Music therapy – how music therapy is helping older people and persons with dementia.

Music therapy for dementia
Music therapy for dementia

Leicester’s Hospitals are working together with OPUS, a leading provider of music in healthcare settings, to bring music onto wards for older people and for those with a dementia.

Following the success of their previous visits to Older Peoples wards, OPUS will now visit all three sites of Leicester’s Hospitals on a weekly basis over the next two years.

Two musicians will be visiting the hospital for a day each week, providing music and song on various wards. OPUS musicians engage with patients, visitors and staff in music-making, creating an environment conducive to health and well-being. The musicians also carry a variety of instruments for patients to use.

Music and singing creates an opportunity for patients to reminisce and retrieve memories which at other times may be lost. This initiative has been supported by the Arts Council and Leicester Hospitals Charity.

Justine Allen, Older Peoples Sister, said: “The first visit from OPUS was inspiring and overwhelming to say the least.  Patients with dementia who had found it difficult to communicate beforehand began to respond. They clapped, touched, opened their eyes, smiled, tapped and sang.

“It was amazing to be part of and was great to see the positive impact OPUS had on the overall environment, for both staff and visitors to the ward.”

OPUS Music Community Interest Company (CIC) is a UK leader in taking music-making into healthcare settings.  The core team of musicians from OPUS are Nick Cutts, Richard Kensington, Oli Matthews and Sarah Matthews.

Nick Cutts, Director and musician at OPUS, added: “We are delighted to be extending our practice at Leicester’s Hospitals to include work with older patients and those with dementia. We know from our experience, and from recent research, that live music-making makes a huge difference within hospitals both to the health and wellbeing of the patients, but also to the visitors and staff.”

The OPUS visits began this September, to support national Older People’s Month, among a calendar of events and ward celebrations arranged by Leicester’s Hospitals patient experience team.

For more information about OPUS, please visit www.opusmusic.org

Lack of community services to support carers is piling pressure on emergency care

Lack of community services to support carers is piling pressure on NHS emergency care
Lack of community services to support carers is piling pressure on NHS emergency care

Due to a lack of appropriate support in the community, unpaid carers are reluctantly taking their loved ones to A&E, according to new research published today by Carers UK [1]. The charity’s report comes as the NHS prepares for its annual challenge of increased A&E visits and hospital admissions during the winter months.

Carers identified serious difficulties accessing primary and community support services, with 1 in 5 saying they had no option but to take their loved one to A&E because it was impossible to see a district nurse or a GP out of hours, and 1 in 10 saying they didn’t know where else to go.

The report, Pressure points, found that the majority of carers who have taken their loved one to A&E in the past 12 months believe their admission could have been prevented with more (55%) or higher quality support (50%) for the person they care for, more local support for them as a carer (32%) or access to a district nurse (25%).

A reduction in the provision of local care and support services is contributing to a rise in A&E visits and hospital admissions, as families say they have nowhere else to turn. Indeed, there were over 500,000 more visits to A&E in the first quarter of 2016 than the same period last year [2].

This growing demand on the NHS is forcing many people to be discharged from hospital too early, often without the right support in place at home and without proper consultation with their family. Over half of carers (58%) said that the person they care for had been discharged from hospital too early; with 12% saying their loved one had to be readmitted at a result. Not only is this counterproductive for the health of the person being cared for but it also causes undue stress and anxiety for families and friends who are often unprepared to take on caring responsibilities or coordinate aftercare themselves.

A lack of community health and care support is not only resulting in more people being admitted – or readmitted – to hospital, but it is also leading to many people having to stay in hospital for longer than necessary as they wait for an appropriate care package to be put in place to enable them to go home. What’s more, the cost to the NHS of delays in discharging older patients alone is £820 million a year [3]; with the number of delayed discharges, and therefore costs, continuing to rise [4].

Heléna Herklots, Chief Executive of Carers UK, said:

“The majority of care provided in England is not by doctors, nurses or care workers, but by family and friends. These carers have told us that they aren’t able access the support they need, when they need it, from community health and care services, so they are reluctantly having to turn to A&E.
“What’s more, a lack of consultation, support and information at the point their loved one is discharged from hospital means that many families are taking on a caring role in a crisis and feel unprepared. This isn’t sustainable and is leading to many people being readmitted to hospital shortly after they’ve been discharged, piling more pressure on an already stretched NHS.

“With more and more families picking up caring responsibilities and older people with care needs being encouraged to stay at home for longer, a step-change is urgently needed to boost investment in community services and involve carers in decisions about the support they, and their loved ones, need to manage at home.”

 Carers UK is calling for:

A Carer Friendly NHS programme, introducing a new duty on the NHS to identify carers and promote their health and wellbeing, as well as policies which ensure carers are involved in decision making around hospital admissions and discharges, and the adoption of a Carer Passport scheme

Increased funding for social care, with the Government putting in place a sustainable funding settlement for social care and ring fencing funding for carer breaks

Greater access to social care and health care in the community, including looking to new technologies to facilitate virtual health consultations and access to electronic patient records

Greater support from primary care services to better help carers look after their own health, including annual health checks for carers and free flu jabs

To download your copy of Carers UK’s Pressure points: carers and the NHS report, visit: www.carersuk.org/pressurepoints

Carers UK recognises that deciding to care or continue caring for someone who is coming out of hospital can be very difficult. The charity has published a fact sheet which outlines carers’ rights during the hospital discharge process, the steps that should be followed before the person is discharged from hospital and advice on what to do if things go wrong. The fact sheet, Coming out of hospital, is available at: www.carersuk.org/help-and-advice/practical-support/coming-out-of-hospital

 

[1] Pressure points: carers and the NHS (2016) Carers UK

[2] A&E Attendances & Emergency Admission Statistics, NHS and independent sector organisations in England (July 2016) NHS England

 

Total A&E Attendances
2015 2016 Percentage change
January 1,732,067 1,906,920 10.10%
February 1,654,846 1,870,776 13.05%
March 1,942,967 2,087,553 7.44%
TOTALS 5,329,880 5,865,249 10.04%

 

[3] Discharging older patients from hospital (2016) National Audit Office

[4] Monthly A&E Report (June 2016) NHS England: In June 2016, there were a total of 171,300 delayed days, of which 115,400 were in acute care – an increase of 31,800 from June 2015.

For practical advice and information about caring, contact the Carers UK Adviceline on 0808 808 7777 (10am-4pm, Monday-Friday) or email advice@carersuk.org. Our listening service is available Mondays and Tuesdays, between 9am-7pm.

 

International Day of Older Persons – Facebook Q&A session on Ageism and Health

International Day of Older Persons
International Day of Older Persons

Ageism is a pervasive and serious form of stereotyping and discrimination that has a significant negative impact on one’s health. Ageism is everywhere – in popular culture, in language, and policies such as mandatory retirement ages. These attitudes and practices marginalize older adults and leads to their exclusion from society. Research shows that negative attitudes towards ageing can even shorten one’s life by 7.5 years.

To mark the International Day of Older Persons on 1 October, WHO is organizing a live Q&A session via Facebook on this year’s theme, “Take A Stand Against Ageism”.  One of our experts will take questions directly from the audience. Questions can also be submitted in advance to healthyageing@who.int with the subject line “Facebook Live”.

Topic: Ageism, population ageing and health

Speaker: Dr John Beard, Director, Department of Ageing and Life Course, World Health Organization

When: Friday, 30 September 2016 at 16h00 Central European Summer Time (10h00 Washington DC, 15h00 London, 22h30 Beijing)

How to connect: Visit http://www.facebook.com/WHO.

Charles Bonnet syndrome – what are the cause, signs, symptoms and treatments of Charles Bonnet syndrome?

Charles Bonnet syndrome
Charles Bonnet syndrome

In Charles Bonnet syndrome, a person whose vision has started to deteriorate sees things that aren’t real (hallucinations).

The hallucinations may be simple patterns, or detailed images of events, people or places. They’re only visual and don’t involve hearing things or any other sensations.

It’s important to be aware that hallucinations associated with Charles Bonnet syndrome are caused by failing eyesight. They’re not caused by a mental health problem or dementia.

People with Charles Bonnet syndrome are usually aware that the visions aren’t real, even if they’re vivid.

Always see your GP if you’re experiencing hallucinations so they can investigate the cause.

Types of hallucination

There are two main types of hallucination that people with Charles Bonnet syndrome tend to experience. They may see:

simple repeated patterns

complex images of people, objects or landscapes

Simple repeated patterns can take the form of grids, shapes or lines, which can appear in bright or vivid colours. The patterns may lay across or cover everything the person sees.

More complex hallucinations can involve people, places, animals and insects. Most people don’t see hallucinations of people they know or past events they’ve experienced.

The hallucinations aren’t usually unpleasant or threatening, but they may be slightly frightening when first experienced. The can sometimes occur out of the blue, and can last for a few minutes or several hours. They may be moving or static.

Who’s affected and why?

Charles Bonnet syndrome affects people who’ve lost most or all of their eyesight. It’s more likely to occur if vision loss affects both eyes.

According to the Macular Society, up to half of all people with macular degeneration – a gradual loss of central vision – may experience Charles Bonnet hallucinations at some time. It’s thought there are more than 100,000 cases in the UK.

People of any age can be affected by Charles Bonnet hallucinations, but they tend to occur later in life after a person starts to lose their sight. The hallucinations often begin when a person’s sight suddenly deteriorates.

The main cause of Charles Bonnet syndrome is thought to be vision loss and how the brain reacts to it. It’s not clear how loss of vision leads to hallucinations, but research is beginning to help us better understand the relationship between the eyes and the brain.

When a person starts to lose their sight, their brain doesn’t receive as much information as it used to. It’s thought the brain sometimes responds by filling in the gaps with fantasy patterns or images that it’s stored. These stored images are experienced as hallucinations.

What effect can hallucinations have?

Visual hallucinations are a normal response the brain has to the loss of vision.

However, as Charles Bonnet syndrome isn’t widely known, many people worry about what it means and fear they may be developing a serious mental illness or dementia.

It can also cause practical problems. People who see complex hallucinations may find it difficult to get around.

Streets and rooms may be distorted, and brickwork or fencing may appear directly in front of you, making it difficult to judge exactly where you are and whether you can walk straight ahead.

Some people can overcome this problem by having good knowledge of their surroundings.

Complex hallucinations can be unsettling. Although the visions may not be frightening, it can be disturbing to suddenly see strangers in your home or garden.

For most people, the hallucinations will improve over time, with episodes becoming shorter and less frequent. Recent evidence suggests most people will still have occasional hallucinations five years or more after they first started.

If the hallucinations do stop entirely, there’s always a chance they’ll reappear after a further decline in vision.

Diagnosing Charles Bonnet syndrome

There isn’t a specific test for Charles Bonnet syndrome. Doctors diagnose it by:

talking to the person about their symptoms

taking a detailed medical history

in some cases, carrying out tests to rule out other possible causes of hallucinations, such as Alzheimer’s disease

If a person has vision loss and they’re experiencing simple or complex hallucinations and they don’t have signs of dementia or mental illness, they probably have Charles Bonnet syndrome.

Treating Charles Bonnet syndrome

There’s currently no cure for Charles Bonnet syndrome.

Simply understanding that the hallucinations are a normal consequence of vision loss, rather than a mental health problem, can be very reassuring and help the person cope better.

No specific medication has been shown to stop hallucinations caused by Charles Bonnet syndrome. Some medications that are designed to treat epilepsyParkinson’s disease and dementia have proved effective for some people.

However, these powerful medications can have serious side effects, and are therefore only recommended for people who are severely affected and under close supervision.

Self-help measures

You could try some self-help measures to help relieve your hallucinations when you experience them. For example, when a hallucination starts, you could:

change the lighting conditions to see if it disappears – for example, if you’re in a dimly lit area, switch on more lights or move to somewhere that’s brighter; if in a brightly lit area, make it dimmer

move your eyes from left to right – do this once every second 15 times without moving your head, then pause for a few seconds and repeat; it’s worth trying this up to four or five times

stare at the image and blink rapidly or reach out to touch the vision – try this for a few seconds

move around or perform a task – for example, get up to make a cup of tea

make sure you’re well rested and are getting enough sleep at night – the hallucinations may be worse when you’re tired or stressed

Some people overcome their fear by getting to know the figures in their visions.

For example, one man with Charles Bonnet syndrome has described how when he wakes up in the morning, he says, “Right, what have you got in store for me today?” to the figures he’s seeing. This allows him to have some control over the way he feels about his visions.

Help and support

If you have Charles Bonnet syndrome, talking about your hallucinations and how they make you feel may help you cope better. You could try talking to your family, friends, GP, optician, or ophthalmologist.

Mental health professionals, such as counsellors, psychologists or psychiatrists, may also be able to help if you’re finding the hallucinations particularly upsetting.

Although Charles Bonnet syndrome isn’t a mental health condition, many mental health professionals have experience of helping people come to terms with hallucinations. Your GP should be able to refer you to your local mental health team.

Read more about counselling and psychotherapy.

There aren’t many specific support groups and forums for people affected by Charles Bonnet syndrome, but there are lots of support groups for people with vision loss.

The Macular Society runs a buddy service for people affected by Charles Bonnet syndrome, where they can put you in touch with someone who’s also experienced visual hallucinations for support and reassurance. Their helpline is available on 0300 30 30 111, Monday to Friday, 9am to 5pm.

Esme’s Umbrella, an awareness campaign for Charles Bonnet syndrome, has a website with links to information and helpful resources for both patients and healthcare professionals.

The Royal National Institute of Blind People (RNIB) also has more information and advice about Charles Bonnet syndrome.

Carers UK responds to report warning of growing strain on sandwich generation of carers

Carers UK responds to report warning of growing strain on sandwich generation of carers
Carers UK responds to report warning of growing strain on sandwich generation of carers

Carers UK responds to research published today by Macmillan Cancer Support, which shows that around 110,000 people in the UK are caring for a parent with cancer, whilst also looking after their own children [1].

Emily Holzhausen, Director of Policy and Public Affairs at Carers UK, said:

“In raising awareness of the pressures facing people who are caring for a parent with cancer whilst also looking after their young children and often juggling work, Macmillan’s research highlights a far wider and deeper issue for carers who support loved ones across many conditions.

“Indeed, there are a staggering 2.4 million people who are sandwiched between raising families of their own whilst providing care to an older loved one with a disability or chronic illness. And it is women who are more likely to shoulder this responsibility, with our research showing that they are four times more likely than men to have given up work due to multiple caring responsibilities.

“Today’s report adds to growing evidence that this is fast becoming one of the hardest pressed generations [2]. As a society, we must recognise that we all likely to either receive or provide care at some point in our lives. Without the right support at the right time, caring can take a serious toll on carers’ health, finances and ability to have a life outside of caring. With this in mind, the Government must use the opportunity of its new Carers Strategy to make lasting change in the way public services and workplaces support families.”

Carers UK is here with advice, information and support wherever you are on your caring journey. For practical advice and information about caring:

[1] Under Pressure – The growing strain on cancer carers (2016) Macmillan Cancer Support

[2] Caring responsibilities in