Do Not Resuscitate (DNR) Communication Failures in Hospital End-of-Life Care (BBC News / RCP)

Summary

The latest Royal College of Physicians (RCP) audit has estimated that one in five families may not be consulted when hospital staff decide not to revive their relatives and issue “Do Not Resuscitate” (DNR) orders.

“Guidelines issued by the British Medical Association and the Royal College of Nursing say that DNR orders should be issued only after discussion with patients or their family”.

This audit is the first RCP End of Life Care Audit to be conducted following the withdrawal of the Liverpool Care Pathway (LCP). It was funded by NHS England and Marie Curie, and commissioned by the Healthcare Quality Improvement Partnership (HQIP).

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‘Unacceptable’ that families ‘not told of resuscitation plans’. London: BBC Health News, May 2nd 2016.

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New RCP End of Life Care Audit shows steady progress in care of dying people. [March Press Release, Re-Launched / Re-Cycled for May Bank Holiday]. London: Royal College of Physicians, March 30th 2016.

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End of Life Care Audit – Dying in Hospital: National report for England 2016. London: Royal College of Physicians, March 29th 2016.

Posted in Acute Hospitals, BBC News, Charitable Bodies, Commissioning, End of Life Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Integrated Care, National, NHS, NHS England, Non-Pharmacological Treatments, Patient Care Pathway, Person-Centred Care, Quick Insights, Royal College of Physicians, Standards, Statistics, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Further Funding for the Dementia Research Institute (Gov UK / MRC / Alzheimer’s Society / ARUK)

Summary

Additional partnership funding has been announced for Dementia Research Institute (DRI). The Alzheimer’s Society and Alzheimer’s Research UK have each committed £50 million towards supporting the work of the Institute, making the total commitment to date around £250 million pounds.

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Historic £100 million charity backing for UK Dementia Research Institute. London: Medical Research Council (MRC), May 1st 2016.

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Charities’ historic pledge sees funding for landmark Dementia Research Institute soar to £250 million. London: Department for Business Innovation and Skills, Medical Research Council and Jo Johnson MP, May 1st 2016.

Possibly also of interest:

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Alzheimer’s Society makes historic £50 million investment in the UK Dementia Research Institute. London: Alzheimer’s Society, May 1st 2016.

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Alzheimer’s Research UK to invest £50m in UK Dementia Research Institute. London: Alzheimer’s Research UK, May 1st 2016.

Posted in Alzheimer's Society, Alzheimer’s Research UK, Charitable Bodies, Commissioning, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Mental Health, Models of Dementia Care, National, Non-Pharmacological Treatments, Pharmacological Treatments, Quick Insights, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Exploring the Relationship Between Worsening Depression and Increased Dementia Risk (BBC News / Lancet Psychiatry)

Summary

Researchers in the Netherlands, following 3325 adults aged over 55 years for 11 years, have discovered an association between symptoms of depression which increase steadily over time in older adults and a greater likelihood of developing early signs of dementia.

Other patterns of depression, including brief and stable chronic periods of depression, appear to be unlinked with heightened dementia risk.

The exact relationship between depression and dementia risk remains unclear, so it may be premature to speculate about strategies for prevention. Potential hypotheses concerning the underlying cause(s) of this statistical relationship are numerous:

“A [research] focus on lifestyle factors such as physical activity and social networks, and biological risk factors such as vascular disease, neuroinflammation, high concentrations of stress hormones, and neuropathological changes, might bring new treatment and prevention strategies a step closer… ”. Dr Simone Reppermund [Editorial comment].

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Worsening depression ‘may predict dementia risk’. London: BBC Health News, April 30th 2016.

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Reference

Mirza, SS. Wolters, FJ. [and] Swanson, SA. [et al] (2016). 10-year trajectories of depressive symptoms and risk of dementia: a population-based study. The Lancet Psychiatry. April 29th 2016. [Epub ahead of print].

Related editorial comment:

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Reference

Reppermund, S. (2016). Depression in old age: the first step to dementia? The Lancet Psychiatry. April 29th 2016. [Epub ahead of print].

Posted in BBC News, Depression, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, Mental Health, Quick Insights, Statistics, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Review of Interventions Which May Potentially Delay Functional Decline in Persons With Dementia (BMJ Open)

Summary

The authors examined 23 systematic reviews about the benefits of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) in people with dementia. Interventions thought to be effective (based on evidence sometimes judged to be “low quality”) include: (i) physical exercise, (ii) dyadic interventions and (iii) pharmacological treatments including acetylcholinesterase inhibitors and memantine, selegiline, huperzine A and Ginkgo biloba.

“Healthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care… ”

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Laver, K. Dyer, S. [and] Whitehead, C. [et al] (2016). Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. April 27th 2016, Vol.6(4), e010767. (Click here to view the PubMed abstract).

Posted in Commissioning, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), Integrated Care, International, Management of Condition, Models of Dementia Care, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Pharmacological Treatments, Quick Insights, Systematic Reviews, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

More on Disjointed Care for Dementia and Comorbidities: the CoDem Study (NIHR)

Summary

The National Institute for Health Research (NIHR) Comorbidity and dementia (CoDem) review confirms the need to improve continuity of care and access to services for persons living with dementia with co-morbidities (as covered in a recent ILC-UK report).  This study looks specifically at three conditions: diabetes, stroke and vision impairment.

“The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning”.

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Reference

Bunn, F. Burn, AM. [and] Goodman, C. [et al] (2016). Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). Health Service Delivery Research. February 2016; 4(8). (Click here to view the PubMed abstract).

Posted in Acute Hospitals, Commissioning, Community Care, Diagnosis, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Models of Dementia Care, NHS, NIHR, NIHRSDO, Non-Pharmacological Treatments, Person-Centred Care, Quick Insights, Standards, Stroke, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Self-Care and the Patient Activation Measure (PAM) Tool (NHS England)

Summary

NHS England has announced availability of an evidence-based tool designed to assist patients in obtaining person-centred support to manage their own care. The Patient Activation Measure (PAM) is a tool in the armoury of the Self-Care Programme, and is used to assess the extent to which people feel engaged and confident about self-care. NHS England has a five-year arrangement for using the PAM tool to help possibly 1.8 million people.

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Nearly two million patients to receive person-centred support to manage their own care. London: NHS England, April 25th 2016.

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Patient activation: people’s ability to manage their own health and wellbeing. [Online]: NHS England, 2016.

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Patient activation and PAM FAQs. [Online]: NHS England, April 2016.

NHS England’s Patient activation and PAM “FAQ” quick links comprise:

  1. What is patient activation?
  2. Why is patient activation important in the context of the NHS?
  3. Why are we using the term ‘patient activation’?
  4. How can measuring patient activation benefit people?
  5. How can measuring patient activation help clinicians?
  6. How can measuring patient activation help commissioners?
  7. Can people be supported to increase their activation? If so, what are the types of interventions that can help to increase it?
  8. Can a person’s activation level go up and down over time?
  9. How can clinicians support patients to increase their activation more effectively?
  10. Can supporting people to increase their activation have an impact on reducing costs for the NHS?
  11. What is the ‘Patient Activation Measure’ (PAM)?
  12. Are there any existing programmes using PAM in the NHS?
  13. How can PAM be used in practice?
  14. Is the PAM survey available in other languages?
  15. Why is the NHS supporting the use of PAM above other measures?

See also

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PAM learning set: how PAM is working in practice. [Online]: NHS England, 2016.

Implications for NHS Financial Sustainability

Background interest: regarding potential financial savings, and waste reduction, for the NHS:

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Hibbard, JH. Greene, J. [and] Overton, V. (2013). Patients with lower activation associated with higher costs; delivery systems should know their patients’ ‘scores’. Health Affairs (Project Hope). February 2013, Vol.32(2), pp.216-22. (Click here to view the PubMed abstract).

Posted in Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Integrated Care, International, King's Fund, Local Interest, Management of Condition, Mental Health, National, NHS, NHS England, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment