The standard of care provided for people with dementia is “patchy”, the National Institute for Curbing Expenditure (NICE) has said. Some people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.

Care services were playing “catch-up” on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles.

But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes.

NICE’s dementia guidance includes 10 standards it wants the care sector to follow.

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: “The general picture is that care is patchy.  We know that it is really good in places but it’s not consistent.  My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically.”

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer’s Society, said people with the condition were being denied the quality of life they deserved.

“These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect,” he said.  “But, as they are not mandatory, it’s a case of ‘wait and see’ as to whether this guidance will drive real change or just sit on the shelf.”

More than 320,000 of the 400,000 people living in care homes in England, Wales and Northern Ireland now have dementia or severe memory problems, the Alzheimer’s Society charity estimates.It said the figure was almost 30% higher than previous estimates because of the rise in the ageing population and improvements in data collection.

Of 2,000 adults surveyed, 70% said they would be scared about going to a home.

Another two thirds felt the sector was not doing enough to tackle abuse.

And just 41% of 1,100 family members and carers surveyed thought their loved ones’ quality of life was good.

Alzheimer’s Society chief executive Jeremy Hughes said: “Society has such low expectation of care homes that people are settling for average.

“Throughout our lives we demand the best for ourselves and our children. Why do we expect less for our parents?”

“We need government and care homes to work together to lift up expectations so people know they have the right to demand the best.”

David Rogers, of the Local Government Association, which represents councils, said: “This report shows the lack of confidence in a care system which is buckling under the weight of rapidly growing demand and years of underfunding.”

“Local authorities want to offer a service which goes beyond a basic level of care but this is becoming increasingly difficult as our population ages, costs climb and the already significant funding shortfall becomes even more severe.”

Around one in three people over the age of 65 will develop dementia in their lifetime.

It is estimated that there are around 800,000 people in the UK who have dementia, but many have not yet been diagnosed.

By 2021 the number of people in the UK with dementia will have risen to almost 950,000, experts believe.

Plans for a £75,000 cap on the amount the elderly will have to pay for social care in England will give people “greater peace of mind”, Health Secretary Jeremy Hunt has said.Mr Hunt told MPs the current social care system was unfair and left many families facing “ruinous” costs.

He also announced a rise from £23,250 to £123,000 in the amount of assets people have before having to contribute to the costs of basic nursing care.

At present, up to 40,000 people every year are forced into selling their homes because they face unlimited care bills.

The health secretary said many families currently faced “often ruinous costs…with little or no assistance from the state” and the proposed new framework, due to come into force in 2017, would bring “greater certainty, fairness and peace of mind”.

Ministers may be giving themselves a big pat on the back for their changes to the social care system- but for many involved in the sector this is just the start of the process.

Firstly, the £75,000 cap is more than double the figure recommended by Andrew Dilnot, the independent expert asked to look at the issue by government two years ago.

While publicly it is being welcomed – campaigners have been promised reform ever since Tony Bliar came to power – there is a nagging fear that it is too high to really get people engaged with planning for their old age.

And, secondly, this reform does nothing to improve the quality of services currently on offer- it is purely aimed at preventing people having to sell their own homes to pay for care.

Local government has long argued the system is dramatically under-funded and services are suffering as a result.

Of all that some say needs to be done, the introduction of a cap may well turn out to be just the tip of the iceberg.

While costs vary hugely, it is estimated that half of all people turning 65 in future will have to pay up to £20,000 towards their basic nursing care – such as help to get washed and dressed – while, for one in ten, the figure will be above £100,000.

This figure would only cover the cost of nursing care and people would still have to pay for accommodation and food – although some support will be provided.

If the changes are approved, people are only expected to start receiving support above the £75,000 cap by 2019 at the earliest.

But the hope is that, by establishing the principle that the state will cover the really high costs, people will start planning for their future care needs in the way their do for their pensions in retirement.

The government is also proposing increasing the means-tested threshold – there to ensure the less well-off get state help towards their care costs.

Currently anyone with assets of more than £23,250 has to pay for their care. Under the plans, the threshold will rise to £123,000, reflecting the fact that rising property prices over the years have effectively meant any home-owner falls outside the state system.

Mr Hunt also confirmed that the plans, expected to cost about £1bn a year, will be part-funded by freezing the inheritance tax threshold – at £325,000 for individuals and £650,000 for couples – for three years from 2015.

That is despite Chancellor George Osborne’s Autumn Statement pledge, in December, to raise the threshold by 1% – to £329,000 for individuals and £658,000 for couples – in 2015/2016. And breaks another election pledge to raise the inheritance tax threshold to £1,000,000.

A meningitis B vaccine that could save thousands of lives has been licensed for the first time, in a move hailed as the most important breakthrough in 30 years.The vaccine could soon be available privately and Government advisers are deciding if it should be introduced into the free NHS childhood vaccination programme.

The jab, called Bexsero, has been licensed for use in babies from the age of two months and offers protection against the majority of meningitis B strains that occur in the UK.

Up to 2,000 people are infected with meningitis B each year in the UK and one in ten will die despite receiving prompt medical treatment.

A further one in four will suffer lifelong disability as a result of the brain disease.

Meningitis is commonly cited as the most feared disease by parents because it strikes otherwise healthy children who can deteriorate and die within hours.

Campaigners urged the Government to introduce the vaccine routinely as soon as possible after previous jabs against the disease took five years from licensing to reach the general population.

Steve Dayman, founder of the charity Meningitis UK, who lost his 14 month old son Spencer to meningitis and septicaemia, said: “This ground-breaking vaccine is the most important development since I lost my son to meningitis 30 years ago.

“The news is the most significant step forward in the fight I have ever heard.

“The Government must introduce the Meningitis B vaccine into the immunisation schedule as soon as possible – it will save thousands of lives and spare families so much suffering.

“Any delay means lives will be lost.  The last major meningitis vaccine took five years to be introduced – we cannot wait that long again.  Cost shouldn’t be a barrier for this vaccine either – you cannot put a price on life.”

“Please support our Beat it Now campaign. Together we can end the heartache caused by Meningitis B.”

There are already vaccines against the other major causes of meningitis, Hib and meningitis C, which saw substantial reductions in deaths and disability from the disease.

The Health Protection Agency estimates that since 2000, the MenC vaccination programme has prevented over 9000 cases of serious disease and more than 1000 deaths. Uptake rates of the vaccines, given to babies, has remained consistently high.

Companies who own care homes in England where abuse is carried out should face unlimited fines and criminal sanctions.Lib Dem MP Paul Burstow has argued for new laws to ensure care providers are held criminally accountable for abuse and neglect on their premises.

This would have tackled a “culture of cruelty” at the Winterbourne View hospital, near Bristol, he added.

Mr Burstow, who was care services minister until leaving the government in September, outlined proposed legislation in the Commons, which he said would see justice for future victims of abuse and their families

He said he did not want to see a repeat of the Winterbourne View care scandal that led to the conviction of six people for their role in abuse and neglect at the private hospital near Bristol, but for which he claimed there had been “no corporate accountability”.

His proposals, which are likely to need government support if they are to become law, include:

•     Amending existing legislation to make a corporate body guilty of an offence if the way in which its activities are managed by its board or senior management neglects or is a substantial element in the existence and/or possibility of abuse or neglect
•     Offences should be punishable by unlimited fines, remedial orders and publicity orders
•     Those with relevant information about suspected abuse or neglect must supply information to Adult Safeguarding Boards if requested to do so.

Speaking in the Commons, Mr Burstow said “no stone should be left unturned” when it came to protecting vulnerable people and reputable owners had “nothing to fear” from his proposed legislation.

“When things go wrong, when terrible abuse and neglect takes place, the public expect those who take the fee to be held to account,” he told MPs. “This new law would act as a deterrent. It would force weak boards of directors to pull their socks up.”

“At Winterbourne View staff carried out horrific acts because of the opportunities a culture of cruelty created. This bill would help to remove some of those opportunities.”
‘Duty of oversight’

Mr Burstow’s bill will be debated for the first time in March.

There is a “disgraceful” variation in the number of proportion with dementia being diagnosed across the UK, according to the Alzheimer’s Society. About 800,000 people in the UK have some form of dementia, but most have not been diagnosed.

Estimates by the charity suggest only 32% were diagnosed in the East Riding of Yorkshire compared with 76% in Belfast.

The government said the variation was “unacceptable” and caused “unnecessary suffering”.

Predicted levels of dementia across the UK were compared with data from GPs on the actual number of patients being diagnosed.

The map suggests a north-south divide, with the highest rates of diagnosis in Scotland (average 64%) and Northern Ireland (average 63%).

Rates dropped to 50% in the north-east of England, 41% in the south-west of England and 39% in Wales.

Across the whole of the UK, the percentage of people with dementia who have been diagnosed has gone from 43% in 2011 to 46% in 2012.

Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: “It’s disgraceful that more than half of all people with dementia are not receiving a diagnosis, and disappointing to see such a disparity in diagnosis rates in different regions of the UK.

“This goes against best clinical practice and is preventing people with dementia from accessing the support, benefits and the medical treatments that can help them live well with the condition.”

The charity said one explanation was variation in “stigma”, which resulted in people not visiting their GP. The higher figures in Scotland were put down to a better relationship between social services and the healthcare system.

Health Secretary Jeremy Hunt said: “The small improvement in dementia diagnosis is good news, but the extreme variation across the country is unacceptable.

“It’s time for the worst performing areas to wake up to the dementia time bomb.”

He said failing to diagnose dementia was delaying treatment and “causing unnecessary suffering”.

The first ever National Audit of Dementia found a “shocking” lack of care delivery.It found that care was often delivered in an impersonal manner, staff ignored patients’ requests for help and staff were not trained sufficiently in the care of dementia patients despite figures showing one in four hospital beds is occupied by people with the condition.

Data from 210 hospitals in England and Wales was used in the report along with ward level data from a sample of 145 wards, over 2,000 staff questionnaires and observations of care on the wards.

Professor Peter Crome, the co-author of the report and Chairman of the National Audit of Dementia Steering Group, said that the report had “found problems across practically every aspect of care for patients admitted to hospitals with dementia.”

He added: “There were deficiencies in the assessment of people and there were deficiencies in the interaction betweem staff and patients.”

Hannah Clack from the Alzheimer’s Society called the report “shocking” and stressed the need for “a huge and radical shake-up of the way the NHS deals with people with dementia.”

She added: “People are going into hospital and they’re coming out worse in terms of their dementia and in terms of their physical health.”

The report recommended that all staff should have basic training in dementia, and that all hospitals should have Dementia Champions on every ward.

Eating fish could protect against Alzheimer’s disease and memory loss – but only if it is baked or grilled, researchers have claimed.A study by US scientists found that elderly people who eat fish at least once a week are three to five times less likely to develop the conditions than people who did not.

But it is essential that the fish is cooked in a manner that preserves the vital Omega-3 fatty acids which help protect the brain, researchers said.

Grilling or baking the meat provides the maximum levels of Omega-3, which increase blood flow to the brain, reduce inflammation and limit the build-up of harmful plaques which precedes Alzheimer’s.

In contrast fried fish has very low amounts of Omega-3 and consequently offers no protection whatsoever against dementia and age-related memory loss, known as Mild Cognitive Impairment (MCI).

Researchers from the University of Pittsburgh studied a group of 260 healthy volunteers with an average age of 76.

In a study Eating Fish Reduces Risk of Alzheimer’s Disease to be presented at the Radiological Society of North America annual meeting they questioned the participants about how regularly they ate fish.

Brain scans carried out ten years later showed that those who did not eat fish regularly had suffered much more shrinkage in key areas of the brain linked to working memory.

A further five years on, they found that 31 per cent of non-regular fish eaters had gone on to develop Alzheimer’s or MCI, compared with between three and eight per cent of those who ate fish at least once a week.

Dr Cyrus A. Raji, who led the study, said further studies could help identify whether Omega-3 supplements yielded similar effects, and whether some types of fish offered better protection than others.

He said: “We know from other studies that salmon gives the maximum amount of Omega-3 fatty acids so it is very possible, but we did not look at which fish people were eating in the study.

“Studies like this definitely justify trials that will look at Omega-3 fatty acid supplements. Having said that, I would speculate that taking supplements is no substitute for a lifetime of eating fish.”

Dr Simon Ridley, head of research at Alzheimer’s Research UK, said: “This study suggests that eating fish on a weekly basis may reduce the risk of cognitive decline, but it is not clear whether other underlying factors may have contributed to the lower risk in people who eat fish.

“As a number of controlled studies using fatty acids from oily fish have failed to show benefits for dementia, there is a clear need for more conclusive research into the effects of dietary fish on our cognitive health.”

Dr Anne Corbett, research manager of the Alzheimer’s Society, added: “This moderately sized study adds weight to existing evidence suggesting that eating fish reduces your risk of developing cognitive decline.

“However, this research did not account for lifestyle factors such as other foods or exercise which could also have had an effect. The best way to lessen your chance of developing dementia is to eat a healthy diet including fruit and vegetables along with taking regular exercise and giving up smoking.”

Death by misadventure was the verdict at the inquest of Amy Winehouse, who died in July.On the afternoon of July 23, the day Amy Winehouse died at the age of 27, a friend rang me with the sad news, saying: “Shows just how deadly heroin is, doesn’t it?” I replied that heroin certainly can be dangerous but that far, far more people kill themselves with booze, with nothing added, than die of taking heroin.

Either they die of a slow disease, like cirrhosis of the liver, or the booze can kill them there and then by poisoning them, depressing their central nervous system until everything stops.

Why did it have to be so called illegal drugs that killed her?

As an example of acute alcohol poisoning, I mentioned (in a blog I wrote that day) the sudden death of Dylan Thomas: his post mortem pointed to “insult to the brain”, caused by alcohol. Supposedly, Thomas had drunk 18 straight whiskies, which is about 36 single measures of whisky in British terms.

Winehouse’s friends had spoken of her having been so drunk, earlier that week in July, that she couldn’t stand. Later her boyfriend, Reg Traviss, and members of her family made it clear she had not taken illicit drugs for some time.

Today the coroner has spoken: the poor singer’s blood contained 416mg of alcohol per decilitre*. “The unintended consequences of such potentially fatal levels,” said the coroner, “was her sudden and unexpected death.”

Professor Suhail Baithun, a Home Office pathologist, said people start losing their faculties at 200mg of alcohol per decilitre, and “when you have levels of 350mg, it is associated with fatalities”.

Why do we always assume illicit drugs are responsible in these sudden deaths? Sometimes they are, obviously. But I also think we blame drugs because they’re strange and frightening, and we don’t like to think of booze like that, we don’t like to think of it as deadly stuff.

Booze is supposed to be our friend, it’s part of our culture, it helps us to relax. Many of us couldn’t cope with life’s daily challenges without it. It is, in the words of those bossy health education campaigns of old, “our favourite drug”.

We prefer not to think about what it can be — a strong poison that kills in overdose.

*This has been expressed in most news reports as five times the drink-drive limit. In Britain the drink-driving limit is normally given in milligrams per 100 millilitres (one deciliter) of blood, or, most commonly, in micrograms per 100 millilitres of breath. The drink-driving limit is 80 milligrams of alcohol per 100 millilitres of blood. It’s certainly a lot of alcohol.

From: http://blogs.telegraph.co.uk/amy-winehouse-was-killed-by-alcohol-our-favourite-drug/

Women who drink two or more cups of coffee a day are less likely to get depressed, research suggests.It is not clear why it might have this effect, but the authors believe caffeine in coffee may alter the brain’s chemistry. Decaffeinated coffee did not have the same effect.

The findings, published in Archives of Internal Medicine, come from a study of more than 50,000 US female nurses.

The experts are now recommending more work to better understand the link.

And they say it is certainly too soon to start recommending that women should drink more coffee to boost mood.

The Harvard Medical School team tracked the health of the women over a decade from 1996 to 2006 and relied on questionnaires to record their coffee consumption.

Just over 2,600 of the women developed depression over this time period.

More of these women tended to be non- or low-coffee drinkers rather than frequent coffee consumers.

Compared with women who drank one cup of caffeinated coffee or less per week, those who consumed two to three cups per day had a 15% decreased risk of developing depression. Those who drank four or more cups a day cut their risk by 20%.

Regular coffee drinkers were more likely to smoke and drink alcohol and were less likely to be involved in church, volunteer or community groups. They were also less likely to be overweight and have high blood pressure or diabetes.

Even after controlling for all of these variables, the trend of increasing coffee consumption and lower depression remained.

The researchers say their findings add weight to the work of others which found lower suicide rates among coffee drinkers.

They suspect caffeine is the key player – it is known to enhance feelings of wellbeing and energy.

How much caffeine?

There is no recommended level a person should consume, but pregnant women are advised to consume less than 200mg a day

• One mug of instant coffee: 100mg
• One mug of filter coffee: 140mg
• One mug of tea: 75mg
• One can of cola: 40mg
• One 50g bar of milk chocolate: about 25mg

Source: NHS Choices

And it has a physical effect on brain function and transmission by blocking certain chemical receptors, like adenosine. But more research is needed to show if this might mean it is useful for warding off depression.

Alternatively, it might be that people with low moods chose not to drink coffee because it contained caffeine, point out the researchers. One of the common symptoms of depression is disturbed sleep, and caffeine can exacerbate this because it is a stimulant.

Too much caffeine can also increase feelings of anxiety.

Prof Bertil Fredholm, an expert in pharmacology and physiology at Sweden’s Karolinska Institute, said the findings were reassuring for coffee-lovers.

“This fits nicely with a lot of the previous work and what we know about caffeine and the brain. It blocks adenosine, which produces a similar effect to increasing dopamine production. And it’s becoming increasingly clear that the dopamine-rich areas of the brain are much more important in depression that previously thought.

“Despite valiant efforts to show how dangerous coffee is for us, it is not proving so.  This removes yet another anxiety regarding caffeine use. Drunk in moderation, the evidence is strong that it is not one of the things we do that is going to damage your health.”

From: http://www.bbc.co.uk/news/health-15059266