Our Ageing Population

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Last Thursday evening I watched episode 2 of BBC2’s Protecting Our Parents programme, and as the elderly and their mental health is something that I am passionate about, I thought that I would share an outline of the programme’s content.  Although I had caught the first episode the previous week, I found the last instalment particularly poignant, as it was exclusively focused on a married couple, Kathleen, aged 80, and her husband, Leonard.  Kathleen and Leonard were both clearly very much in love, and it was perhaps this observation in general, that made their story quite heart-breaking to watch.  The couple had been married for 60 years, and Leonard still recalled, with obvious fondness, Kathleen’s beautiful hair when she was younger.

Kathleen was recovering from a kidney infection in hospital, and desperately wanted to go home.  Her husband, Leonard, was missing her terribly, and she, in turn, I think was missing him.  The problem with Kathleen’s return however, was her constant habit of calling ambulances.  To date, it had cost the health authority £57,000!  Kathleen’s general reason for phoning was because she needed assistance with being moved in bed; Kathleen was uncomfortable, and it was still to be some time before her home-carers were due.  The reason for phoning was for anything, except for a real emergency!

Before Kathleen could go home therefore, the social workers needed to make arrangements that would alleviate the risk of her constant phoning of 999.  The hospital was keen for Kathleen to go, as her bed was costing them £310 per day, and was moreover required for someone who was more in need than Kathleen.  To help determine Kathleen’s mental capacity, a Consultant Psychiatrist questioned Kathleen about the reasons behind her ambulance calling, but she clearly denied all knowledge of ever making the calls.  The psychiatrist carried out a mini-mental state examination, first asking Kathleen to repeat and remember three objects – a lemon, a key and a flag.  Kathleen was then asked to say the days of the week backwards, which she managed to do, but was then asked to recall the three objects.  She failed this last task.  The psychiatrist concluded that Kathleen had genuine memory impairment, and therefore lacked full capacity.

It was interesting to note that the social workers did not agree with the psychiatrist’s conclusion.  Kathleen seemed fully lucid when they spoke to her about the ambulance calls, and she seemed to comprehend why they were wrong.  The social workers decisively concluded that Kathleen fully understood about the emergency calls.  In order to minimise the risk of reoccurrence, the social workers decided to arrange two extra care visits, per day, to Kathleen and Leonard’s home.

On the day that Kathleen was due to be discharged from hospital, it was found that Leonard had disappeared.  Eventually it was discovered that he was also at the hospital, suffering from a twisted bowel.  Kathleen’s return for that day was therefore in jeopardy; particularly on account of her being alone and isolated once she had returned home; and therefore perhaps, as a consequence, she may have been more tempted to call the ambulance again.  However, the discharge went ahead, with two carers attending to meet her at home.  The bed in the hospital was just costing too much, and evidently was more costly than the expense of two home-carers.

In the morning, Leonard arrived home with plenty of painkillers.  Kathleen and him-self were so happy to be reunited.  Their affection was candid and touching, and had the effect of making the observer feel so warm and empathetic inside.  Kathleen talked about never wanting to give up her home, and moreover never wanting to go into a care home.  Leonard commented that he would like to die first, as he could never cope with being on his own and was not emotionally strong enough to cope without his wife. 

A month later, it was revealed that the emergency services had been called forty more times!  Kathleen was demanding 24 hour care in her home; not in a care home.  The social workers visited her to discuss these issues, and said that she could have home care if she was willing to pay for it.  Kathleen instantly rejected this, as she felt that her-self and Leonard had paid enough in taxes and national insurance contributions throughout the years.  The social workers’ response was to offer Kathleen, and Leonard, a nursing home; the social workers desperately wanted to keep them together, which was only morally right.  Kathleen was adamant though, that a care home was not going to happen; she was intent on staying in her home.

Kathleen was upset, and so her GP came to pay her a home visit.  He brought along a different psychiatrist whom Kathleen had met before.  The GP was worried about Kathleen’s incontinence and pressure sores, and how having occasional care visits was not really addressing these issues.  The psychiatrist performed a different type of mini-mental state examination, and Kathleen did not respond very well as she was clearly emotionally upset.  Kathleen told the psychiatrist that she felt a nuisance.

On leaving the house, the psychiatrist told the GP that Kathleen’s mental capacity was definitely questionable.  A ‘best interest’ decision was mentioned for the first time. 

We later learned that Kathleen went back to the hospital, having contracted pneumonia.  Leonard, in his isolation, telephoned the ambulance and told them that he could not stand being on his own.  Leonard later had a fall and was admitted to hospital himself. 

Six months later, it was definitely decided that Kathleen no longer had mental capacity.  Kathleen and her husband had very different care needs, and it was hard to practically unite the care plan and the couple as one.  In response, a multi-disciplinary team meeting was held, with Leonard in attendance, on behalf of him-self and Kathleen.  Everything was carefully explained to him, and he had several opportunities to put across his views.  Leonard was happy to go along with the nursing home plan, because him-self and Kathleen would remain together, and she would also be able to receive the 24 hour care that she so desperately needs.  Leonard knowingly predicted however, that Kathleen would not comply with this option, and of course, knowing his wife for sixty years, he was absolutely right.

Total overnight care was another option that had been previously mentioned; perhaps more as a compromise in meeting Kathleen half-way.  At the end of the programme therefore, we learned that Kathleen had gone home with Leonard.  Kathleen was now receiving eleven visits each day, and this presumably, included overnight care.  In the short time since Kathleen had been home, the ambulance had been called thirty-eight times, and there had been visits to Accident and Emergency on several occasions.

It seems that it is only a matter of time before Kathleen will be forced to go into a care home, albeit with her husband.  The ambulance and care-worker costs combined must be far more than the expenses that are charged in a care home; and to add weight to the argument, desperately ill people, who need the emergency services, are potentially having their lives put at risk. 

In an ever increasing ageing population, it seems that stories like Kathleen and Leonard’s will sadly become more common.  It must be so hard to accept some of the changes that accompany the ageing process; especially when you have shared your life and home with a partner for over 60 years.  It is up to us as nurses therefore, to offer the elderly compassion, care and understanding.  We must try to make what is potentially a difficult journey, just a little bit easier, with some heart-felt kindly words and a good measure of empathy.   

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For more information, please visit:

The Open University

OU on the BBC, Protecting Our Parents

http://www.open.edu/openlearn/whats-on/tv/ou-on-the-bbc-protecting-our-parents

 

BBC Two

Protecting Our Parents

http://www.bbc.co.uk/programmes/b041mq9q

Reading books is good for your mental health

Happy Birthday, Shakespeare

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Today is William Shakespeare’s birthday; to be more precise, it is his 450th birthday!  Reputedly, as well as being born on the 23rd April, Shakespeare also died on the 23rd April.  In just a couple of years, 2016 is set to mark 400 years of the date of his demise.

Many people first encounter Shakespeare’s work during their school days, and often may have struggled with the unfamiliar and archaic language.  A Mid-Summer Night’s Dream, Hamlet, Macbeth or Romeo and Juliet are the usual contenders for purposes of study.  While the language is somewhat different from our contemporaneous vocabulary, it remains compellingly enigmatic with its iambic pentameter, its rhyming couplets, quatrains and soliloquys.  Shakespeare’s work, for me, is a thing of beauty, and many authors – be they playwrights, poets or novelists – can never hope to match the Bard in his sheer productive quantity of plays and sonnets.  Shakespeare was prolific with his mighty pen.  If in doubt, just take a look at the Complete Works of Shakespeare, and you will be faced with a heavy and cumbersome volume of text.

If Shakespeare is not your thing though, there is a fantastic array of reading material in our libraries, bookshops and on the Internet.  Whatever your taste, there has got to be something to suit – fiction or non-fiction.  I personally favour the literary classics, especially Thomas Hardy, and I also love Scandinavian crime fiction, especially Henning Mankell and Jo Nesbo.  Reading books is good for your mental health.  It is healthy to be intellectually stimulated, to escape, to learn and to imagine.  To promote this positive pursuit further, it is a special reading occasion, today and tonight.  To find out more, please read on…

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World Book Day and World Book Night

In honour of the Bard, today is also UNESCO’s World Book Day and World Book Night.  World Book Day first began in 1995, and was launched as a tribute to authors and their books, and to encourage the reading habit as a pleasurable pursuit, with a particular emphasis upon engaging the young.

Every year, a World Book Capital is chosen for a period of exactly one year, and the 2014 choice is Port Harcourt in Nigeria.  The city is intent upon improving literacy rates amongst its young people, and as Irina Bokova, UNESCO’s Director General states: ‘books are our most powerful forces of poverty eradication’.  Education, as we know, is often key to building our future prosperity.

For more information, go to http://www.un.org/en/events/bookday/

To support and advocate the ethos of literacy promotion, World Book Night is literally spreading the word.  Tonight, many free books will be handed out, by community book givers, at public events and places all around the world.  The event is run by the Reading Agency, and here in the United Kingdom, the twenty books for distribution this year are:

Getting rid of Matthew by Jane Fallon

The Boy with the Topknot by Sathnaw Sanghera

Today everything changes by Andy McNab

Vengeance is mine inc. and other stories by Roald Dahl

The Boy in the Striped Pyjamas by John Boyne

Four Warned by Jeffrey Archer

Black Hills by Nora Roberts

Tales of the City by Armistead Maupin

Confessions of a GP by Dr. Benjamin Daniels

Rivers of London by Ben Aaronovitch

Hello Mum by Bernadine Evaristo

The Recruit by Robert Muchamore

Theodore Boone by John Grisham

The Humans by Matt Haig

Geezer Girls by Dreda Say Mitchell

Whatever It Takes by Adele Parks

Gorky Park by Martin Cruz Smith

After the Funeral by Agatha Christie

The Perfect Murder by Peter James

59 Seconds: Think a little Change a lot by Professor Richard Wiseman

For more information, go to http://www.worldbooknight.org/books/2014-book-list

You might just be one of the lucky ones, and end up being given a book.  Books are your own personal ticket on a journey to another world.  You can travel to virtually anywhere you want to!

Books on Prescription

Many people who experience common mental health problems, such as depression, anxiety, obsessive compulsive disorder and eating disorders, can be helped further in their recovery through some medical reading.  Thirty self-help books in the Reading Well Books on Prescription scheme have been specifically chosen by health professionals, to address sufferers’ problems through the process of CBT – cognitive behavioural therapy.  In very simple terms, CBT is designed to encourage positive attitudes, and to displace the more negative ones.  It is a way of re-training the mind.

Books on Prescription schemes have been operating for several years across selected parts of the UK.  From June 2013, the Reading Well Books on Prescription titles were extended to include libraries within England, and should now be helping readers to understand and self-manage their conditions more effectively.  A growing wealth of evidence supports the efficacy of the books, and the English scheme is supported by the Department of Health’s Improving Access to Psychological Therapies Programme, the British Association for Behavioural and Cognitive Psychotherapies, the Royal Colleges of GPs, Nursing and Psychiatrists, and is also compatible with the NICE guidelines.

For further information, and to find out which books are in the scheme, go to  http://www.booksonprescription.org.uk/books

New beginnings and endings

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As I observe all the signs of new life around me, it is clear that as far as nature is concerned, Easter is a time for new beginnings.  There are buds and blossom on the trees, daffodils, magnolia and hyacinths in the gardens, lambs in the fields, and birds building nests in expectation of their hatchlings’ arrivals.  On a secular level, Easter is, of course, a time for chocolate eggs, which are symbolic of the concept of new life, and have particular reference to the fluffy yellow new-born chicks.

On a more religious, and specifically Christian, level, the same chocolate eggs are again symbolic of new life, but this time with reference to the story from the Bible, in which Jesus arose from the dead.  This same event is remembered through the crosses on our hot cross buns, which we traditionally eat on Good Friday.  The cross on the buns is also evocative of the cross on the donkey’s back, when Jesus rode into Jerusalem on Palm Sunday.

The main new beginning that I write about today is my recent start as a Year Two student nurse.  For this first semester, we are able to study our own optional module choices.  My choices are the Supporting Families and Carers module and the End of Life, or Palliative Care module; and it is the latter of these two that I wish to discuss today.

Palliative care is only a recently recognised concept within the field of medicine, as the emphasis has previously been upon making people better.  People only went to the doctors when something was wrong, and the hospitals were there to sort out the problem and to provide a cure.  Through advocating the benefits of eating a healthy diet, taking regular exercise, limiting alcohol consumption and giving up smoking, preventative medicine has become another huge part of the 21st century health service; but so too is dying, and has been since man first appeared on this earth.

For something that is a certainty in every person’s life, death is a topic that many people are quite reluctant to talk about, and will often take great measures to avoid it altogether.  The reasons for this avoidance, I would guess, probably include feelings of discomfort, embarrassment, living for the day without worrying about tomorrow, and straightforward fear.  In an ever increasing ageing population, it may be something however, that needs to be given a little thought.

For the past week, I have been working on an assignment for End of Life, and while researching and reading the material that I required, and by also attending my weekly lectures, I have discovered a wealth of really interesting material about this subject.  Whichever field of nursing you are from, it is inevitable that eventually you will encounter a death.  As End of Life Care is not a compulsory part of the nursing curriculum, I thought that I would share some of the things that I have found really useful.

To get people talking, there is a really good website called Dying Matters, http://dyingmatters.org/.  It is aimed at ‘chang[ing] public knowledge, attitudes and behaviours towards dying, death and bereavement’.

There is an excellent booklet called Dying for Change, available to download at http://www.demos.co.uk/publications/dyingforchange which is again aimed at getting people to talk about dying.  It is written in an interesting and very readable format, and it addresses the main concerns about trying to get people to plan for the type of death that they foresee for themselves in the future.  For most people this is a death at home, but presently, this is likely to be a death in a hospital.  To help people to get their wishes, certain measures are recommended.

Planning for your future care – A guide is available on the NHS Choices website, http://www.nhs.uk/Planners/end-of-life-care/Pages/what-is-end-of-life-care.aspx  The booklet provides a simplistic general overview of some of the measures raised above, such as Advance Care Planning and other options.  ACP is a discussion about wishes and preferences, plans to refuse certain treatments, asking someone to speak on your behalf, and if things became really bad, to make decisions on your behalf and to look after your financial matters; this person is a Lasting Power of Attorney, and would have to be legally appointed.  The ‘What is End of Life Care?’ pages at NHS Choices provide greater detail and signposting on all of these matters.

For even greater detail on these concerns visit the Gold Standards Framework site at http://www.goldstandardsframework.org.uk/advance-care-planning  There are lots of resources available here, and one of my favourites is the Prognostic Indicator Guidance (PIG), which is used for recognising the signs and symptoms of when people are approaching the end of their life.  About 1% of the population will die every year, and it is quite often GPs who will predict whom they are likely to be.

Further information on Advance Decisions to Refuse Treatments can be found at http://www.adrt.nhs.uk/

A brilliantly informative End of Life Care website is St. Christopher’s Hospice http://www.stchristophers.org.uk/  St. Christopher’s was set up by Dame Cicely Saunders, the great nurse, doctor, social worker and writer, in 1967.  St. Christopher’s was the first purpose built modern hospice, and was the foundation of all the hospices that we see around us today.  St. Christopher’s website has loads of information and resources; there are some very good End of Life journals that are available for reading.

The National End of Life Care Strategy is available at https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life

And a good general overview of everything End of Life is available at http://www.endoflifecumbriaandlancashire.org.uk/index.php

Programmes to watch

I have also watched two excellent TV programmes regarding End of Life and death.  The first was a BBC2 production called Edge of Life, presented by Louis Theroux.  Louis visited a hospital in LA and spoke to dying patients and their families.  It was striking how many Americans would not accept death and choose to die in some kind of comfort.  The majority preferred to fight on with any available treatments, even though there was little hope and much physical pain to endure.  Although amongst the bleak prognoses, a miracle does actually happen.  It is heartening to see how much faith the Americans place in their religion, and that sometimes it does actually pay off.  I recommend that you watch this programme, if you can find it on the Internet; it is very good viewing.

The second programme was Choosing to Die, presented by the writer, Terry Pratchett.  Pratchett, himself, is currently coping with the neurodegenerative disease of Alzheimer’s.  This production is a fascinating account about terminally ill people who choose to end their life by euthanasia.  It tells the story of a few families who go to the Dignitas clinic in Switzerland, and voluntarily end their suffering by drinking a lethal poison.  This topic is highly controversial, and divides opinion massively.  Whatever your personal feelings, it makes compelling, but quite upsetting viewing, and actually features the last moments of a dying person.  Pratchett finds comfort in the lack of suffering and peace of the event.  It is not as grim as it sounds, and is again highly recommended.

Finally, I would like to wish you all a very happy and peaceful Eastertime with your family and friends.  Apologies, if you have found the topic slightly heavy, but while it is fresh in my mind, I felt that it was important to share.  Happy Easter everyone, and enjoy your chocolate eggs!

Welcome to my Thoughts on becoming a Mental Health Nurse

My name is Amanda Butler, and I have just started my second year as a Student Mental Health Nurse in Manchester. I am not your average eighteen to twenty something student; I am what they call a mature student. I have tried various career pathways in the past, including IT and teaching, but it is only now in my early middle years, that I have actually really found what it was I was looking for.

Like many things in life, it was a couple of major events that allowed me to reach my turning point. I lost both of my maternal grandparents to dementia – Alzheimer’s and Vascular dementia, respectively. I had been exceptionally close to both of these lovely gentle people, and I knew that I had to do something to help similar people, and their families, who were suffering with dementia. The disease is very cruel and often completely changes peoples’ personalities. The decline is progressive and it can be emotionally painful to witness.

The first part of my plan was to start a new job as a Care Manager in a residential care home which had a dementia community. The work was really tiring, both physically and mentally, but I found that I really enjoyed it and achieved enormous satisfaction from it. The residents were so trusting, so generally helpless and grateful for the workers’ efforts. I loved to hear the residents’ stories; they were an endearing and interesting combination, of both accuracy and confusion. It was impossible not to feel attached to these lovely vulnerable people and to care for them, with compassion and commitment, like you would your own family member.

After 12 months experience of working full time as a carer, I applied to various local universities for a place as a student nurse. I applied for the mental health branch, without a degree of hesitation, as I knew that I wanted to help not only people with dementia, but all those individuals with debilitating depression, bi-polar, schizophrenia and so forth. I feel strongly that sufferers of these conditions have been stigmatised and discriminated against for far too long. More mental health professionals are desperately needed to bring about the necessary changes, and I want to be one of them.

I found the university I was looking for in May 2012. Upon arriving, I received the slightly disappointing news that all the places for September 2012 had already gone, but today we would be competing for March 2013 places. This news was initially unwelcome, but when I thought about it rationally, it didn’t really matter if I got my place on the course; I would just have to be more patient!

The other students that I met that day were really friendly, and I was impressed with the facilities that were provided on campus. I had already passed one hurdle by being selected for an interview, but before that took place I was presented with two tests to tackle in numeracy and literacy. The literacy one was fine, as that is my favourite subject, but I was really nervous about the numeracy test, as mathematics has never been a natural strength of mine. Looking back, it did not go particularly well, as I never had enough time to complete all of the questions. I had revised beforehand, but I know that I was very slow in completing my calculations.

The face-to-face interview however, I feel, went well, as I found the interviewer easy to talk to. We comfortably chatted about our common interest in mental health issues, and so I felt really positive when I left to go home. I eagerly awaited to find out if I had been successful, and after about two weeks the good news appeared on my on-line UCAS account. I was going to be a Student Mental Health Nurse. I was going to make a difference. I was absolutely ecstatic and didn’t know how I would wait until March!

It is now April 2014 and I have completed my first year of training, and I am officially one third of the way to becoming a registered Mental Health nurse. The tutors say that the second year of our training tends to be the hardest, as it is still quite a way until the end of the course, the academic work steps up a level, and our mentor’s expectations on placements will be slightly higher because we are second year students. I am ready for the challenge however. I never expected it to be easy, and I am raring to go. Welcome to Year Two!