Older people’s health

Posted on May 31, 2018May 30, 2018 Older people's health

Report helps people plan for their future treatment and care

Long term care

Polling finds while majority appreciate importance of recording and sharing their wishes, less than 1 in 10 have done so

Compassion in Dying is today (Wednesday 30 May 2018) launching a new publication designed to help people think about their priorities for the future and make plans for their treatment and care. Officially endorsed by the Royal College of Nursing, Planning ahead: My treatment and care aims to support people to discuss and record their wishes so they can get on with living life, knowing they have prepared for the future.

Polling conducted by YouGov in 2018[1], commissioned by Compassion in Dying, found that the vast majority (87%) of the public feel it is important that healthcare professionals caring for them know their wishes for future treatment. Top of their end-of-life concerns were ‘to have my symptoms and pain well controlled’ (23% listed this as their top priority) and ‘to be able to maintain by dignity and independence’ (20% listed this as their top priority). Just one in ten (10%) said they would want a doctor to make final decisions regarding their treatment and care if they were to become unable to make these choices for themselves.

Despite this, less than one in ten people have recorded their wishes in a legally binding way, either by making an Advance Decision (‘Living Will’) which allows someone to state whether they want to refuse life-prolonging treatment in certain circumstances (4%), or by making a Lasting Power of Attorney for Health and Welfare to appoint a trusted person(s) to make healthcare decisions on their behalf (7%). This means that doctors may be left to make important decisions without knowing a person’s values and preferences.

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Peter Coe, 69, from Lyme Regis, whose experience is featured in Planning Ahead, is well aware of the benefits of discussing and recording healthcare wishes with loved ones. He explained:

“My dad had memory problems and wanted me to support him in enforcing his healthcare decisions and ensuring that his choices were undertaken. He made me his attorney for health and welfare, which provided an opportunity to discuss his wishes for the future.

“Sadly, in 2016 we were told his kidneys had failed and Dad didn’t have the capacity to make a decision over whether to opt for dialysis. We were told it might delay the effects for a few months but would involve arduous trips to the hospital several times a week. At the time Dad was living alone with support for daily tasks from his carers and me, and being able to spend his days in the garden, watching the sea, was very important to him. He had previously discussed what decision he would have made in such circumstances. I therefore felt confident that I could make the decision to refuse dialysis on his behalf, while ensuring he was comfortable and pain-free.

“It was a hard decision to make and I had to discuss it thoroughly with the

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doctors, but it would have been much more difficult if I hadn’t spoken to Dad about his priorities. I knew it was what he would have wanted and as a result he was able to spend his final months doing the things he loved most, seeing his family and enjoying his garden.”

Planning Ahead explains in simple language the information people need to understand how treatment and care decisions are made, how they can plan ahead to ensure they stay in control of these decisions, and who to talk to and share their wishes with. It also includes answers to the common concerns that Compassion in Dying hears on its free information line such as, ‘can I have a ‘Living Will’ as well as a Lasting Power of Attorney for Health and Welfare?’, ‘can anyone override my wishes?’, ‘how will it feel to plan ahead?, and ‘is it expensive?’

Natalie Koussa, Director of Partnerships and Services at Compassion in Dying, said:

“We produced Planning Ahead because sadly any of us could become unwell and unable to tell the people around us what we do or do not want. By making plans now, you can record your preferences for treatment and care so that if you are ever in that situation, your wishes are known and can be followed. It gives you control and allows you to express what is important to you, providing peace of mind. Planning ahead means you can get on with living, safe in the knowledge that if an illness or injury leaves you unable to make decisions about your treatment and care, it will be easier for those around you to respect and follow your wishes.

“We are thrilled to have official endorsement from the Royal College of Nursing and the backing of other leading organisations in the sector, such as the Alzheimer’s Society. We hope Planning Ahead will be a valuable tool for individuals, their loved ones and health professionals alike.”

Amanda Cheesley, Professional Lead for Long Term Conditions and End of Life Care at the Royal College of Nursing, said:

“We are delighted to endorse Planning Ahead. Discussing death with family and friends and letting them know our wishes can help ensure people’s experience of care at the end of their life is as personal and compassionate as possible.

“The more we make talking about future treatment and end-of-life care a normal and sensible thing to do, the less frightening it will be for patients. This useful and easy to read booklet will be helpful to many people.”

Jeremy Hughes, Chief Executive Officer at Alzheimer’s Society, added:

“This is a valuable resource to help anyone think about what kind of care and treatment they would want in the future. It can be an incredibly emotional and difficult time when making these decisions and this guidance will help walk people through all the aspects that need to be considered. This is particularly important for people living with dementia, as they may not be able to make these important decisions later on.

“This guide can also be a useful tool to start conversations with those closest to a person with dementia and it can be reassuring for wider families and friends to have some clarity about what someone wants for the future. Too many people with dementia die with their wishes unknown and unmet. This publication seeks to empower people with dementia and ensure their rights are upheld.”

Leave a comment Posted on April 28, 2018April 28, 2018 Older people's health

Research helps frail older people in hospitals

A team led by Leicester scientists and clinicians has devised a ‘risk score’ which will be used to help frail older people have better support in hospital.

Using the concept of frailty (which captures vulnerability), researchers have created a risk score that will help identify older people who are more vulnerable.

This will help commissioners and hospitals identify this group of people, evaluate their outcomes and improve services to be more responsive to their needs.

Simon Conroy, geriatrician at Leicester’s Hospitals and professor at the University of Leicester Department of Health Sciences, said: “Leicester researchers are leading the way in improving outcomes for older people with frailty who have to come to hospital. Many older people attend hospitals throughout the UK every day, but some are more vulnerable than others.

“The ‘Hospital Frailty Risk Score’ was able to identify older people at significantly increased risk of harms, longer stays in hospital and readmission following discharge from hospital.

“It is hoped that by identifying and focussing upon this high risk group that hospitals will be able to provide more holistic care to vulnerable older people to improve their outcomes.”

Collaborators involved include the Nuffield Trust, the Universities of Leicester, Newcastle, Southampton and the London School of Economics.

The research, funded by NIHR, is published on 26 April 2018 in The Lancet and can be found here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30668-8/fulltext

Leave a comment Posted on March 24, 2018March 24, 2018 Older people's health, Patient Talk

Retirement linked to a decline in memory

“Retirement causes brain function to rapidly decline, warn scientists,” The Daily Telegraph reports, before adding that “workers looking forward to enjoying a long and leisurely retirement after years of toil, may need to think again”.

In fact, the study being reported on – an analysis of thinking and memory (cognitive function) in retired civil servants – only found a decline in one area. This was in “verbal memory function”, which is the ability to recall words, names and other spoken information.

When taking the natural decline with age into account, verbal memory function declined 38% faster after retirement than before. The good news is that other important cognitive functions, such as the ability to think quickly and identify patterns, were largely unaffected.

It’s not clear whether the faster decline of verbal memory function had meaningful clinical significance. It certainly doesn’t prove that people were more likely to develop dementia.

Memory decline is a complex problem affected by many different factors, not just retirement. Staying active during retirement may also help to improve overall quality of life, maintain social networks and help prevent loneliness.

Despite the Telegraph’s dire warning, it is entirely possible to “enjoy a long and leisurely retirement”. Read more advice about how women and men can stay physically and mentally healthy after the age of 60.

Where did the story come from?

This study was carried out by researchers at University College London, King’s College London and Queen Mary University, also in London. It was funded by the Economic and Social Research Council and the Medical Research Council. The study was published in the peer-reviewed journal the European Journal of Epidemiology.

The Daily Telegraph and Mail Online reported the results of the study accurately, but were arguably guilty of exaggerating the implications.

The Telegraph presents a particularly harsh depiction of the research and states “those looking forward to enjoying a long and leisurely retirement after years of toil may need to think again”. The coverage implies a link between retirement and dementia, stating retirement “makes it more likely dementia will set in earlier”. The study mainly looked at age-related cognitive decline. It noted any diagnoses of dementia, though there were very few. In any case the study can’t prove direct cause and effect.

What kind of research was this?

This study looked at data from 3,433 people from the Whitehall II Study. This is an ongoing prospective cohort study looking at wellbeing and mental and physical illness in an ageing population.

Large prospective cohort studies such as this are a good way of looking at a large body of data to see whether different exposures may be linked with later outcomes. However, the best sort of study will set out with the purpose of examining the influence of a specific exposure or risk factor to ensure they have gathered the right information and assessed possible confounders.

This study wasn’t specifically set up to look at the effect of retirement on cognitive decline. This means the authors can suggest association, but they can’t rule out confounding from other factors.

What did the research involve?

The Whitehall II Study recruited civil servants aged 35-55 working in the London offices of 20 Whitehall departments in 1985-1988. The response rate was 73% resulting in a sample of 6,895 men and 3,413 women. The participant’s employment ranged from clerical grades, through to senior administrative grades.

This particular study looked at data collected every 2 to 3 years between 1997 and 2013 (4 waves in total) when information on cognitive function was collected. This analysis included 3,433 people (72% male) who moved from work to retirement and had cognitive assessment at least once before and once after retirement.

At each of the 4 assessments self-reported employment status, memory and health status were measured. The memory examinations tested people’s:

verbal memory (memory for words and verbal items)

abstract reasoning (ability to think quickly and identify patterns)

verbal fluency (retrieve specific information)

The researchers looked at the relationship between retirement and cognitive function, adjusting for the following confounders:

year of birth

gender

education

smoking status

alcohol consumption

depression symptoms

blood pressure

body mass index

total blood cholesterol

cardiovascular disease

cancer

diabetes

They also looked at whether retirement was due to long-term sickness, which was defined as health-related retirement.

What were the basic results?

Verbal memory was the only cognitive outcome linked with retirement after adjusting for age and other confounders. Retirement had no significant impact on the other cognitive domains.

Declines in verbal memory were 38% faster after retirement compared to before. After retirement, verbal memory scores declined by 0.143 every year (95% confidence interval [CI] -0.162, -0.124). The scores are based on how many of 20 words the participants could recall after 2 minutes.

Higher employment grade was protective against verbal memory decline while people were still working, but this was lost when individuals retired, resulting in a similar rate of decline post-retirement across employment grades.

How did the researchers interpret the results?

The researchers state: “In support of the ‘use it or lose it hypothesis’ we found that retirement is associated with faster declines in verbal memory function over time, but has little impact on other domains of cognitive functions, such as abstract reasoning and verbal fluency.”

Conclusion

This study has some strengths in that it was able to assess a large number of people and look at cognitive change over a long time period, both before and after retirement. It also took into account a number of important factors that may be confounding the analyses.

However, this study only showed a decline in verbal memory. It had no effect on other areas, so certainly doesn’t show that people are at risk of faster overall cognitive decline after retirement. It also doesn’t show any links with a clinical diagnosis of either mild cognitive impairment or dementia.

It’s unclear whether the 38% greater decline in verbal memory would make meaningful difference to a person’s everyday life. The study also can’t show that retirement is the direct cause of the greater decline because other factors may be involved. However, it is possible.

Verbal ability is likely to be enhanced in the work environment due to the need for self-organisation, communication and collaboration. Therefore it may be fairly normal for this to be poorer after retirement.

There were a number of other limitations that may have affected the results:

It’s difficult to untangle whether verbal decline may be directly due to termination of employment, or primarily due to other social factors related with this.

The study hasn’t assessed the effect of post-retirement activities such as voluntary work, social and physical activities that may modify the risk of cognitive decline. Some people may be more cognitively and physically active and therefore happier in retirement.

Compared with the general population, those recruited to the Whitehall II study (civil servants) may have more mentally challenging roles, meaning their cognition cannot be regarded as being representative of the general population.

The sample had double the amount of men to women, which may have affected the results as men and women may have different retirement patterns and activities after retirement.

Regardless of employment, memory declines with age. Staying physically and mentally active, with a good social network, can help to maintain overall quality of life and wellbeing. This may also help to maintain cognitive function.

If you have concerns that you or a loved one is experiencing memory loss it’s important to visit a GP so that this can be investigated further.

Analysis by Bazian
Edited by NHS Choices

Leave a comment Posted on October 20, 2017October 20, 2017 Older people's health

Taking Charge of Your End-of-Life Care

End-of-Life Planning and Advanced Directives

Planning for end-of-life care is an essential part of managing senior health. Creating advanced directives, commonly known as living wills or advance decisions, ahead of time makes it easier for seniors to appropriately budget for palliative treatments or hospice services, reducing the burden on family and caregivers. Take advantage of how seniors are staying active longer, and use the time to take charge of your end-of-life care for greater independence and to ensure your wishes are respected when advanced directives are required.

Staying Active Longer

Seniors are more active than ever, and staying active longer enables those aged 65+ to take a bigger role in managing their end-of-life plans. This gives seniors the opportunity to seek out trusted advice on managed healthcare (debunking myths that can prevent informed decisions) and get realistic quotes to set expectations for expenses.

Technological advances in care for the elderly can keep seniors involved and able to enjoy active lifestyles. According to the University of Illinois at Chicago, internet usage is on the rise among seniors. Elderly patients can take advantage of online health monitoring tools, participate in social communities with others who share similar interests or health conditions and even get real-time wellness feedback using wearable devices. All of these advances make it easier to more accurately determine end-of-life needs.

Establishing an Advanced Directive

Advanced directives explain your wishes for care when you are unable to communicate them due to illness or injury. These directives are not always focused on life support, but can also include key decisions such as the types of treatments provided (surgical, nonsurgical, experimental, holistic) and set durations for treatment. Advanced directives can also establish proxies, transferring power of attorney over medical decisions to trusted family members or friends.

Doctors do not turn to advanced directives for momentary lapses or temporary conditions. Many states require terminal illness or permanent unconsciousness before physicians may allow advanced directives to trump standard practices. This ensures that patients are given every chance at recovery before doctors enact these planned decisions. State laws vary on the witness requirements for certifying advanced directives, but none require a lawyer or any additional fees for filing.

Preparing for Hospice

Hospice caregivers help assist those suffering from terminal illnesses with no known cure. Since heart disease, cancer and diabetes are such common causes of death, hospice services are typically available for sufferers who have a diagnosis that puts the end of life within six months. The major difference in this type of healthcare versus normal treatment is that pain management and ensuring quality of life takes precedent over recovery. Regular monitoring and attention to progression are hallmarks of such care. These services regularly include end-of-life counseling and advice for estate planning and are regularly extended to family members.

According to the University of Southern California, hospice services often offer respite care for family involved in caregiving. Respite plans include regular checkups by health professionals at home or in a managed-care environment and a specific amount of time spent taking the load off of those who normally attend to elderly or ill family members. This pre-arranged service helps relieve some of the stress and strain associated with ongoing caregiving.

Agreeing on When to Act

The best time to create advanced directives and decide on end-of-life care is as soon as possible. Illness and injury can strike at any time, and seniors are likely to face additional challenges over time. Falls pose a serious risk for elderly patients, leading to severe injury or even death, making it more important than ever to have such directives in place.

Caregivers should remain alert for the signs that a senior needs help and never shy away from important end-of-life discussions. Elderly patients may wish to avoid being seen as dependent on others, making it important for caring loved ones to reach out and assist as they can with getting advanced directives established. Agreeing on what signs should result in actively seeking end-of-life care from established providers and when to seek to enforce living wills can reduce stress when the unforeseen arises.

For more information, check out Bradley University’s Online Nurse Practitioner programs “The Aging Population: End-of-Life Planning and Advanced Directives” graphic.

Leave a comment Posted on July 14, 2017July 14, 2017 Older people's health

How to Maintain Mobility in Older People

Mobility in older people

One common consequence of old age is a decrease in mobility. Where once you could spritely take yourself virtually anywhere, you may now find yourself struggling to even move up and down the stairs. This decline in mobility brings with it a loss of independence, which in turn could affect the self-confidence of an older person.

This video from Be Independent Home Care examines how older people can maintain plentiful mobility into their senior years. Some recommended actions are common sense, like obtaining daily exercise and maintaining a healthy diet. Others prioritize the enhancement of certain anatomical features. For instance, take special care of your eyesight and go for regular check-ups on your vision. If this starts to let you down as you get older, inevitably you will find it a lot harder to move about. Also, be good to your feet. Select your footwear carefully so that you can move around easily. If shoes feel uncomfortable, it’s time to switch to a different pair that fits you better.

In some cases, it may be a good idea to customize your home so that you can maintain mobility. This could involve the fitting of a stairlift to transport you up and down the stairs with ease, or perhaps adding grab rails and walk-in bathroom units. Essentially, if it will help you to remain mobile, it’s worth the investment of time, money and effort, as no price can be put on the importance of strong mobility in older age.