Recovered memories of abuse:new research

New research suggest that memories of abuse recovered through therapy may be less reliable than memories which are recovered spontaneously.

Some years ago an intense debate began about the reliability of recovered memories of abuse when a number of very high profile cases hit the headlines in a number of coutnries. In some of these cases memories of abuse had been recovered through intensive therapy and there was much debate whether such memories could be relied upon as accurate recollections of past events.

The whole issue of the reliability of recovered memory became a very hot topic in the fields of psychology and psychiatry with fierce advocates on both sides.

Elke Geraerts, a psychology post doctoral researcher at Harvard University and Maastricht University, the Netherlands, aimed to try to throw light on this problem using a large-scale research study designed to test the validity of such memories.


Of course people who recover memories in this way will tend to be convinced they are real authentic memories and this makes validating the recovered memories difficult.

Geraerts and her colleagues avoided this problem by using outside sources to corroborate the memories.

The researchers recruited people who reported being sexually abused as children.

They divided them into three groups.
1) Those whose memories were categorized as either "spontaneously recovered" (the participant had forgotten and then spontaneously recalled the abuse outside of therapy, without any prompting),
2) those whose memories had been "recovered in therapy" prompted by suggestion

3) those whose memories ofthe abuse was "continuous" in that they had always been able to recall the abuse.

Interviewers, who had no knowledge of which group the subject fell into, then interviewed other people who could confirm or refute the abuse events. these included others who heard about the abuse soon after it occurred, others who reported also having been abused by the same perpetrator, and those who admitted having committed the abuse.


The results to be published in the July issue of Psychological Science, journal of the Association for Psychological Science, showed that,

1) overall, spontaneously recovered memories were corroborated almost as often (37% of the time) as continuous memories (45%) but were less reliable.

2) memories that were recovered in therapy could not be corroborated at all.

Of course not being able to of confirm that the abuse had happened does not prove that the memory is false. It does however suggest that memories recovered in therapy need to be treated with a great dela of caution, as the therapy context raises the opportunity for suggestion.
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Source: news release issued by Association for Psychological Science.

Care Home Standards:When big is not better

The Care Home market in the UK has seen a significant move over recent years towards the consolidation of ownership into the hands of fewer and larger ownership organisations. While in financial terms this may make sense there has been concern among commissioners and regulators whether these larger corporate organisations are always delivering a better quality of care in their homes in comparison to the smaller or single single home providers that are becoming a less significant part of the market.

Much of the concern about the standards in the Care Homes provided by the "big players" has admittedly been anecdotal and we are not aware that there has been any systematic study of this in the UK. Nevertheless the anecdotal evidence seems quite strong and it has been interesting to speculate why these larger organisations sometimes do not match the quality of care in smaller scale provider organisations.

Now a study by the University of Michigan School of Public Health suggests that the very strengths of the larger nursing home chain- its ability to standardize and perfect administrative practices throughout the chain-may also be the very thing that hurts patient care. While the study was confined to the more Nursing Home oriented facility in the US, it may have important lessons for the delivery of care across the Care Home sector.

"Consumers need ways to identify what is a good or bad nursing home when making choices about where to place a loved one," said Jane Banaszak-Holl, corresponding author on the study. "Right now, we have an easier time distinguishing the quality in McDonalds versus Boston Market than we have distinguishing how, for example, a Sun-owned nursing home differs from a Beverly Enterprises nursing home."

As in the UK these larger chain-owned nursing homes are the predominant type of institutional care in the United States. Studies in the US have shown that care in chain-owned nursing homes is generally not as good as care in nonprofit and singly-owned nursing homes.

"If they (chain-owned nursing homes) are really not as good, we need to think about how to improve them," said Akiko Kamimura, a U-M doctoral student in Health Management and Policy at the School of Public Health, and first author of the study.

The study suggests that corporate standardization of clinical and facility processes improved resident care, but that corporate standardization of administrative processes hurt patient care. The study concluded that chains need to balance administrative efficiency with the local needs of the individual chain-owned facilities to optimize the quality of their patient care.

The researchers surveyed 203 nursing homes in Michigan and North Carolina and looked at the effects of corporate standards and training in three areas: administrative processes, clinical processes, and facility design. The study examined the impact on the total number of health deficiencies given to facilities on state inspections, and the percentage of residents with bedsores. An example of a health deficiency would be inserting a catheter unnecessarily because it makes care easier.

An example of standardizing administrative processes would be to share common marketing materials. An example of facility standardization would be to use the same facility layout, and an example of standardizing clinical processes might be to implement guidelines for the treatment of resident bedsores throughout the chain.

"Standardization is a way to think about changing service delivery across many areas, including administrative and clinical processes and even within facility layout," said Banaszak-Holl. Chains that over-emphasize administrative processes don't take advantage of how much their staff can learn---and ultimately improve patient care---from the shared knowledge of developing protocols for handling resident needs.

"What we have stressed in the larger project is that chain ownership is not necessarily bad for the quality of health care, Banaszak-Holl said. "What is problematic is a shift away from community values and local needs, and an overly strong emphasis on administrative rather than clinical outcomes. A good corporate chain can implement a set of practices that still attends to local needs and resident outcomes while introducing greater economies of scale and better business practices."

The study, "Do corporate chains affect quality of care in nursing homes" The role of corporate standardization" appears in Health Care Management Review.

Dementia: Research supports person centered care

An intensive comparative study of two nursing home units using contrasting approaches to dementia care for elders with severely disturbed behaviors has shown that "humanizing" approaches to dementia care may not only extend quality of life for patients, but also their length of life.

Central Michigan University professor of anthropology Athena McLean in her recently published book, "The Person in Dementia: A Study of Nursing Home Care in the U.S.," demonstrates the very different outcomes of two approaches to dementia care: a rigid task-oriented maintenance approach which placed emphasis on disease progression and a flexible person-centered approach which focussed on the older persons communication and individual needs.

There were dramatic differences in patient quality of life at the two nursing units.

Patients at the person-centered unit, where staff looked beyond physical and reasoning abilities to the person's will and relationship with others, were happier, had improved quality of life and lived longer.

Those at the unit which focussed on disability and pathology tended to have personal needs ignored, were heavily medicated and often failed to thrive.

"These findings address issues that medicine can't answer," said McLean. "They are valuable not only for improving the general quality of life for these elders, but also for the long-term outcome based on how they are treated and cared for. These elders require attention, time and a lot of caring interaction."

The study also showed that relations among professional and administrative staff within a service can significantly affect the quality of the dementia care elders receive.

According to McLean; "Good caregivers are leaving the profession because they are underpaid and unappreciated. It needs to be understood by policy makers, family members and clinicians alike that money needs to be put into retaining quality caregiving staff, instead of only fancy facilities, which is currently the trend."

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Translate documents to Braille free

A Danish company has launched a free service which will automatically translate documents into either Braille or speech. The service is free for non-commercial use and may be of great assistance for organisations seeking to ensure equality of access for the sight impaired.

The service can be obtained through the RoboBraille website .

RoboBraille allows the user to;

• Translate documents into contracted Braille
• Translate documents into speech
• Translate text into visual Braille
• Convert text documents between different character sets
• Convert Braille documents to specific Braille character sets
• Partition documents into smaller parts

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.