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  • 1st May 2018 | By David Jolley

    The weather has continued to be determinedly influential – our bowling green is too wet to bowl on and there are days when every step out of the door finds rain. Despite this the trees and plants, birds, bees and other creatures are pressing on and making for a beautiful Spring.

    Wednesday threatened and provided rain – but in bursts – rather more dowsing than showers. This was the day I had been invited to a meeting of the executive committee of Christians on Ageing. Across the Pennines, past the university and The Crucible to the Central United Reform Church where the ground floor is a warm and busy café. The church activities are on the first floor and were suitably sober brown, quiet.

    Christians on Ageing is 35 years old and has a membership of 200. Its website: http://christiansonageing.org.uk/who-we-are/ summarises its spectrum of activity and ambition: as works throughout the United Kingdom, operates as an ecumenical, Christian organisation, publishes resources for individuals and local ministries, arranges conferences and events, promotes research and innovation, comments on current issues affecting older people.

    There is a Dementia Network run by the marvellous Rev Dr Albert Jewell, author of some of the most important and earliest books on age and spirituality and faith. The network produces a newsletter every six months, its membership exceeds that of the base organisation. Rev Dr John Lansley is editor of ‘Plus’, the quarterly magazine of Christians on Ageing. I have not read it previously but from its current issue it is a well-presented collection of thoughtful, quality reflections on age-related topics. A good read and potentially useful and inspiring resource.

    This is an association of very good people and there is huge potential for influence in this country and, I would think, throughout the world. I must look for similar organisations in other countries. Barbara Stephens has remarked, in discussing the development of Dementia Conversations, that every town and village has a church or churches. The Christian Community offers a skeleton for activities and support. In most denominations the majority of active members are old. Part of the rationale in the establishment of Christians on Ageing was to counter the perception that many churches were, and maybe are, at least as ageist as the secular world. Dwindling congregations want to see young people joining them, to offer a future. This is a complex issue but it seems to me that working with the positive message of membership and evidence that as we age we give more value to spiritual life and to faith, says the churches will gain from standing against a culture which dismisses old people and faith: Old and proud in faith.

    There are already links and mutual respect with other major faiths and this will surely be another dimension for the future

    Wednesday was a good day. It seems to me that Dementia Pathfinders and Christians on Ageing can help each other. Let us see: Following Providence as it emerges.

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    Wigan peers 23 April 2018 | Comments (0)

    23rd April 2018 | By David Jolley

    Wigan and Leigh’s Hospice is a special organisation. http://www.wlh.org.uk/

    Here it was, quite a lot of years ago, that Dr Mary Neal (previously Harrison) became Medical Director – having moved on from her post as Consultant Geriatrician in Crewe. Mary had married David who was the Consultant Psychogeriatrician in Crewe and both were close friends to our family. So the hospice has a treasured place in our hearts.

    It is a special place and latterly is leading the world in transforming end of life care for people living and dying in nursing homes. Our approach at Willow Wood Hospice for Tameside and Glossop has been to add a specialist service for people with dementia to the spectrum of services provided by the hospice. This means the palliative approach to dementia diffuses across all the places people are living and dying with dementia: home, hospital, care homes or hospice. This is a model we learned from St Christopher’s Jan Scott and Victor Page. It works well and has much to commend it but it has not proved as popular with commissioning organisations as we would think right. There are only 15 such services nation-wide – a static figure over several years.

    Wigan and Leigh’s model is different - it has developed a special relationship with a group of nursing homes – I think there are about a dozen registered to the scheme and the number is growing. The model is of ‘hospice in your Home’ – providing education, training and care which enables people approaching the end of life with dementia, cancer or whatever mix of pathologies have come to them, to receive competent, confident palliative care to the end in the place that has become their adopted home.

    It was good to hear the presentations from hospice staff, from a nursing home manager, and from two brilliantly determined women living in the nursing home and carrying evident pathologies. Both spoke positively of the benefits of having completed an advance directive. They now feel in control of their futures.

    We heard of the practical issues which crop up, including the decision to register residents with one, interested local General Practice. Even so, keeping to plans is not always straight forwards when needing medical support out of hours.

    There are huge advantages in hospice in your Home for patients, families and staff. Commissioners are impressed by the reduced use of general hospital admissions. We know that St Christopher’s is doing something similar and that many other hospices are looking at adopting this model. Three cheers for Wigan and Leigh.

    Of the other presentations I caught, one was an inspirational reflection from a retired nurse lecturer who lives with a diagnosis of Alzheimer’s disease ten years on and remains busy and helpful to others. The other aimed to clear the mists of doubt and confusion which sometimes cloud the use of DoLS.

    Won’t it be wonderful when the government gives the go-ahead to the Law Commission’s suggested alternative!

    So this day of study and learning has become a part of the hospice in your Home project. The people attending are mainly from the nursing homes, but also from primary care and other community agencies. There is a real sense of community. I would encourage other hospices and localities to look at what is being done here, but would still argue for a hospice-based palliative care service for people with dementia across the full range of settings where they are housed – complementing that focused on nursing homes. While we hear that 90% of people with dementia in Holland die in nursing homes, this is the case for only 60% in this country and many of those dying in such care have moved there quite recently. Wrapping them round with the cloak of hospice competence before that makes for an easier passage.

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    17th April 2018 | By David Jolley

    This is a major breakthrough: application of the principles identified here will improve life for so many people.

    Shamefully I had not known about the LIFEPATH consortium https://www.lifepathproject.eu/ until I came across a paper in last week’s BMJ from Silvia Stringhini and colleagues: Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study https://www.bmj.com/content/360/bmj.k1046

    The paper reads as something written by a committee whose languages span the globe – and so it is. They have brought together and ‘harmonised’ the data from 37 cohort studies for 24 countries to examine the hypothesis that socioeconomic status is at least as powerful in determining ability and self-care in later life (and survival), as recognised risk factors.

    WHO is aiming to reduce premature deaths by 25% before 2025 and is targeting: alcohol (did you see front page news on Friday that heavy drinking reduces life expectation? https://www.theguardian.com/science/2018/apr/12/one-extra-glass-of-wine-will-shorten-your-life-by-30-minutes ). This is not a new insight – we have known the ‘alcohol is a self-limiting illness’ for many years.

    Insufficient physical activity, tobacco, high blood pressure, excessive salt intake, diabetes, and obesity.

    The LIFEPATH consortium asks how socioeconomic circumstances compare with these disease risk factors in predicting the onset of disability and death. They find that socioeconomic circumstances are as powerful a predictor as any of the more often cited and targeted risk factors.

    This is so important because it gives the opportunity for countries to manipulate their taxes, services and job opportunities to improve the prospects for the least well off, to produce a healthier population. It seems very likely that we have stumbled on an understanding that it is this measure which underpins all the other rises in risk of impairment in older age: better economic status will reduce the likelihood of excessive use of alcohol, tobacco, salt and food. It will give time and money to take exercise. The incidence of diabetes will be reduced.

    We are reminded of the finding that the incidence of dementia has fallen where economic circumstances have improved, but risen where they have deteriorated. http://www.cam.ac.uk/research/news/new-cases-of-dementia-in-the-uk-fall-by-20-over-two-decades

    ‚ÄčThis is a real breakthrough in understanding… We need now the will to use it.

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    9th April | By David Jolley

    We thought we had quelled all this hoping for a cure and settled for a sensible use of the evidence we have that what works for dementia are preventative approaches and care, so that expenditure on research into possible cures should be rationed internationally and more resources directed to care and health promotion.

    Yet the Guardian carried ‘Humans keep making neurons for learning throughout life’ on Friday. The article and the references it drew on had the virtue of reminding me of the existence of the dentate gyrus, but reading the references I could not be convinced that they were describing the development of new neurons in adult life or old age – to the contrary most of the research seems to confirm that lots of neurons are established at birth and very early life – the number decreases with age. Somehow the alternative story has taken a grip.

    At our weekly seminar we learned that much time of very great men and women is being devoted to consideration of how the NHS will cope when (when) a cure for Alzheimer’s disease via monoclonal antibodies becomes available – at vast expense and with expansion of the need for therapy into decades before the possible/probable emergence of the clinical syndrome.

    I remember being glad that I had not been required to spend my creative years planning for what this country should do in the event of a nuclear war. By comparison this seems a positively reasonable expenditure of a life. The zombie keeps on walking! https://www.researchgate.net/publication/5059675_APOCALYPSE_NO_population_aging_and_the_future_of_health_care_systems

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