Do you want to live to be 100? Answers from older people

Karppinen, H. et al. Age Ageing. Published online: April 13 2016.

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Image source:okeos // CC BY-NC-ND 2.0

Background: little is known about the oldest-olds’ views on ageing.

Objective: to investigate older people’s desire and the reasons they give for wanting to live to 100.

Design: a postal questionnaire, analysed both quantitatively and qualitatively.

Setting: population based in Helsinki, Finland.

Subjects: a random sample (response rate 64%; N = 1,405) of community-dwelling older people (aged 75–96).

Methods: a structured self-completed questionnaire with an open-ended question on the reasons why/why not participants wished/did not wish to live to 100.

Results: one-third (32.9%) of home-dwelling older people wanted to live to be 100. Those who did were older, more often male and self-rated their health better than those who did not. Often the desire for long life was conditional: ‘Yes, if I stay healthy’. Among the reasons is that many were curious to see what would happen. Many stated that they loved life, they had twinkle in their eye or significant life roles. Those who did not want to live extremely long lives gave various rationales: they would become disabled, life would be meaningless, they were reluctant to become a burden to others or they feared loss of autonomy or suffering pain or loneliness. Some people also shared the view that they should not intervene in destiny or they felt that they had accomplished what they wanted in life.

Conclusions: one-third of the oldest-old participants wanted to live to 100. Identifying what motivated them to desire long life could be a resource in their care plans.

Read the abstract here

End of life care commissioning toolkit

05 April 2016 – NHS England

Providing high quality end of life care that is truly centred around the needs of the individual and their loved ones is an important outcome to aim for.  Given the complexity of ensuring all the patient’s needs are met, wherever possible, requires all the agencies to work together.

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Image source: NHSIQ

The ‘Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020’, stresses how we must all work together to find new ways of delivering better care to make a difference.  The role of commissioners in collaborative working continues to be fundamental in making progress in end of life care.

The toolkit is aimed at being a useful resource which is complimentary to the overall national strategic direction, whilst aiming  to support commissioners ‘commission high quality end of life care’ and to be complimentary to their local Sustainable Transformation Plans.

View the full toolkit here

View the full commentary here

The blind leading the blind in the land of risk communication

Elwyn, G. BMJ Clinical Evidence Blog. Published online: 14 April 2016.

It is often said that humans are terrible at understanding risk. Maybe so when it comes to ratios and rates – abstract forms of data. But all of us navigate the world by moving, walking or driving – constantly comparing distances, magnitudes and likelihoods, making estimates about the risk of collisions, repeatedly, and accurately. We are actually risk calculators extraordinaire – and we do it all effortlessly, using heuristics, and get it right, most of the time. Our survival depends on it.

But when it comes to health care – we are less confident. When to start a medication? When to have an operation or a test? Plus, we have much less experience to draw on. And less data. Often, no data at all.

Risk of conditionitis

Figure 1: icon array (www.iconarray.com)

When it comes to risk communication, pictures, though not perfect, help show what happens at population levels. An icon array (see Figure 1) elegantly combines the idea of reference class (100 men between 50 and 60). They have conditionitis and are asked to consider the benefits of treatment A (blue stick men) or treatment B (green stick men). Treatment A is twice as effective as treatment B (relative risk), but the absolute benefit is more modest number, i.e. 5 more men in a hundred (10 minus 5). But note that even then 85 men who do not benefit at all. And by the way, stick figures (bathroom symbols) are better it seems than smiley faces or ovals. It is the kind of graphic that should guide all conversations about decisions in healthcare. In the land of the blind, we could at least become partially sighted.

Read the full blog post here

NICE calls for safer use of controlled drugs

Wise, J. BMJ. 2016 353:i2137

https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods#/media/File:Ritalin-SR-20mg-1000x1000.jpg
Image source: en:User:Sponge // CC BY-SA 3.0

GPs should advise patients on the safe storage of controlled drugs such as morphine, methadone, and diazepam, new guidance from the National Institute for Health and Care Excellence (NICE) states.1

The guidance brings together legislation and existing advice to help minimise the potential harms associated with controlled drugs. A seven year review of safety incidents reported to the National Reporting and Learning System in England and Wales found that the risk of death was far greater with controlled drugs than with other medicines. It found that five commonly used controlled drugs were responsible for 88% of the recorded incidents that led to death or severe harm.2

The guideline says that GPs should discuss storage options for prescribed controlled drugs, such as a lockable or non-lockable storage box. It says that this discussion should consider whether the controlled drugs will be accessible to people who should not have access to them and whether the storage method could increase the risk of patient safety incidents.

View the commentary here

View the guidance here

Horticultural therapy for dementia patients

C0026838 Purple flowers
Image source: Wellcome Library// CC BY-NC-ND 4.0

Fourteen people attending an adult day programme were recruited to a structured horticultural therapy programme which took place over 10 weeks. The effects were assessed using Dementia Care Mapping and questionnaires completed by family carers.

High levels of wellbeing were observed while the participants were engaged in horticultural therapy, and these were sustained once the programme was completed. This study adds to the growing evidence on the benefits of horticultural therapy for people with dementia who have enjoyed gardening in the past.

Full reference: Hall, J.  et al.  Effect of horticultural therapy on wellbeing among dementia day care programme participants: A mixed-methods study published online before print. Dementia April 11, 2016

Public participation in primary care commissioning

NHS England has published a Framework for patient and public participation in primary care commissioning. This framework is a guide for primary care commissioners and anyone who is interested, including patients and the public, the voluntary sector, and providers of health and social care services on how to involve patients and the public in the commissioning of primary care services.

Budget decisions can decrease alcohol deaths in less than 18 months

BMJ Talk Medicine. Published online 9th April 2016.

Alcohol consumption has been a perennial problem, but recently The economic downturn and rises in alcohol taxation seem to have stemmed the persistent rise in associated mortality.

Nick Sheron, head of clinical herpetology at Southampton university, and one of the authors of an analysis article, explains how government fiscal policy has the ability to immediately reduce alcohol related deaths.

View the original source here

Impact of NHS deficits on patient safety is a resigning issue for Hunt, says head of King’s Fund

Kmietowicz, Z. BMJ. 2016 353:i2041

England’s health secretary, Jeremy Hunt, should consider resigning because the financial pressures on the NHS are putting patient safety at risk, a leading health policy adviser has said.

Chris Ham, former government health adviser and the head of the King’s Fund think tank, said in an article in the Guardian that Hunt should examine his conscience about whether the improvements in patient safety he instigated can be realised in the NHS’s current financial climate.

As most trusts are running large deficits, many are looking to cut staff to reduce spending, which risks repeating the failures that led to nearly 500 unnecessary patient deaths in Mid Staffordshire from 2005 to 2008, Ham said. Robert Francis’s report into the scandal in the Midlands was the impetus for Hunt’s patient safety agenda.2

Ham wrote in the Guardian article, “Hunt now faces unpalatable choices about the direction of health policy, akin to the dilemmas that led Iain Duncan Smith to resign as work and pensions secretary. Just as Duncan Smith felt his mission to reform welfare was undermined by budget cuts, so Hunt’s ambition to improve quality of care is at risk from financial constraints.

View the original newspaper article here

View the full commentary here