Agitation in dementia patients can be relieved with painkillers, new research shows

A recent study published on the British Medical Journal website has found that painkillers significantly cut agitation in dementia patients. Agitation, a common dementia symptom, is often treated using antipsychotic drugs, which can have severe side effects. Statistics suggest that each year about 150,000 patients in the UK are unnecessarily prescribed antipsychotics, which have a powerful sedative effect, and can worsen dementia symptoms, and increase the risk of stroke or even death.

Antipsychotics are often given to patients whose dementia makes them aggressive or agitated, a common symtpom of dementia. Researchers have speculated however that the agitated behaviour may sometimes be caused by pain, which patients were unable to express in other ways. This was investigated in a study using patients with moderate or severe dementia in nursing homes. Half were given painkillers with every meal, the rest continued with their usual treatments.

 After eight weeks, there was a 17% reduction in agitation symptoms in the group of patients being given painkillers - a greater improvement than would have been expected from treatment with antipsychotics.
The researchers concluded that if patient's pain was properly managed, doctors could reduce the number of prescriptions for antipsychotic drugs. The research suggests that many dementia patients being prescribed "chemical cosh" antipsychotic drugs could be better treated with simple painkillers. 

Professor Clive Ballard

Professor Clive Ballard, one of the report authors and director of research at the Alzheimer's Society, said the research findings were significant.
"At the moment, pain is very under-treated in people with dementia, because it's very hard to recognise," he said.  "I think this could make a substantial difference to people's lives - it could help them live much better with dementia."

The Alzheimer's Society is issuing new guidance calling on doctors to think much harder before prescribing antipsychotics, and to look at prescribing pain medication instead.


Research into painkiller use in dementia treatment has been going on for some time, with studies in 2001 and 2009 stating that painkillers could delay the onset or even prevent Alzheimer's disease (one of the most common forms of demenia).While the findings were considered exaggerated, this recent study shows great promise for the use of painkillers in the management of dementia, as opposed to harsher antipsychotic drugs.

Inspections reveal poor standards of care at older people’s care homes across Scotland

A recent freedom of information request has revealed that one in ten of Scotland's homes for older people are providing either ‘weak' or ‘unsatisfactory' care for residents.
 
The statistics from Social Care and Social Work Improvement Scotland (SCSWIS, the recently unified independent scrutiny and improvement body for care services in Scotland) reveal that of 880 homes across Scotland, 67 were considered to provide a weak service, while a further 11 were ranked as unsatisfactory - the worst ranking possible.

The inspection findings from SCSWIS, which are revealed in the wake of the recent deaths of two residents of Elsie Inglis care home in Edinburgh, which prompted a police investigation and the home's closure, reveal that the most common area of failure for those care homes criticised is ‘quality of care and support'. This finding unfortunately does not come as much of a surprise, after numerous recent findings of poor care and treatment of residents in homes across the UK, including the regular horrific abuse of vulnerable residents in a care home in Bristol revealed in a recent Panorama television program.

Among the lowest-rated homes was Tranent Care Home, ranked ‘weak' in all four areas examined: quality of care, environment, staffing and leadership. The home, owned by the troubled Southern Cross company, has faced serious criticism in recent years over low staffing levels and poor food standards. In 2007, a 74-year-old resident of the home, weighing six stone, died after suffering dehydration and poor nutrition.

Another home ranked "weak" in all four areas was the Glebe House home in Ayrshire. In total, 102 homes in Scotland were rated either "weak" or "unsatisfactory" in at least one category. At the other end of the scale, only five per cent (44 out of 880 homes) were described as ‘excellent', the highest ranking, with the majority rated either ‘good' or ‘very good'.

A spokesman from Scottish charity Age Scotland said: "The argument will be that nine out of ten care homes are providing a ‘good' or better service, but that is simply not good enough, especially for the residents in one of the ten per cent of homes that are not up to scratch.

"We have a growing generation of adults moving into later life who are extremely sceptical of the manner in which care is delivered to their parents and have serious concerns about the impact the choices we make for the future will have on them. It's time to get serious and provide proper reassurance for them and for all of those currently in care."  

Indeed, efforts must be made by service providers in the Scottish care sector, and across the UK, to reassure Service Users and their families that the utmost is being done to respect their basic human rights, dignity and privacy in striving to provide the highest quality of care and support possible.

Free care for older people in Scotland is becoming unsustainable

Scotland's free personal care for individuals over 65 is under threat, as the current system becomes increasingly unaffordable.

The Convention of Scottish Local Authorities ­(COSLA) has warned that change to free personal care in Scotland is “inevitable”, and older people could face a means test to obtain the free care. Free personal care in Scotland is not currently means tested, meaning that anybody in Scotland assessed as requiring the care will receive the £159 "free" care per week, regardless of their income. This could be set to change, however, as the costs of the system are becoming unsustainable.

Douglas Yates, health and wellbeing spokesman for ­COSLA, said: “The current ­system is not sustainable. The reality is that, with the baby boomers coming up to pensionable age, we need to look at a different system and perhaps charging.”

Care for older people has been largely 'free' in Scotland for ­almost a decade, and was a flagship policy of the first Scottish Executive after being introduced in 2002. Since then, however, its costs have almost doubled in  to around £370 million a year.

Scottish local authorities say they are severely underfunded, and the situation has been magnified as spending cuts start to come into effect.

Douglas Yates, COSLA

Mr Yates added: “If there was a decision made to apply means testing, it would perhaps mean that many of those who receive free personal care might not do so into the future.”

Currently, anyone over 65 in Scotland assessed as being ­eligible for personal and nursing care at home is entitled to receive it regardless of income.

Those paying residential care costs – so-called self-funders – receive a weekly contribution of £159 to their personal care, which rises to £231 if nursing is also required.

The Scottish Government’s budget will fall by £1.3 billion this year and cuts will continue. A report by Holyrood’s Independent Budget Review group said the free personal care policy was “hard to justify”.

A Scottish Government spokesman said it was committed to “protecting vulnerable citizens”.

He added: “We have worked with COSLA leadership to agree a council funding package, which maintains key public service commitments, including free personal care.”

 

Is the future of our care in Scotland in danger?

Care of older people a "personal priority" for Scottish Health Secretary

Scottish Health Secretary Nicola Sturgeon has stated that she is making care of older individuals in Scotland a "personal priority" in the new parliamentary term, with particular focus on individuals suffering from dementia.

She announced that the Healthcare Improvement Scotland (HIS) and the Scottish Government's Chief Nursing Officer will have key roles to play to ensure high standards of care for older people are maintained. The implementation of a new regime of inspections was also announced, to ensure care in hospitals and care homes is meeting national standards.

Nicola Sturgeon, Health Secretary

 Ms Sturgeon, now directly responsible for older people's care, said she is ready to tackle the "huge challenge" of modernising care services in Scotland. As well as inspections, the chief nursing officer will oversee the implementation of dementia standards in hospitals.
"Quality, compassionate care for older people that protects their dignity and independence, is one of the most sacred duties of any civilised society," said Ms Sturgeon. "It is something I believe we generally do well - but that is not good enough. We must do it well for every older person on every occasion, in care homes and in hospitals.

"I consider improving care for older people - whether that means ensuring the implementation of the dementia standards, making sure older people are treated with care and compassion wherever they are and whatever their diagnosis, or better joining up health and social care - to be a personal priority."

The announcement came after a number of recent cases which raised concern over the care of elderly patients in Scotland. The Mental Welfare Commission criticised Ninewells hospital in Dundee over the care of an 80-year-old woman with dementia. It was found that the use of sedatives in the days leading up to the woman's death was distressing and unnecessary.
The recent deaths of two elderly former residents at Elsie Inglis Care Home in Edinburgh prompted a police investigation and the closure of the facility.

SNP ministers have also raised concern over the thousands of older Scots being cared for by under-threat care home provider Southern Cross, which is suffering from serious financial problems, and has a large number of care homes across the UK.

The Health Secretary's comments came as the Scottish Government published two major documents as part of Scotland's first ever National Dementia Strategy. Standards of Care for Dementia have been unveiled to help people with dementia, their families and carers understand and assert their rights. The standards state that people with dementia should be treated with respect, their physical care environment should be personalised, and their specific needs and preferences recognised and factored into their care package.


The Scottish government will consult on the standards over the next six months, which will be tested before being formally adopted.



Find out more about care for older people in Scotland.

Warnings issued over social care reform in Scotland

COSLA, the umbrella group for local authorities in Scotland, has warned that plans from political parties to make changes to social care in Scotland are an "expensive distraction designed to gain short-term electoral advantage". Cosla warned that transferring social care from councils to the NHS could cost more than £300m.

Councillor Douglas Yates, COSLA's health and well-being spokesman, said: "In anyone's book, £300m to change the badge on a social care worker's shirt is not a good use of public money.
"There are huge challenges that we need to address but the national parties' plans to move social care into the NHS are an expensive distraction designed to gain short-term electoral advantage.

"The red tape that this will create would take years to unravel and force staff to spend that time sorting out structures and legal issues rather than delivering services to communities. And worst of all, there's no evidence that the public would end up with a better social care service.
 
What are the political parties saying?

The SNP are backing a lead commissioning model, involving councils and health boards working together to deliver social care in Scotland. Labour propose a National Care Service merging health and social care in one new service.
The Conservatives support the merger of the health and social care budgets, while Liberal Democrats are against centralisation of services.

Labour's health spokeswoman Jackie Baillie said her party's plans would end the "postcode lottery of care" facing older people in Scotland. " Too many older people fall in the gap between hospital and social work meaning they don't get the care they need and deserve. The current system is not fair, is not working and the status quo is simply no longer an option."
SNP Public Health Minister Shona Robison said the SNP's model for councils and health boards working together would improve services. She added: "Cosla are rightly critical of Labour's plans to create a new and expensive bureaucracy but what all parties recognise is we must improve services to meet the twin challenges of an ageing population and Westminster cuts to Scotland's budget. "Our lead commissioning model avoids the costs of Labour's bureaucracy whilst improving services. A re-elected SNP Government will work with the NHS, local authorities and Scotland's older people to provide the best possible care services for all older Scots."
Conservative health spokesman Murdo Fraser said the Tories have supported the merger of the health and social care budgets for a long time. He proposed the benefits of such a system to include faster response time to those in most need of care, and reduction the number of delayed discharges.
However, Liberal Democrat finance spokesman Jeremy Purvis said: "In stark contrast to the SNP and Labour, Liberal Democrats are determined to keep decision making for social work local. Cosla's warning of the £300m cost absolutely confirms the Lib Dem argument that centralisation is not only bad for delivering local services, but can cost hundreds of millions of pounds."

 An alternative reform

In response to the refrorms proposed, COSLA intends to instead promote an alternative vision for reform: an "outcomes focused approach" based on developing public services that are integrated at a local level. Their manifesto urges political parties "not to opt for a clumsy and disjointed restructuring of services", which could "lead to a weaker democracy in Scotland".
They have presented their argument to the Christie commission on the Future Delivery of Public Services, a commission established by the Scottish Government last year to develop recommendations for the future delivery of public services.

What is decided, remains to be seen... Could such a reform benefit vulnerable individuals in Scotland?

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Click play to view (May take a few seconds to load).

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Alma Safe Care Limited is a live-in care agency which provides registered nurses for live-in care across Scotland. The Nurses live in the Service User's home to provide continuous care, companionship and help with household tasks. We provide nurses for permanent nursing care, or temporary post-operative, respite or palliative care. We can also provide appropriate nursing care for complex care cases.

UK Care Industry on the brink of collapse

According to a report by Unison, the UK care industry is on the "brink of collapse".

There have been growing concerns about the UK's biggest care-home provider, Southern Cross, who are experiencing serious financial difficulties. Unison said that other large companies in the sector are also experiencing financial problems, and that if they were to go under, taxpayers would have to pick up the bill.
The Department of Health has denied that these financial issues have undermined the UK care system.

Southern Cross, which currently has around 31,000 residents in care homes across the UK, has said it will have to reduce the amount of rent it pays to its landlords for the next four months. The Unison report said the next biggest provider, Four Seasons, was also in serious financial trouble, although this was denied by Four Season's Chief Executive.

Unison general secretary Dave Prentis said: "We have already seen the huge impact of the Southern Cross collapse, but the care crisis is far from over. "Taxpayers will have to pay the price again, as they will be forced to pick up the bill for collapsing companies.

Is our social care sector on the road to disaster?? What can we do to escape from this crisis?