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  • 21st September 2018 | By David Jolley

    Harvest Festival at Bowden

    Simon Jenkin’s incoherent rant (God aside, for whom does Welby speak? Guardian September 14th https://www.theguardian.com/commentisfree/2018/sep/14/god-justin-welby-archbishop-canterbury-gig-economy moved me to offer a letter to the Guardian: The question requires a calm, simple answer. What the Archbishop of Canterbury, the Pope and other faith leaders are saying is not of politics – it is of a higher order. The principles they declare are fundamental and recognised to be right across cultures and across the ages. Restricting true values to the realm of spirit only, and letting selfishness, greed and prejudice rule everyday life is not right. Welby speaks for me, an ‘ageing (Methodist) communicant’, and for many others.

    It doesn’t look likely to be published for there are several excellent responses in today’s Guardian. The busy week had been dominated by plans for our second Dementia Friendly/Family Friendly/ Traditional Harvest Festival at Bowdon Vale. It has been marvellous to invite those who come to Dementia Conversations, and find that the very mention triggers memories of years ago when everyone carried a small basket of fruit or vegetables to school or church, to be part of a joyful celebration that God is Good – and what a wonderful world it is that we live in – with all its unsolved and insoluble mystery.

    We have a reason to produce invitations to households throughout the village – taking them up short and long drives to the letter box. On the way we see people and homes more closely than at other times. The local shop had a pile of invitations too.

    Naked vegetables and fruits gave anxiety to some who were afraid of potential waste – so much safer with tins and sell-by dates. In the event one of the congregants was pleased to carry a sackful to a nearby residential complex for older people, where we know the cooks will make good use of the fresh produce – Take the risk and you never know what might happen. ‘Merely to follow Providence as it emerges’ – John Wesley.

    The ladies of the church – with some male assistance – produced a magnificent display. People came and doubled or trebled the usual congregation. We had the reading of ‘the sower’ and an unusual interpretation which came out with positives for everyone. We had the very best of harvest hymns and prayers to match.

    We were comfortable. No-one was restless – but we were engaged and at one.

    People stayed for simple lunch of bread, cheeses, pate, fruits and cakes, with tea, coffee, water or juice.

    It felt right.

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    A moment in time 10 September 2018 | Comments (0)

    10th September 2018 | By David Jolley

    This year Altrincham Methodist Church celebrates 50 years in its building on Barrington Road. Last night we celebrated with an anniversary dinner in the presence of a former minister and his wife. They had travelled up from the South Coast. The M6 introduced them to 18 miles of upgrading for a ‘Smart Motorway’. Single lane for miles and miles, slows you down and strains the smiles. It was no surprise that the theme of journeys and journeying gave structure to the evening.

    This building brought together the congregations of five churches or chapels which had been struggling. So the beginning of this 50 year journey was not a beginning, nor an ending but a continuation. The Methodist Movement began in the 18th Century – a development from the Church of England, which was a development from the Catholic Church. Christianity dates from events 2000 years ago and grew from the Jewish faith which has history recorded for thousands of years before.

    We talked of an extension which provides a venue for a coffee bar and other activities through the week. We reflected on the removal of pews. The evening would raise money for a new, pitched, roof for the extension – Whoever thought that flat roofs were a good idea in the North West of England!

    Western Europe is the only part of the world where religions are in retreat, but this is the part of the world in which we live – and the 50 years have seen weekly congregations tumble from 300 to 100. The other three churches linked in the Altrincham Circuit are smaller and have also seen reduction and ageing of membership. Extrapolation is a gloomy business.

    This was not a night for gloom, but for celebration, reminiscences of humorous and wonderful happenings, as well as of sadness for the passing of good friends. But it was also a night for reflection on the nature of journey: We are travelling, learning as we go and aiming to make a better place. But there is no Promised Land, no destination that will mean no more travelling.

    As it is with the churches, so it is with our services to work with people who are unwell, and the families caring for them. It is reasonable to take stock at key times. It is appropriate to take pride in achievements and to be thankful for the dedication and triumphs of key people – and others who are the supportive cast. We find much to be saddened and frustrated about – there is much to be done to right inequalities and frank unfairness. This is the journey and we will be ever looking yonder – best to feel OK with that.

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    04th September 2018 | By David Jolley

    The last of the summer specials on our park – but the good news is we are back to our regular Friday reviews with colleagues at Wythenshawe.

    This introductory week found us wrestling with a familiar problem: the role of medication when an individual with dementia becomes persistently disinhibited, sometime aggressive. Help in this situation is clearly something which psychogeriaticians must be able to provide.

    There is everything to be said for keeping to the basics: obtain a history so that you know as much about the individual and the circumstances which have generated the behaviour as possible, know about their general health and medication – examine the patient physically as well as their mental state – as far as is possible. It is essential to spend time with staff who are caring for the individual, and with their family – to gather the history and to agree a course of action.

    Sometimes there are obvious physical health problems which are contributing and may be reversible. Some will be painful and the pain can be countered by analgesics. There is always need to check bowels and to think of constipation. Urinary Tract Infections are common and can contribute to distress or delirium.

    Unfamiliar or over-stimulating surroundings can drive people to become aroused and distressed. Recognising this may open approaches to encourage calm.

    In the crisis situation, all these factors will be taken into account – but achieving them can take time, during which mayhem can continue, confidence lost and extremes grasped:

    ‘He has to go and we will never have him back.’

    Medicines can help.

    Doctors, including specialists in the care of older people, are constrained by the heavy publicity attached to the hazards of new generation ‘anti-psychotics’, otherwise ‘Neuroleptics’. The hazards relate to increased risk of stroke, and increased death rate, when prescribed to people with a diagnosis of dementia. The increase is of the order of 1% when compared with other people of the same age and with similar pathology who are not prescribed such medication.

    Strokes and ‘death-brought-forwards’ are certainly serious considerations – but the management of sustained difficult or dangerous behaviour is also a serious matter with its own morbidity and mortality.

    Current practice and recommendations have diverted away from the use of new generation neuroleptics. I hear from colleagues and from friends who are carers, that benzodiazepines and antidepressants are being used more widely in these situations. Memantine has become almost routine, and analgesics are also seen to have a role and real potential.

    I have misgivings about the use of benzodiazepines for these are prone to exacerbate disinhibition directly, and most – especially those with short half-lives – produce rebound excitement as their blood level falls. The temptation then is to prescribe more and at higher doses – a vicious spiral.

    Antidepressants may have a role but I had little experience of their use other than when patients had obvious depressive symptoms and/or a history of previous depression. Strangely, of course, trials have suggested that antidepressants do not improve mood for people with dementia. My own experience is that they often do. Using them as the mainstream treatment for agitated states amongst people with dementia feels odd.

    Memantine has risen from ‘of doubtful benefit’ to being used a great deal. For some patients it does seem to be helpful.

    Analgesics have belatedly been recognised to be helpful in states of agitation amongst people with dementia. We probably feel this is because the individual is experiencing pain which they cannot communicate in words. It is always important to look for physical illness and sources of potential pain – and to treat these directly if possible, as well as prescribing symptomatically for the pain.

    For me, the short term prescription of a neuroleptic was often most helpful. Before the newer neuroleptics became available haloperidol, perphenazine, thioridazine and others were used to good effect. The important caution is that, as with all prescriptions, their effects must be monitored and dosages adjusted accordingly – For many patients the medication can be stopped after a while when calm and confidence has been re-established. This avoids the dreadful scenario – people being ‘drugged into submission and progressive frailty’.

    Just a reflection to hold on to the best of knowledge gained – not to be washed away by all that is fashion.

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    26th August 2018 | By David Jolley

    Island of dreams? The Isle of Wight gave us Dementia Conversations. We are grateful for this, pleased to be part of this initiative in the North West and wishing and hoping to spread the idea to other centres.

    The beginning came when Barbara Stevens and The Reverend Veronica Brown picked up the bewilderment and frustration of family carers who were attending a meeting on the island to encourage awareness of dementia and the appropriateness of treatments and services. They hear accounts of good practice – but had found the reality to be that when they and their family member with dementia had needs, there was rarely anyone or anything to help them.

    This year Barry Jackman came to the annual review of Dementia Pathfinders at the Hallam Centre July 11th. He told of his anger and frustration in trying to find appropriate help for his wife and himself on the island, the support he has received from Dementia Conversations and his crusade, along with others, to improve matters for people with dementia and their carers on the Isle of Wight. Barry is a very able man. He has found willing and able collaborators and they have established Dementia Awareness Partnership on the island. https://www.newsarchyuk.com/new-partnership-in-dementia-conference-to-help-improve-isle-of-wight-care/

    Their energy and talents have engaged families and individuals, and professionals and organisations at every level. Their progress may have been helped by a critical report for the Care Quality Commission: www.cqc.org.uk/provider/R1F/reports

    History tells us that sometimes when things get really bad – and are recognised to be so – it is then that something can and will be done about it.

    The conference organised by the Dementia Awareness Partnership – it must have cost a fortune – I wonder where the money came from – attracted hundreds of well informed and motivated people, including the Chief Nurse, national figures in dementia care, as well as leaders of services on the island. They are impressive people and they talk the talk very well: https://www.youtube.com/watch?v=nfjaA_J35mQ&feature=youtu.be

    The task now is to translate these brilliant insights and powerful intentions into walking the walk – This will depend upon small but determined steps on the ground.

    There is a lot going on, on the Isle of Wight. There seems to be a spirit of cohesion and ownership within the island population which will have some atypical features, for the population is skewed to older age https://www.iow.gov.uk/azservices/documents/2552-Isle-of-Wight-Demographic-and-Population-factsheet-2016-17-Final-SS-v2.pdf

    Delegates at the conference refer to the large number of care homes https://www.carehome.co.uk/care_search_results.cfm/searchcounty/Isle-of-Wight

    Others reflect on lack of resources in these austerity years and encourage moves to ‘do things differently’.

    The activities of Dementia Conversations and The Dementia Awareness Partnership on the island are important and impressive. The challenges on the island may be as extreme as anywhere in the UK. We need to see, now, whether all this good can become something real. 

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