Mild Cognitive Impairment and Driving Cessation

Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this | Dementia and Geriatric Cognitive Disorders

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Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI.

One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period.

Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis.

A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics – such as age, cognition, and function – and changes in these measures over 6 months predict driving cessation.

Full reference: Connors, M.H. et al. (2017) Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study. Dementia and Geriatric Cognitive Disorders. Vol. 44 (no. 1-2) pp. 63-70

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One in three cases of dementia preventable

A new report identifies powerful tools to prevent dementia and touts the benefits of nonmedical interventions for people with dementia | ScienceDaily

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Image source: The Lancet

Managing lifestyle factors such as hearing loss, smoking, hypertension and depression could prevent one-third of the world’s dementia cases, according to a report by the first Lancet Commission on Dementia Prevention and Care. Presented at the Alzheimer’s Association International Conference (AAIC) 2017 and published in The Lancet, the report also highlights the beneficial effects of nonpharmacologic interventions such as social contact and exercise for people with dementia.

The commission’s report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia — one in three cases — is attributable to these risk factors, the report says.

By increasing education in early life and addressing hearing loss, hypertension and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined.

In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact and managing diabetes could reduce the incidence of dementia by another 15 percent.

Realising the potential of allied health professions

An AHP is someone trained to perform services in the care of patients other than a physician or registered nurse – including occupational therapists and physiotherapists, but also many other professionals | King’s Fund Blog

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These wider professional groups, and the multidisciplinary teams they are part of, are crucial to care delivery. Data from the National audit of intermediate care 2014 demonstrates that the greater the number of professions in a care team – skill mix, not head count – the better the outcome for the person receiving care. I’m not one for jumping on a soapbox about this, but I do think that there continues to be a fundamental challenge across the system about what prevents the effective use of AHPs.

My view is that it is just not possible for everyone to know the range of skills these wider professions can offer across the health, care and wider system and the impact they can make. But every organisation should have someone who does. In NHS England the Chief Allied Health Professional Officer, Suzanne Rastrick, holds this position. At a trust level, the AHP lead is responsible for ensuring effective professional governance, management and leadership for AHPs. The role involves maintaining and developing high-quality, innovative practice and services across the trust and supporting the organisation to recognise the positive, wide-ranging and added value that AHPs can bring to services and how to use this to best effect.

Read the full blog post here

Deaths linked to Aids have halved in a decade

A report by the Joint United Nations Programme on HIV/Aids (UNAids) showed deaths had fallen from a peak of 1.9 million in 2005 to 1 million last year | BBC News

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Image source: UNAIDS

The condition, which is caused by HIV, used to be one of the top 10 causes of death worldwide. It said the “scales have tipped”, with more than half of people getting drug treatment for the first time. An HIV infection cannot be cured – it can only be contained with daily doses of antiretroviral therapy.

Unchecked, it destroys the immune system, causing Aids. At this point people tend to die from other “opportunistic infections” such as tuberculosis. Worldwide, 36.7 million are living with HIV and 53% of them are getting the therapy that gives a near-normal life expectancy.

Creative Health: The Arts for Health and Wellbeing

The All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) was formed in 2014 and aims to improve awareness of the benefits that the arts can bring to health and wellbeing.

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Image source: APPGAHW

The Inquiry Report, Creative Health: The Arts for Health and Wellbeing, presents the findings of two years of research, evidence-gathering and discussions with patients, health and social care professionals, artists and arts administrators, academics, people in local government, ministers, other policy-makers and parliamentarians from both Houses of Parliament.

Videos:

Four service users and expert patients were filmed in conversation with Lord Howarth of Newport to create these videos.

 

Quality improvement in mental health

Quality improvement in mental health | The King’s Fund

This report explores the potential opportunities arising from the application of quality improvement approaches in the mental health sector and identifies relevant learning from organisations that have already adopted these approaches.

The authors were specifically interested in understanding how and why some mental health organisations have embraced quality improvement strategies and what has enabled them to do so. It explores what changes are needed from senior leaders to cultivate a quality improvement ethos within their organisation.    

Key findings

  • Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
  • Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
  • Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
  • Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
  • The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.

Download the full report: Quality improvement in mental health

Specialist mental health care in England

The state of care in mental health services 2014 to 2017| Care Quality Commission (CQC) 

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Image source: http://www.cqc.org.uk

This report describes how CQC inspectors found that the majority of services are caring and compassionate towards their patients. However, the report also identifies several areas of concern: difficulties around accessing services, physical environments not designed to keep people safe, care that is over-restrictive and institutional in nature, and poor recording and sharing of information that undermines the efforts of staff to work together to make sure that people get the right care at the right time.

Full report: The state of care in mental health services 2014 to 2017

Additional links: CQC press release | NHS Confederation