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Wednesday, 31 March 2010

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Apology after death of dementia patient

Published Date: 25 March 2010

HEALTH chiefs have been ordered to apologise to the family of a frail dementia patient after a "damning" report ruled she failed to get proper treatment before her death.

The Public Services Ombudsman has upheld a series of complaints against NHS Lothian after the death of the elderly woman at the city's Liberton Hospital.

In the wake of the findings, critics have called for independent advocates to be appointed for patients with dementia.

Ombudsman Jim Martin upheld three complaints against NHS Lothian which were lodged by the woman's husband after her death in August 2008.

He made eight separate recommendations, telling NHS Lothian to apologise to the woman's husband and ordering a review of nursing care on the ward.

The woman, identified only as Mrs C, was admitted to the ERI on 18 August after a fall and then moved to ward one at Liberton Hospital. She already had multiple health problems including dementia and asthma, and since falling four days earlier had become increasingly confused, lost her appetite and was becoming less mobile.

But even though her dementia meant she was deemed incapable of consenting to treatment, when she refused to take oral antibiotics for her pneumonia, this was not written into her records and her husband was not told.

When her condition worsened and she became distressed, her husband raised his concerns with medical staff, but instead of having her treatment reviewed, she was given the sedative haloperidol.

It was not until two days after she first refused medication that she became so agitated that a doctor recommended intravenous antibiotics to combat her worsening pneumonia. Despite the change in her treatment, she died a few hours later.

The ombudsman said: "I . . . consider that the board failed to provide appropriate treatment to Mrs C during the time that she spent in (Liberton Hospital] in the form of regular medical review, reassessment following a failure to respond to treatment and in the face of a deteriorating clinical state. Mrs C also received sedative medication without appropriate assessment."

He also criticised the hospital probe into Mrs C's death, which was led by the consultant responsible for her care, who he said would not have been sufficiently objective. He did acknowledge that ensuring that Mrs C had taken the prescribed antibiotics was unlikely to have improved her chances of survival.

The city council's Labour health spokeswoman, Councillor Lesley Hinds, said:

"It worries me that we continue to have cases like this and while the health board say 'we're going to take up the recommendations', who follows it up?"

NHS Lothian nurse director, Melanie Hornett, said: "We will formally write to Mr C, but I would like to take this opportunity to offer my sincere apologies for the distress caused and the shortcomings in the care provided.

Is the UK ignoring Dementia?

dementia.jpg







Is there enough support for you if you're caring for someone who has dementia? Millions are ploughed into cancer research but 12 times less goes into looking for a cure for dementia.

Dementia costs the country £23 billion per year and more than cancer and heart disease combined.

According to the Alzheimer's Research Trust 822,000 suffer with dementia - and it's estimated that figure will pass the one million mark before 2025. Each patient costs the country almost £28,000 each year and yet just £61 per person is spent on research.

How will we cope with dementia?

Billy Cartin who has dementia

Published Date:

15 March 2010

Action to help dementia sufferers and their carers have been announced as it was revealed the numbers living living with the condition in Northamptonshire will double over the next 15 years.

A third of people over 80 are expected to develop dementia and with people living longer, the increase in dementia patients will put pressure on health services and the husbands and wives left to care for them.

A series of workshops are currently being held in Northamptonshire to create a plan on how to cope with dementia in the future.

Annette Lumb, programme manager for dementia for the Department of Health East Midlands, said: "Health and social care teams need to get these services right otherwise there are going to be problems with service provision in the future.

"Ideally we want to allow people to live at home rather than be admitted to a care home or a hospital bed."

The announcement also comes as new figures show there are more than 27,000 unpaid carers looking after loved ones in north Northamptonshire, 2,800 of whom are in poor health themselves.

Doreen Cartin's husband Billy, 72, was diagnosed with dementia two years ago. He now needs help with everything from getting dressed and going to the toilet to drinking a cup of tea.

Mrs Cartin, of Higham Ferrers, said: "I think he knows something is wrong but he doesn't know what. I still love him deeply but he is not the same man."

There are currently 7,258 people diagnosed with dementia in Northamptonshire, including 560 in Corby, 1,024 in east Northants, 1,017 in Kettering and 847 in Wellingborough. The total number is expected to rise to 11,899 by 2025.

Poor medical care put elderly residents of Cumbrian private care home at risk

Staff at a Cumbrian nursing home over-sedated vulnerable residents, gave out wrong doses of drugs and allowed some medications to run out.

Riverside Court has in Maryport been given a zero-star poor rating by the Care Quality Commission (CQC).

Inspectors said the elderly had been put at risk by poor medical care, nutritional standards and safety procedures.

In one case a doctor ordered the use of sedatives to be reduced but the dosage was in fact tripled.

In another, a sedative should have been increased at night. Instead it was cut and the higher dose was doled out during the day.

The resident’s records contained entries such as ‘sleepy this morning’ and ‘very lethargic today’.

There was no evidence to suggest the dosages had been altered intentionally.

A stock take led to the discovery that some medicines were missing and there was an excess of others.

Inspectors said this meant they had not been administered properly.

Drugs were also allowed to run out – including angina medication and painkillers.

On occasions swabs should have been taken from wounds to check for infection but weren’t because staff said they didn’t have the right paperwork.

And a catheter bag fitted to someone with a kidney infection was left lying on the floor. Inspectors had to make a member of staff put it on a stand.

Among the other failures in duty of care were incomplete care plans and delayed tests for people on blood thinning drugs.

The CQC noted that residents had been losing weight, a significant amount for some, but the situation was not being monitored.

Elsewhere in the report it was revealed that staff had not received nutrition and dementia training.

Inspectors found the quality of the Salmoor Way premises off Irish Street was lacking too.

Stained bathroom tiles were falling off the walls and one of the baths had been out of use since 2008.Toilet seats and handrails were not screwed in properly, gaps in bedroom windows had been stuffed with paper and call bells were missing.

The home has been given until the end of March to meet all of the 17 statutory requirements it breached.

Or the CQC will take further enforcement action.

Riverside charges up to £585 a week and is owned by Four Seasons Healthcare.The firm has 350 homes across the UK and has recently wiped out £800m of its £1.6bn debt by giving creditors a stake in the business.

A Riverside spokesman said: “We recognise that the home has not reached the high standards demanded in a number of areas.

"We do note that the home was praised by residents and relatives during the inspection for its caring staff.

"A comprehensive plan is in place and under the leadership of a new manager and with support from the senior management team we expect these issues to be addressed.”

“We are working closely with the Care Quality Commission and social services and are confident that the improvements being made will be acknowledged.”

Dementia 'losing out' to cancer in funding stakes

patient playing dominoes

Dementia now costs the UK economy twice as much as cancer but gets a fraction of the funding to find causes and cures, a report seen by the BBC shows.

For every one pound spent on dementia research, 12 times that sum goes on investigating cancer, figures from the Alzheimer's Research Trust indicate.

Bridging this gap is urgent, it says, particularly given the numbers with dementia are much higher than thought.

With 821,884 sufferers, dementia costs the UK £23bn annually, the report says.


The number of sufferers is 15% higher than had been estimated, according to the Dementia 2010 Report , and the trust says it will now pass the one million mark before 2025.

The annual burden on the economy meanwhile is 35% higher than the previous calculations of £17bn.

Researchers from the University of Oxford compared the cost of caring for a person with dementia to the cost of dealing with cancer, heart disease or stroke - the three main causes of death in the UK.

Shouldering the burden

As well as immediate health care expenses, they looked at the costs of social care, unpaid carers and productivity losses.

Every dementia patient, they found, costs the economy £27,647 each year - nearly five times more than a cancer patient, and eight times more than those with heart disease.

It was the costs met by unpaid carers and incurred by long-term institutional care - rather than expenses shouldered by the NHS - that pushed up the burden of dementia.


But they also found that the costs of these conditions appeared to bear little relation to the respective amounts invested by government and charities in research into causes, treatment and prevention.

With nearly £600m a year, cancer research funding was 12 times that of the £50m devoted to dementia, while heart disease received three times as much. Only stroke research received less.

They calculated that for every person with cancer, £295 is spent on research, compared with just £61 for each person with dementia.

Donation dilemma

The researchers believe the fact that a larger proportion of the cost of caring for cancer and heart disease falls on the NHS, rather than the individual and their family, goes some way to explaining the discrepancy in government funding for research.

Cancer and heart charities have also tended to be larger than those devoted to dementia.


But our own perceptions of this disease - one which primarily strikes in old age - may influence what we are prepared to donate, the researchers suggest.

"Many of us know people who have had cancer or heart disease but have been successfully treated and survived, so there is a perception that something can be done, and that more research will allow even more to be done," says Alastair Gray, professor of health economics at the University of Oxford and author of the report.

"In contrast there are no cures for dementia at present; there are not even many ways of delaying it or slowing it down, so there may well be a feeling of inevitability surrounding it. However the lack of effective treatments is surely an argument for devoting more effort to research, not less."

Rebecca Wood, head of the Alzheimer's Research Trust, said the true economic impact of dementia "had been ignored for too long. This report shows that dementia is the greatest medical challenge of the 21st Century".

"If research leads to a cure for Alzheimer's and other dementias, annual saving to the UK economy would be equivalent to hosting the London Olympics twice, or funding every British university for three years."

Michelle Mitchell, charity director for Age Concern and Help the Aged, said the disease was not going to go away and it was of "paramount importance" that the research was funded now.

Andrew Ketteringham, of the Alzheimer's Society, said: "We've got a lot of catching up to do and a lot of investment to do. And if people say, 'Well, how can we afford that?', I say, 'Well, we can't afford not to do that.'

"If we could just delay the onset of dementia by five years, we'd be able to save huge amounts."

But Care Services Minister Phil Hope said that by next year the government would be investing nearly £1bn in health research. "This money is awarded to the best quality research for any health condition, including dementia.

"I have set up a new ministerial group which will drive forward research into the causes, cure and care of dementia and help dementia researchers get more access to funding. This group will hold its first meeting later this month.

"I have also just appointed a new National Clinical Director for Dementia, Professor Alistair Burns, to provide leadership across the whole dementia strategy and help bring up standards of dementia care across the country.

Research funding per person affected Cost of each patient

Doctors 'need more dementia training' - 18 Mar 2010

Doctors 'need more dementia training' People in doctors' jobs need more training about dementia, a charity group has stated.

According to the Alzheimer's Research Trust (ART), many people across the UK have dementia but have not yet been diagnosed with the condition.

The organisation believes giving doctors more training on the symptoms of dementia could help to tackle this problem.

However, the ART also noted that more research into how to spot dementia in its early stages must be carried out as well.

"We simply don't know enough about Alzheimer's and other dementias to be able to reliably diagnose it in every case," a spokesman said.

According to figures from the ART, about 820,000 people in the UK currently live with dementia in the UK.

However, the organisation believes factors such as the rising life expectancy of British people will lead to this statistic going up in the near future.

ART figures also show that while a quarter of the government's medical research budget goes towards fighting cancer, less than three per cent is used for tackling dementia.

By Claire Johnson