Research: Dementia patients die from prescribed drugs

Research by a leading UK dementia charity, the Alzheimer's Research Trust, has revealed that many Alzheimer’s patients die early because of prescribed sedatives. The research is the largest neuroleptic withdrawal study of Alzheimer's patients and the only long-term one of its type.

The research results were presented at the Alzheimer's Research Trust conference in Edinburgh. Results from the five-year project, which was funded by the Alzheimer’s Charity revealed that the prescribed drugs were linked to a significant increase in long-term mortality - patients dying on average six months earlier than normal.

The investigation was conducted by King’s College London researchers and found that the sedatives, known as neuroleptics, were associated with significant deterioration in verbal fluency and cognitive function. They also found that neuroleptic treatment had no benefit to patients with the mildest symptoms.

In nursing homes they found up to 45% of people with Alzheimer’s disease are prescribed neuroleptics as a treatment for behavioural symptoms such as aggression.

Professor Clive Ballard, Professor of Age Related Disorders at King’s College London, and lead researcher on the project, said:

“It is very clear that even over a six month period of treatment, there is no benefit of neuroleptics in treating the behaviour in people with Alzheimer’s disease when the symptoms are mild – specifically when a measure of behavioural disturbance known as the Neuropsychiatric Inventory Score is equal to or less than 14. For people with more severe behavioural symptoms, balancing the potential benefits against increased mortality and other adverse events is more difficult, but this study provides an important evidence base to inform this decision-making process.”

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:

“These results are deeply troubling and highlight the urgent need to develop better treatments. 700,000 people are affected by dementia in the UK, a figure that will double in the next 30 years. The Government needs to make Alzheimer’s research funding a priority.

“Only £11 is spent on UK research into Alzheimer's for every person affected by the disease, compared to £289 for cancer patients.”

It will be interesting to see if this research results in changes to prescribing patterns for Dementia patients, particularly in care setting where there has been concern at the use of medication as a form of chemical restraint.

An outsiders view of Elderly Care Home Standards

Random Acts of Reality is written by a London Ambulance worker. He has written about his experience of visiting a care home to pick up an elderly lady. It makes sobering reading and illustrates just how far some care settings have to go to achieve reasonable standards.

Scottish Care Commission Frequency of Inspection New regulations

The Scottish Commission for the Regulation of Care (The Care Commission ) will in future operate under a new framework of Scottish Regulations for the minimum frequency of Inspection.
The Care Commission previously operated under a minimum frequency of Inspection of 12 months for all registered care services. The new minimum inspection frequency regulations change the minimum frequency for certain types of regulated services;

• For Housing Support services operated by a social Landlord minimum inspection frequency becomes 36 months.
• For Day Care of children services where the service is only for children aged 3 yrs or over minimum inspection frequency becomes 24 months.
• For Child Care Agencies - 24 months
• For Nurse Agencies - 24 months.
• For all other service types the minimum inspection frequency is 12 months.

Mental Welfare Commission Scotland Guidance April 2007

The Mental Welfare Commission for Scotland produces a number of helpful guidance documents;
The current list -

Nutrition by artificial means- a guide for mental health practitioners - new legal and ethical guidance for practitioners considering the use of artificial nutrition for mental disorder.

Consent to treatment - new guidance to help mental health practitioners interpret the legal basis for treatment and to give treatment that is in line with best legal and ethical practice.[2006]

Covert medication - a legal and practical guide - new This guidance responds to cases and research evidence that identifies this is an issue for those using and providing mental health and learning disability services in Scotland. The guidance suggests that there may be situations in which this might be necessary to keep an individual from harm. A Covert medication care pathway and review is provided to support decision making, that is structured and recorded in a way that safeguards that the health, safety and legal rights of the individual. [2006]

Guide to interpreting - new a toolkit for people who need to use interpreters in mental health and learning disability settings. Includes checklists for service providers, service users and interpreters. [2006]

Carers and confidentiality - new good practice guidance on how to balance the principle of carer involvement with the patient's right to confidentiality. [2006]

Rights, risks and limits to freedom (new edition) - guidance updated to take into account the principles of the new mental health act. Includes an appendix of legal considerations by Hilary Patrick. [2006]

Guide to welfare and financial guardianship in care homes - a summary guide for residential care workers with checklist that can be attached to resident's files. [2006]

Safe to Wander - Principles and guidance on good practice in caring for residents with dementia and related disorders where consideration is being given to the use of wandering technologies in care homes and hospitals. [2005]

Information for general hospitals - guidance on treatment of patients with a mental illness, learning disability or other mental disorder in general hospital settings. [2006]

Guidance on the admission of young people to adult mental health wards - guidance on the provision of care and treatment to under 18 year olds when admitted to adult wards. [2005]

When to invoke the Adults with Incapacity Act - updated guidance reflecting recent case law. [2005]

Authorising significant interventions for adults who lack capacity - guidance on the use of the Adults with Incapacity Act by Hilary Patrick. [2004]

Care of older people with mental health problems - a position statement on mixing dementia patients and patients with longer term mental disorder in a single ward. [2004]

CSCI hands over childrens services regulation

The Commission for Social Care Inspection (CSCI) has predicted that the handover of the inspection of children's services to education regulator Ofsted would not see immediate changes to the inspection approach.

CSCI's made the handover to Ofsted officially on April 1 at which point responsibility for regulation and inspection of most children's social care services in England moved from the Commission for Social Care Inspection (CSCI) to Ofsted.

The office of the children's rights director, Roger Morgan, based within CSCI, also joins the new Ofsted.

A CSCI statemnt said: "The inspection and regulation of children's services does not change significantly in the short term, with many CSCI staff transferring to Ofsted and continuing the focus on the experience of children who use services."

CSCI retains all functions for adult social care including services for younger adults and older people. It will also continue to regulate a small number of services that serve both adults and children - some home care services, nurses agencies, care homes and specialist further education colleges registered as care homes. CSCI will also continue to have an interest in the transition from children's to adults' services.

Ofsted also has a new title as the Office for Standards in Education, Children's Services and Skills.

Christine Gilbert, chief inspector of education, children's services and skills, , said: "The reach of the new inspectorate is extensive. At least one person in three makes use of the services we shall inspect or regulate. This puts us in a position to make a difference to the lives of many millions of our fellow-citizens, of all ages. This is a privilege, and a great responsibility."

CSCI: One person childrens Homes and childrens services reports

A recent Commission for Social Care Inspection (CSCI) report raises questions about the value of "one-person children's homes". Councils can pay anything up to £6,000 a week to place children with extreme and complex needs in such homes but there appears to be no proof that approach benefits the children concerned.
In "one person children's homes" a child is often kept in a private house together with non-resident staff working in shifts. CSCI found that despite government guidance stressing the importance of children in care staying in their local area they are often located far from the child's own community.
The number of such children's homes is increasing, but it is not clear that councils have properly considered their efficacy. Children may stay in these homes for a few months or for periods of years.
CSCI notes that the homes are "extremely expensive" and questions whether the councils who are getting a good deal. Private providers are able to charge so much for the services because the provision is so scarce.

Denise Platt, CSCI chairwoman, said: "We don't know enough about how children respond to living on their own in these one place children's homes... It may well be convenient for local councils to place children with complex needs in these homes, but the impact on the children who live there is still unclear."
In some cases the impression was that the care process had not been "thought through", Dame Denise said.

Children living in some of the one-person homes told inspectors they were glad to escape bullying and enjoyed more attention from staff but they also often missed the company of other children and felt lonely.
Inspection reports revealed the homes did worse than larger children's homes in key areas, including support for individual children and the training and competency of staff.

Some councils do not use one person homes on principle and those who do tend not to do so as a first choice. Youngsters being placed usually have complex emotional or behavioural difficulties, learning disabilities and mental health problems, and may be difficult to control.
Some homes were found to be illegally limiting children's freedom - although they are not officially secure accommodation.

CSCI has also published a report on childrens services , The report found a need to improve progress in a number of areas including;

Increasing financial pressures are resulting in high eligibility criteria and thresholds for access to local council services. Children and families are, as a result, not always getting the help they need.
There is not enough support for children when they are taken into care and placed in a children’s home or with foster parents.
There are shortfalls in services to vulnerable children and young people with mental health problems, and in particular for children in care and their families.
Children in care do less well in education. While there have been improvements, more needs to be done, and done quickly.
Services to children with disabilities vary considerably depending on where they live. Services to children whose parents are disabled are similarly variable from one local council area to another.
There is insufficient coordination between children’s and adults’ social services teams in local councils to ensure coordinated help.

Scottish Executive guidance on Social Care Staff recruitment

The Scottish Executive has published a document Safer Recruitment through Better Recruitment which gives advice on safe staff recruitment practice in the social care sector.