You can say, ‘Molly, you are 95, your mum is dead, you have dementia, you live in a care home, sit down.’
Doctors are great at diagnosing or assigning diagnoses. It is something that makes many of them very happy. It provides the doctor with certainty, a finite box in which to insert their patient and to focus treatment – antibiotics, pain killers or anti-depressants. (I am sure there is a dopamine release every time a doctor signs a prescription).
‘Diagnosis – Florence Syndrome’
‘Treatment – avoid visiting Florence and/or trips to art galleries. Watch more TV’
The doctor calling the ambulance rationalises their actions, ‘I don’t know what will happen to their chest (NB not ‘Albert’, but his chest – a lapse into pathology and medical-speak
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
In today’s blog Rod tried to explain what he meant when he wanted to say something was to complicated to be summarised by the word ‘screen’
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).
We want to be associated with the best – the best team, country, organisation.
Others don’t really care.
Some see the whole of the moon.
Imagine being able to converse with a cat.
That’s what Nakata can do.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
All resonating, taking me back and creating an atmosphere.
Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.
I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”
If I was in my last hours of life and the tunnel and the bright light were there
These are not stupid people.
Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.
Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”
Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.
We have closed schools which has reduced transmission; we can’t close care homes.
Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)
…designed for maximum efficiency of staff and outcomes, not necessarily for the comfort or dignity of patients – we erect a thin curtain between beds and pretend it is sound-proof, for example.
You will note this is the opposite of ‘There is no bus to Upton, you are 93, you have dementia, you are in hospital’ approach, which is likely only to worsen the anxiety.
Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.
Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.
Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.
First, I wanted to mention Neprilysin (and its inhibitor) as it seems to me to be such a cunning piece of high-tech science it should reach this blog. Then I’ll get to the cardiologists!
He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.
In the Yorkshire and Humber Clinical Network for Dementia we are working to increase knowledge and understanding of delirium. This is a state of reversible confusion and disorientation that occurs more frequently in those living with dementia and at times can be mistaken for dementia itself. It isn’t, dementia, that is. It is different, withContinue reading “This afternoon I described death.”
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
This tells you how many boxes are ticked – it doesn’t tell you anything else.
And that is the thing.
It doesn’t tell you about quality or whether the interaction led to change or care.
Now we are learning that language, behaviour, how we behave and relate to people living with dementia is probably more important than the medicine;
In the hospitals (the hole) we sit and wait.
Eventually, inevitably, the older person will fall-in;
Outside I could hear Michelle.
I don’t know what she was doing but, there was laughter.
Camerado, I give you my hand!
I give you my love more precious than money,
I give you myself before preaching or law;
Will you give me yourself? will you come travel with me?
Shall we stick by each other as long as we live?
In Glasgow, if you say somebody or something is mental it means little more than whatever they are doing or saying doesn’t make sense. It isn’t pejorative. In the world of health and care where the stigmas of good and bad still at times run rampant, mental can have a different implication. In general, itContinue reading “Mental”
Time almost always does the trick;
And staying calm.
The NHS has a tried and tested technique; it is called hospitalisation.
Old man. In his nineties, he fell. He fell again after arriving in hospital. What to do with him? He wants to go home; we risk and capacity assess. Determine what is right, good or not and let things happen. We tried to get him home. I can tell you something; he’ll fall again. WeContinue reading “Today there was a thing about falls.”
As a generic
It is the way we teach people to blindly follow protocols, pathways and guidance; it is what makes the nurse challenge my wearing a watch but miss all the dirt on the floor or the nurses not washing their hands; it is, to quote Master Lee, staring at the finger and missing the heavenly glory.
When was the last time you saw someone you don’t know asleep? This happens to me every day. It is a standard of hospital practice; take a person, young or old, lay them in bed, add the complexities of an acute medical illness and there you go. Asleep. This does not mean that at threeContinue reading “Asleep”
I had intended this blog to focus on my planned trip to India in a couple of weeks; readers will have to wait. I want to talk about frailty. For those of you who haven’t kept-pace with my career moves over the past few months, I am now working on the Assessment Unit in RotherhamContinue reading “Frailty. No.”
I hadn’t laughed so much (about me, A and C’s stupidity) since arriving in Rotherham; this is the secret to significant improvements in health.
None of my patients seem to fit-into pathways, and that is a problem, for, as I say, the system is bedevilled with them.
How many older people enter hospital and never leave? Are never aware that the paramedics who carry them from their living-room floor will never bring them back; their secrets, mementos, curios, stashed-away in corners only to be discovered by relatives when clearing-out the house after they have moved-on or died.
Rod’s Blogs, Poems, etc. Table of Contents I search for meaning. 6 ‘Behavioural’ 8 10 Years. 10 10 years. 11 99+. 13 1559 days. 15 A response to Henry. 17 A tale of two times?. 18 Acute. 20 Advance Care Plan, Human Rights & I want what I want 23 alea iacta est 25 AllContinue reading “Blogs, Poems, etc 2017”
This medicine is an old-fashioned anti-depressant, taken in small doses to help pain caused by nerve injury or damage – we call this neuropathic;
Even Stephen King says that dementia keeps him awake at night.
Sure, we know that unnecessary hospitalisation is bad, but what about inappropriate institutionalisation?
Boab hands me my phone and is longer shouting, he is calm the rest of the day and the next.
There’s no need to talk to me like that. I was just trying to help. Don’t, swear either, and, No, you’re not going home. It’s not safe tidy ready You’re not safe well able Stay here. Sit down or you’ll fall. Passive-aggressive tropes that fill me with sadness.
I know it is Christmas Eve Day & all, but, I couldn’t help myself – you see, the way it is, when I get these thoughts in my head, the options are either to put them to paper or allow them to dissolve; a little like dreams. Some thoughts hang around longer than others, forContinue reading “Dead”
Dr Rod Kersh’s first blog for us is about Urinary Tract Infections or UTI’s. At Dementia Congress this year, we both heard a presentation about how home carers should respond to issues like UTI’s. It is fair to say that Rod didn’t agree with all that was said, so I asked him to share hisContinue reading “UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson”
You hear this term all the time nowadays, at least, if you work in an NHS hospital, are an inpatient or carer or relative of someone who is occupying a hospital bed. Most often… Are they medically fit? When will they be medically fit? If they are medically fit, have you done the take-home medicines?Continue reading “Medically fit – today and tomorrow (3)”
72 hours after admission Nigel has become distressed. Anxious and fearful, he wants to leave the hospital, he can’t understand why we won’t let him go, he feels we are trying to harm him, poison him, deprive him of his liberty.
There is a phrase that is consistent across the fields of dementia, delirium and person-centred care, that is, if you have seen one person with dementia (or delirium, or pain), you have seen one person with dementia (or delirium, etc). Statistics, data, evidence have little to do with the interpersonal one-to-one relationships with people experiencingContinue reading “Dementia – dream state”
I have been struggling with this recently. Or, at least, some of my team have found this a tricky instruction and have become concerned. I’ll explain the context. Most recently this arose in relation to the care of some of my patients on the ward. You see, when a person passes through the doors ofContinue reading “At nurse’s discretion”
I started writing this, a little chuffed with myself as I thought I had invented a new word. Alas, someone has beaten me to it, although their meaning is slightly different from the one I intend to use here. In the Encyclopaedia of Ageing and Health edited by Kyriakos S Markides*, Polydoctory is defined asContinue reading “The Hazards of Polydoctory”
Most of us know this from our family and social lives – one lie begets ten more and on and on, yet, the multiplication of lying is dependent on the person you are talking to having the capacity to hold-on to the matter of your conversation.
Stan, Not his real name And Len, Not his real name either, Meet in an unintelligible environment, Clinical, yet, homely, Hotel? Hostel? Hospital? It is all a fog, Stan, because of the progression of his dementia, Len, because of his fading eyesight and general deterioration. They stand Side by side, Looking out the window,Continue reading “Two old men”
Just as with suffering, it is not something that can be measured and compared, it isn’t absolute, it is relative like everything else in the universe.
Our health and social care staff need to gain a better understanding of this condition – how to identify the early signs, how to diagnose and treat.
Many of you reading this will be familiar with This is me – the person-centred document we have been using in the hospital for the past five or six years. It was originally developed by the Alzheimer’s Society working with the Royal College of Nursing, then, a couple of years ago I got together withContinue reading “This is me (&you)”
His autonomy was not violated. We reached a conclusion that avoided any crossing of boundaries between care and carer.
The pain or care home relocation after a period of notice can often be avoided by the skilful use of person-centred techniques.
There is a science of sleep. This evening as I was driving home, I heard Peter White discussing sleep disorders in those who are blind or have significant visual impairment. Unlike our crepuscular cousins, humans are diurnal; we are designed to sleep when it is dark and potter during the day, creating industry, building things.Continue reading “Sleep”
In most instances it is straightforward, and here is the trick.
Stop, look and listen.
When in doubt, don’t UTI.
Is it any wonder your frustration is occasionally perceived as anger and my compassion as hurt?
I spent a few hours in York yesterday. I travelled up to present some of the work we have done in Doncaster in relation to Quality Improvement, dementia and delirium (signing, dancing, dog-visits – that sort of thing). Recently, I have been talking about the perpetual Narnia which the government has foisted on the NHS;Continue reading “York – somewhere else;”
After a while, she walked-off.
OK. It is Dementia Awareness Week 2017. Now, until Sunday the 21st. If you want to see what was going-on last year, look here. Today, we released to the world, via You Tube, our most recent film, focusing on Person-Centred Care and Dementia. Just because you have dementia doesn’t mean you stop being you. DementiaContinue reading “Dementia”
We are constantly working to refine the ways that people, particularly those who are older and frail interface with the health and social care system.
For those conditions which respond to treatments or remedies, we need tablets and love; for those without the tablets, whether in the form of placebo or not, we need at the very least, love.
That is less perhaps of concern, as the more any of us learn , the less we all realise we know.
I remember a recent patient, G. who became lost after a couple of seconds of redirection, ‘Where am I?’ Was his usual refrain; G had Alzheimer’s.
I have spent so long recently crying over our beloved system, this was more like a time to celebrate.
Indeed, the last walking stick I saw came to a bad end when it wasn’t used as a walking stick.