Tuesday.

She had a tumour that produced similar symptoms to Alzheimer’s but was offered much better care than would have been offered to a dementia patient.

‘What struck me was the cornucopia of services that were available to her and her family,’ she said.

Elderly patients are often diagnosed with dementia without other options being considered

‘She was bed-bound, she was doubly incontinent, agitated – her presentation was 99 per cent similar to the people that I see with advanced dementia. So we manage to provide care when there’s a diagnosis of a brain tumour, yet the prognosis is the same as someone in the advanced stages of dementia.’

Jonathan Waite, a consultant in old age psychiatry from Nottingham, said he felt the NHS prioritised the care of younger people. He said: ‘I’m really concerned about the ageism inherent in the whole process.’

Speaking afterwards, he added: ‘Older people have been contributing to the system their whole lives yet we seem to prioritise resources on the young.’ He warned that many older people who appeared to have dementia could have a simple short-term condition such as delirium instead.

One NHS consultant said that healthcare prioritizes resources on the young despite older people 'contributing to the system their whole lives'

He said confused patients in their 90s were often diagnosed with dementia without other options being considered properly.

Another doctor, who did not give her name, admitted colleagues tended to make less effort with elderly patients as soon as they realised they had dementia.

‘Sometimes, even if I think someone who is 95 has Alzheimer’s disease, I might not diagnose it because I know it will be a negative stigma for the patient,’ she said.

‘It won’t be in the patient’s best interests to have the diagnosis because once they have that diagnosis we won’t care about their physical health as much. It’s a very serious thing because in a hospital a doctor will say: “The patient is 94, has dementia – OK we don’t care as much about his physical health”.’

Speaking at last week’s conference, Dr Peter Bagshaw, a GP from South Gloucestershire, said: ‘The thought of missing a preventable diagnosis is the thing that keeps me awake at night.’

Alzheimer’s and other forms of dementia affect around 850,000 people in the UK with the figures expected to reach two million by 2051 as the population ages.

 SOURCE: Rosie Taylor, Daily Mail

Music provides best medicine in dementia care

A VETERANS care home has been awarded a grant to bring meaningful music to dementia patients.

Erskine were given the cash boost from the Armed Forces Covenant Fund for the six month pilot project ‘Playlist for Life’ within Erskine Park Home.

‘Playlist for Life’ works to bring benefits of personally meaningful music in dementia care to as many people as possible, regardless of where they are in the UK.

The project was founded by Scottish broadcaster and writer Sally Magnusson.

Sally visited Erskine Park Home on Wednesday to talk about the effect the project will have on those living with dementia and met with staff, residents and their families at the Relatives Cafe.

She said: “I am thrilled that the wonderful Erskine Park Home is implementing Playlist for Life.   “Personal music is such a fantastic way of reconnecting people living with dementia with their loved ones and their memories, and in many cases to lost identity.   “I am delighted to know that Playlist for Life is now going to be implemented in Erskine Park Home.

“Families will be helping staff to find the music that means the most to the resident.

“The more personal it is the more it is going to be beneficial.   “This is a joint enterprise with your wonderful staff and yourself.   “The Care Inspectorate has suggested every care home in Scotland implement Playlist for Life and I am delighted to see the message spreading which can make a real change to people’s lives.

“I wish you all the best in the Playlist for Life journey – there is going to be lots of singing and dancing!”

The broadcaster previously cared for her mother with dementia and has spoken of how she noticed that music became the only thing keeping her with the family.

She noted that music became the only thing keeping her with the family and became a tool to help her mother live with the illness. The project encourages families and caregivers to create a playlist of personally meaningful music on an iPod for people with dementia.

Researchers have highlighted the potential for music to alleviate dementia symptoms such as anxiety and agitation, reducing the need for medication.

Erskine Park Home is a 40-bed care home which offers specialist dementia care to residents who are veteran or spouses of veterans.

SOURCE: Evening Times, Holly Lennon

Dance, music and drama boost care home residents' memories

Musical activities have been shown to improve the cognitive abilities and memory recall of people living at 17 care homes run by the Anchor Group.

A series of creative workshops held at Anchor care homes in Surrey, have revealed how the innovative adoption of dance, drama and music in care home activities can soothe and stimulate at the same time, bring back memories from the past and help to engage underused but still active areas of the brain.

The care home workshops, part of a six-month trial, funded by the older people’s charity Beth Johnson Foundation (BJF), reveals a number of benefits for people living with dementia. Staff saw the sessions boost residents’ mental health, self-esteem and self-confidence, after they started getting involved in drama, dance and music.

Based on the trial’s findings, a report ‘Experiences of Being’ was published by Anchor recommending the use of drama, music and dance in care homes to help those living with dementia.

Colin Hann, executive chair of BJF said: "Dementia is an area for more work and creative thinking and this report shows how the arts and drama can make an important positive contribution to those who have dementia...in the longer term let’s also work to find a cure."

For six months, Anchor trialled the integration of drama, music and dance workshops into its dementia care, which was attended by 200 care home residents. The sessions saw positive changes in residents, many of whom experienced greater movement and physical exercise through the encouragement of dance or subtle actions using their hands or feet.

In one session, while music played, a mixture of scarves, hats, over-sized glasses, wooden spoons and maracas were given to residents to try on, prompting conversations among residents and some role play.

The report stated: 'The props acted as stimuli for the residents, with powerful and diverse reactions. The session ended with a ‘goodbye’ song, during which the props were collected and each resident was given a ribbon to wave or use in any way they choose to signify goodbye and thanks.'

One 96-year-old resident with dementia had never joined in with her care home's activities but spent all day in her room, even eating her meals there alone. She attended a weekly one-to-one prop box activity, using boxes of beads, pictures and other small items and engaged in gentle hand movements set to music.

After attending, staff noticed the resident was enjoying the sessions and “now has animated conversations about her life when she was young – memories triggered by the items in the prop box.” The staff said the workshop has improved her confidence and self-esteem and breaks down the monotony of her day.

The One-hour workshop sessions were followed by a feedback and training session for staff at the care homes who gave their own input into how they thought the sessions could be modified.

The success of the sessions has seen participating care homes introduce the workshops to the activities programme.

Anchor and BJF hope the results of the 'Experiences of Being' report will encourage everyone working with older people across the UK to consider the innovative use of arts-based activities in the homes of those living with dementia.

Jane Ashcroft, chief executive of Anchor, a not-for-profit care provider, said: “We’re keen to embrace innovative ways to enhance the lives of our residents and, with such positive results, this project has been a pleasure to be part of. I hope others learn from the report and are encouraged to introduce similar creative activities.”

Actor Linda Marlowe, who played Sylvie Carter a character with dementia in TV soap EastEnders this year, has also welcomed the workshops. To prepare for her acting role, she visited care home residents living with dementia. Ms Marlowe said: “I was there for three days spending time with the residents who had dementia to various degrees. This was invaluable in playing my role in EastEnders. I am now committed to promoting the use of drama and the arts to make a positive difference to help those who are living with dementia”

SOURCE: carehome. co.uk, Angeline Albert