ElderWeb

PRESS RELEASE
New course will help people with dementia

The first nationally accredited training course aimed at improving the lives of people with dementia is being launched at the University of Sunderland.

The distance learning course for professionals will help further raise the level of care offered to thousands of people across the country living with dementia.

Sunderland has teamed up with the Alzheimer'™s society, BUPA care homes and the Joseph Rowntree Foundation to provide the new course, '˜an introduction to Dementia care'™.

Through open learning, the use of videos, group discussion and working with people with dementia, the course will encourage staff to view dementia care as a career choice and help in the understanding of the illness.

Vicki Lawson-Brown, senior lecturer in health studies at the university said: 'ÂœThis course recognises the attitude, expertise and knowledge needed to deliver successful dementia care.

'œIt'™s an exciting new development to provide a better quality of care for people who have dementia, treating them with the respect and dignity they deserve. We welcome the opportunity to recognise the work of care staff in this field.'

The new course is part of a range of Joseph Rowntree programmes awarded to the University of Sunderland by the trust two years ago.

Studies have shown that up to 75 per cent of people living in nursing and residential care homes have Alzheimer'™s or another form of dementia.

The Alzheimer'™s society hopes that all care providers will eventually use the course to help improve training for those working with people with dementia.

Daren Felgate, the Alzheimer'™s society'™s training and development manager, said: 'œWe hope this course will become the key introductory course for care workers helping people with dementia.

'œWorking with people with dementia is often seen as difficult and challenging, but with the right support many care staff will see it is the most rewarding work they have ever done.'

The course has already been piloted through four BUPA care homes and the Joseph Rowntree Foundation in York. It will be launched at the Royal Society in London on April 22, where speakers from BUPA and the Alzheimer'™s Society will be highlighting the importance of effective dementia care training.

More info is at http://www.sunderland.ac.uk/

The British Medical Journal (BMJ) published several articles about using exercise programs to prevent falls in older people. One half of those aged 80 years and older will fall in any one year, often with serious health and social consequences, so fall prevention is a topic worth investigating. The BMJ research found that an exercise program delivered by a physiotherapist or trained nurses had some success in reducing falls and moderate injuries in elderly people, but were not always cost-effective.

The British Department of Health announced that a new National Service Framework (NSF) for Older People has been launched with the aim of improving care for older people and rooting out age discrimination. The NSF is being backed by 120 million over the next three years to refurbish old-style Nightingale wards, which have fallen below acceptable standards of care. Health secretary Alan Milburn said that the new investment, on top of the 1.4 billion unveiled for older people's services under The NHS Plan, will ensure that old people are treated with dignity and privacy. Professor Ian Philp has been appointed the National Director for Older People?s Services to drive forward these new standards.

The plan includes provisions for champions in each health and social care setting to ensure staff are properly able to care for older people; a process for monitoring access to health and social care services to make sure there is no age discrimination; additional services particularly important for older people, including 70,000 more cataract operations, 16,000 more hip and knee replacements; 3,000 more coronary revascularisations; new services to provide for expert treatment and care at home or in other residential settings; and a new emphasis on healthy living for older people.

A recent issue of the British Medical Journal (BMJ) included an interesting history of the theories about longevity. The Journal, in an article which is easily understandable by both professionals and consumers, discusses the way that theories on "how to live forever" have changed over time. For instance, BMJ points out that people have known for years that eating roasted meats is unhealthy. Now we avoid roasted meats because of the artery clogging effects of cholesterol and the carcinogenic qualities of nitrosamines in the charred parts, but the theory some time back was that consuming roasted food used up too much body energy in the way that a gas burner uses up gas more quickly when the flame is turned up high. The article talks about ways that "fountain of youth" qualities have been attributed to a wide variety of food, drink, and lifestyle issues, like maintaining body heat and moisture, avoiding wine, sleeping on your right side, and taking rhubarb pills.

The British Medical Journal (BMJ) reports on a promising treatment for macular degeneration. They report that clinical trials showed that photodynamic therapy with verteporfin could reduce the risk of moderate and severe vision loss from 61% to 33% at one year and from 69% to 41% at two years in patients with neovascularisation extending under the centre of the retina and predominantly classic appearances on fluorescein angiography -- an appearance that has a high likelihood of growth and vision loss within months if left untreated.

They state that approximately 20% to 30% of the 200,000 cases of neovascular macular degeneration that present to ophthalmologists in the United States each year are candidates for prompt photodynamic therapy. Once extensive vision loss has occurred the treatment is no longer beneficial. It is important therefore to teach older patients with drusen who are at risk of developing neovascular macular degeneration to screen for the possible development of neovascularisation.

The British Medical Journal reports that a majority exists within the Scottish parliament in favor of providing free personal care for older Scots. This action came in response to a report from the Royal Commission on Long Term Care for the Elderly which recommended making personal services free to all. It has been estimated that it will cost ?110m ($165m) a year to pay for the improved package of care in Scotland. The personal services the Commission recommended covering include:

Personal toilet (washing, bathing, skin care, personal presentation, dressing and undressing and skin care)

Eating and drinking (as opposed to obtaining and preparing food and drink)

Managing urinary and bowel functions (including maintaining continence and managing incontinence)

Managing problems associated with immobility

Management of prescribed treatment (e.g. administration and monitoring medication)

Behavior management and ensuring personal safety (for example, for those with cognitive impairment - minimizing stress and risk)

UK's National Institute for Clinical Excellence (NICE) has issued guidance to local councils on the use of drugs for the treatment of Alzheimers Disease. Three drugs, Aricept, Exelon and Reminyl, have been approved for treatment of mild to moderate Alzheimers. NICE estimates that there are about 400,000 people in the UK with Alzheimers, and that about 250,000 of them have mild to moderate levels of the disease.

NICE reports that Donepezil is marketed by Pfizer/Eisai as Aricept, rivastigmine by Novartis as Exelon and galantamine by Shire Pharmaceuticals and Janssen Cilag as Reminyl. The annual cost in the UK of donepezil is 891 (5 mg)/1,248 (10 mg), taken in a single daily dose, for rivastigmine is £821 (all doses), taken twice per day, and for galantamine is £876 (16 mg)/1049 (24 mg) (allowing for an initial starting dose of 8 mg daily), taken as 8 mg or 12 mg twice per day.

NICE points out that it is difficult to estimate the total aggregate cost of using these medications, but that the cost may be offset by later entry to a nursing home. For example, a delay of 12 weeks at £370 per week would yield a cost saving of about £4,500.

The NICE website includes full guidance for local councils and leaflets for patients.

The British National Health Service (NHS) has unveiled a pilot of an online "best practices" health library which will be available to both professionals and patients over the Internet. The National electronic Library for Health (NeLH) is expected to be fully functional by March 2002. The role of the NeLH will be to provide health care professionals and the public (through NHS Direct Online and the New Library Network) with knowledge and know-how to support health care related decisions.

The NeLH aims to become one of the great libraries of the world. It will provide easy access to best, current knowledge and know-how; improve health and healthcare, clinical practice & patient choice; and will be available via NHSnet and the Internet. The library's goal in its first phase it is to provide clinicians with access to information within 15 seconds, with a longer term goal of reducing the wait to one second. One of the main features of the library will be its ability to act as a quality filter so that the data accessed through the site, for both clinicians and the public, will not only be the best current knowledge, but will also be free from bias and conflict of interest.

British scientists have announced what they say is the first evidence of a cure for rheumatoid arthritis. A research team at University College in London led by Professor Jonathan Edwards says it has discovered what causes the body's defenses mistakenly to attack healthy joints and tissue. Its cure focuses on the role of B-cells, white blood cells that defend the body against viruses and bacteria by making antibodies that attack the hostile microbes. B-cells can accidentally make antibodies that attack healthy tissue. In the case of arthritis, the result is a self-sustaining attack on joints and tissue.

Researchers followed 20 patients who have had rheumatoid arthritis for an average of 20 years and who all failed to respond to any standard therapy, and put them through 18 months of treatment. Of the 20, five now have only some residual pain from the damage already done. Researchers said they have returned to leading a more or less normal life, with one going to the gym and one taking up gardening for the first time in ages.

Prof Edwards and his colleagues believe that they have found a way to break the circle, using drugs that seek out and destroy B-cells. He said: "Unlike with other cells in the immune system, most people can live without any B-cells for a while. By the time we reach adulthood we have already made most of the antibodies we need." After a single treatment to wipe out all the B-cells, the body responds by making fresh ones. The chances of these new B-cells making the same mistake as their predecessors, however, thereby triggering a return of rheumatoid arthritis, is small.

Edwards said the B-cell based therapy might also offer hope to patients with other auto-immune diseases, such as Crohn's disease, lupus and even multiple sclerosis.

The team will announce the results of its research Monday at the annual scientific meeting of the American College of Rheumatology in Philadelphia. The findings will be also published in the leading journal Rheumatology.

The Genetics and Insurance Committee (GAIC) of the British Department of Health announced that genetic tests for Huntington's Disease can be used by insurance companies when assessing applications for life insurance. The Association of British Insurers is trying to have the policy extended to include testing for Alzheimer?s and breast and ovarian cancer. Patients will not be required to have testing performed, but they will have to disclose results if tested in the past. If a patient refuses to disclose results, insurers can either deny or charge much higher fees for coverage. Critics in the UK view the policy as discriminatory and have expressed concern over the government?s plan to expand the practice.

Professor John Durant, Chairman of GAIC said, "Genetic test results are already used in certain circumstances by insurers and the Committee was asked to look at the reliability and accuracy of the genetic test for Huntingdon's Disease...This decision will mean that those with a negative test result will not be asked to pay more for life insurance because of their family history of Huntington's disease...Many who have a family history of a genetic disorder such as Huntington's Disease have difficulty in obtaining insurance because of their family history. The approval of the two tests for Huntington's Disease will allow insurance to be provided at normal rates to those who have a normal test result."

The Financial Times reports that plans to allow councils to "lend" elderly people the cost of their long-term residential care, secured against the value of their homes, are being drawn up by ministers. Councils would meet the cost of the care then claim the money back from the person's estate. Ministers are also planning to allow three months of state-funded residential treatment before people would be forced to use the assets from their home to pay for the cost of care. Ministers hope this "property disregard" will act as an incentive to the elderly to give up National Health Service beds because they know they would not be charged for short-term care of up to three months.

Round-the-clock nursing home care costs about £330 a week and accommodation can be £200. Under plans to be set out in the white paper "Quality, Choice, Fairness - better services for the elderly" the government will meet the nursing costs of treatment but not the residential or "hotel" component of their care. Alan Milburn, the health secretary, has been negotiating the cost of this policy with the Treasury.

The United Kingdom's Department of Social Security has issued its annual report, titled "Life Begins at 50." This report summarizes many of the programs available to older persons, including both financial and medical assistance. The report also talks about upcoming government white papers on long term care issues.

New measures to tackle prejudice and discrimination against older people in the United Kingdom were announced today by Alistair Darling, Social Security secretary. Speaking at the first ever National Listening Event for Older People in London, Mr. Darling said a summit of employers and older workers? representatives will be called later this year to examine ways of fighting age discrimination in the workplace. And representatives from TV, advertising and the media will be brought together to discuss how to tackle negative images of older people.

He pledged to hold meeting with employers to find ways to counter ageism in the workplace, and to meet with the media to identify ways to replace negative images of older people with positive role models.

The Audit Commission issued a report, "Charging With Care," found wide variations in what people are charged for home help services and in how councils manage charges. It found charging policies in some areas leave some people with less to live on than the income support level appropriate for people of their age. The report also shows how financial arrangements can create incentives for managers to move people into residential homes when they could remain in their own homes.

More than 500,000 people receive home care throughout England and Wales, and 420,000 of them are over 65. These services range from help with shopping and cleaning to personal care services like bathing and dressing. Councils charge users for these services, and the income from charging enables many councils to improve services for the most vulnerable. However, there is no consistency from council to council on charging policy. Charges for similar users in different parts of the country vary from nothing to over £100 per week for the same level of service. About two-thirds of councils exempt those on the lowest incomes from charges, but 30% charge against income support, and some take up to 90% of the attendance allowance, the main disability benefit many older people receive. The Audit Commission also reported that users may be prematurely admitted to residential care because of the perverse financial incentives created by the systems of charges.

The Audit Commission previously issued reports on equipment services and mental health services for older people.

A study by the Imperial Cancer Research Fund shows that older women in Britain are more likely than younger ones to exercise. Their study showed that women over age 65 exercised about twice as often as women age 25-34. Nearly half of the older women exercised daily, compared with only about one quarter of younger women. The most often cited reason for failing to exercise was a lack of time.

Age Concern released a report showing that 50 elderly patients had been labelled "not for resuscitation" (NFR) by doctors without their consent. Age Concern released its list after a 66-year-old cancer patient discovered the comment "inappropriate for resuscitation" was written on her medical notes.

An editorial in the British Medical Journal reported that doctors in Britain do not consult up to two thirds of patients on decisions that could lead to their deaths. Patients listed as NFR were 30 times more likely to die than other patients. Do not resuscitate orders are more commonly used for older people, suggesting that doctors have stereotypes of who is not worth saving.

The Department of Health said it did not plan to investigate whether the claims were widespread, saying doctors and hospitals had clear guidelines on the issue.

The BBC reports that the British government is trying to change retirement rules to prevent Britains under age 55 from retiring. Currently, people with occupational or private pensions are given tax breaks if they take early retirement after 50. The government is said to be planning to increase to 55 the age at which the tax help comes into effect.

Social Security Secretary Alistair Darling will soon announce the findings of a report titled "Winning the Generation Game." A report from Downing Street's Performance and Innovation Unit referred to in the paper shows that 2.8 million people aged between 50 and 65 are not working, costing the government £16 billion every year. Ministers believe some of that money could be recouped if the trend towards earlier retirement were halted.

Research by Dr. Kay-Tee Khaw and colleagues at the University of Cambridge School of Medicine in the UK was published in the American Journal of Clinical Nutrition. Their study reported a correlation between tea drinking and bone mineral density in older women. They postulated that tea may reduce the risk of osteoporosis in older women.

The UK Emergency Bed Service said there was not a single intensive care bed available in all of London several days this winter. The shortage meant that doctors had to make decisions about who got a bed and who would be transferred, sometimes to hospitals many miles away. People over age 75 filled 290 of the 500 intensive care beds in January, and part of the bed shortage was due to the fact that these older people could not be sent home until social services assessed their home conditions, which sometimes took several weeks.

London's senior officials are determined that the same thing should not happen again this winter, and a team, comprised of medical experts and lay people, has been set up to look at the entire chain of events. There is also hope that a new infusion of £2 billion to the budget of the National Health Service will help solve the problem.

A study published in the British Medical Journal found that preventable adverse events were more common among elderly patients. Researchers speculate this is because of the clinical complexity of their care rather than age based discrimination. They also concluded that preventable adverse drug events, events related to medical procedures, and falls were especially common in elderly patients and should be targets for efforts to prevent errors.

Another study published in the British Medical Journal documents an attempt to quantify the value of preventative home visits to elderly patients in reducing later need for hospitalizations or other medical care. Researchers concluded they could find no evidence that these preventative visits made any difference in later medical care needs.

A Lifelong Learning initiative in the UK is supported by the Individual Learning Division of the Department for Education and Employment (DfEE). They have launched a Learning in Later Life competition to find the country's oldest learner and the "most inspiring" older learner. Entrants don't have to be engaged in a structured degree program. If they are over the age of 85 by 7 April 2000 and are deliberately learning a new skill or subject, brushing up an old skill or developing their abilities, they are eligible for the competition. Learning may cover a wide range of activities including, arts, crafts, creative writing, IT, languages, genealogy, cookery, dancing etc. The two national winners and 18 regional winners will receive a crystal trophy commemorating their achievement. The oldest applicant to date is Fred Moore, 107, who has been attending weekly art classes ever since he was 82, a period of 25 years!

Britain'™s National Health Service (NHS) has come under fire for alleged age discrimination over kidney care policies that sacrifice older patients in favor of saving younger victims of renal diseases. A confidential memorandum, leaked to the London Daily Mail, was signed by 12 senior clinicians at major hospitals in London. It indicates that a shortage of funds is forcing doctors to send kidney patients as young as 50 home to die so that the limited available funds can be channeled into treatment for the young.

This is the latest in a series of accusations that the National Health Service is actively promoting age discrimination in the delivery of health services. Age Concern's report Turning your Back on Us cites examples of ageism in the National Health Service. The report stated that old people are told that treatment is unavailable to them because of their age or are given a low priority. The Age Concern survey found that one in 20 people over the age of 65 in Britain had been refused treatment by the NHS, and that as many as one in 10 people said that they had noticed a difference in treatment since their 50th birthday. Areas of special concern are routine breast screening, cancer and coronary problems.

Prime Minister Tony Blair wants to mobilize Britain's senior citizens into a "Grey Army." The government has been talking to the several organizations - Age Concern , Reach the Retired, Senior Volunteers Programme, Community Service Volunteers , and the National Centre for Volunteering. The government will launch an "Experience Corps" nationwide that will support and mobilize opportunities for people over-50 to get involved.

Duff & Phelps Credit Rating Co downgraded Care Homes Securities, and warned of trouble in the whole care home industry sector in the UK. They mention rising operating costs, low occupancy, and limited fee increases as contributory factors in a number of operator failures.

Britain's National Health Service (NHS) is in the process of greatly expanding and revamping long term care services. The changes are being made in response to recommendations made by The Royal Commission on Long Term Care. Under the new NHS Plan the government will make new investments in intermediate care and associated services amounting to £900 million a year by 2003/2004 to promote independence, provide more choice for older people and deliver higher quality care. On top of this they will be targeting additional resources, for £360 million a year by 2003/2004, to tackle the anomalies and inequities of the present funding system for long term care. Many of these changes will become effective in April of 2001.

Under the new rules, NHS nursing care will be free in all settings. This change will benefit around 35,000 people at any time who could save up to around £5,000 for a year's stay in a nursing home.

Requirements for people to sell their homes to qualify for care will be softened. For the first three months from admission to residential care, the value of the resident's home will be disregarded from the means test to allow people time to decide whether it will be necessary to sell the property to pay care costs. This change will benefit around 30,000 people each year, who will save up to £2,000- £2,500 during the first three months of their stay. The NHS is still reviewing a suggestion that local councils extend loans to low income persons who need care so that they don't have to sell their homes during their lifetimes.

New statutory guidance will be issued to reduce the variation in the amounts people are asked to pay for help at home, which now vary greatly from one local council to another -- a system critics call the "postcode lottery". The means test for getting assistance from local councils will be increased from £16,000 to £18,000, which will benefit around 20,000 people in residential care homes and nursing homes.
Resources behind two social security benefits, the Preserved Rights to higher levels of Income Support and the Residential Allowance, will be transferred to local councils to make available additional resources to support the care costs of pre-1993 residents whose income support rates have fallen short of their care home fees.

The Government will investigate the regulation of long term care insurance after a Treasury led committee has reported on how the financial services industry can reassure its customers about the quality and reliability of the products available for financing long term care.
The report of the Royal Commission recommended that personal care, including nursing care and some social care tasks such as help with bathing, should be funded from general taxation, subject to an assessment of need. The NHS responded that three quarters of those in residential or nursing care already get some or all of their personal care costs met from public funds through local councils, and that making personal care free for everyone would consume most of the additional resources they plan to make available for older people through the NHS Plan without necessarily improving services. Therefore, this recommendation will not be followed.