Care at Home - Elderly home care forum

One in three of us will be diagnosed with cancer during our life.
The disease tends to affect older people - but can strike at any time.

Excluding certain skin cancers, there were more than 270,000 new cases of the disease in 2001 - and the rate is increasing by about 1% a year.

Some cancer, such as breast, are becoming more common, while new cases of lung cancer fall away due to the drop in the number of smokers.

However, while the overall number of new cancers is not falling, the good news is that successful treatment rates for many of the most common types are improving rapidly.

BBC News Online has produced, in conjunction with Cancer Research UK, a guide to some of the most common forms of cancer and the treatments used to tackle them.

To learn more about different types of cancer, and to read the experiences of patients, click on the links to the right.

For more in-depth details on the following types of cancer click here - article by The BBC

Bladder cancer
Bowel Cancer
Breast Cancer
Cervical and Uterine Cancers
Leukaemias and lymphomas
Lung Cancer
Ovarian cancer
Oesophageal cancer
Pancreatic Cancer
Prostate cancer
Skin cancers
Stomach cancer
Testicular Cancer

Stroke services are improving, but there are still some gaps in care, an audit of hospitals in England, Wales and Northern Ireland has shown.

The Royal College of Physicians quizzed 224 hospitals about their services.

The study, funded by the Healthcare Commission watchdog, found improvements, particularly in provision of clot-busting thrombolytic drugs.

But it concluded that more should be done to ensure access to scans and make the most of specialist stroke beds.

Some 15% of these beds did not have stroke patients in them, which was described as a “nonsensical” situation and a waste of resources.

“There is a powerful consensus for change and this audit demonstrates that we are gaining momentum” Joe Korner, Stroke Association

The report also pointed out that while most hospitals had specialist stroke beds, just 16% of them were employing direct admission to them as they were expected to do.

It also raised concerns about access to CT and MRI scanning, which is essential for the diagnosis of stokes and, in particular, mini-strokes known as transient ischaemic attacks which can often get missed.

Guidelines say scans should be done within 24 hours and while all hospitals have CT scans and most MRI machines, access at weekends and nights was patchy because trusts struggled to have enough staff to operate them out-of-hours.

Concern was also raised about access to stroke rehabilitation units.

Nearly all units had a policy of not admitting people who were deemed not being able to benefit significantly, even though doctors believe all patients can be helped to some extent.

But overall the report praised the way stroke units were now set up.

More than 90% of hospitals had stroke units - up from three quarters six years ago - while a similar number had doctors with specialist knowledge of the condition.

And the availability of thrombolytic drugs had increased four-fold since the last audit was carried out two years ago.

Deaths

In total, a third of hospitals were actively using the clot-busting treatment when necessary.

The news comes as the government is rolling out its stroke strategy, which has promised an extra £105m investment over the next three years to improve services.

Strokes are the third biggest killer - behind cancer and heart disease - responsible for 50,000 deaths a year.

Dr Tony Rudd, of the Royal College of Physicians, said he was “delighted” with the results.

But added: “Hopefully these results will not induce a sense of complacency because we still have a long way to go.”

Health minister Ann Keen agreed there had been “major improvements” in recent years.

She also pointed out that many hospitals were beginning to work together in networks, while local authorities were putting programmes in place to support the long-term needs of stroke survivors.

Joe Korner, of the Stroke Association, said: “There is a powerful consensus for change and this audit demonstrates that we are gaining momentum. But we have a long way to go.”

News reported by The BBC

A new vaccine has completely eliminated a type of breast cancer tumour in tests on mice, say researchers.

The vaccine targets breast cancer caused by an excess of a protein called HER2 - and even destroyed tumours resistant to current drugs.

The US team said it might also be used to prevent initial development of the tumours in cancer-free women.

But UK experts warned the vaccine was at a very early stage, and it was not known if it would work in humans.

“This is very early research that has only been carried out in mice so we don’t actually know if it could be used in women.” Dr Sarah Rawlings

Breakthrough Breast Cancer

The study, by Wayne State University, appears in the journal Cancer Research.

HER2 receptors promote normal cell growth, and are found in low amounts on normal breast cells.

But HER2-positive breast cells can contain many more receptors than is typical, promoting a particularly aggressive type of tumour that affects up to 30% of all breast cancer patients.

There are drugs to treat this form of the disease, including Herceptin, but they do not work for a significant proportion of patients.

The new vaccine contains genes that produce the HER2 receptor, and a compound which stimulates the immune system.

Electrical pulses

The researchers used electrical pulses to deliver the injected vaccine into leg muscles in mice.

Once there, the vaccine produced a huge quantity of HER2 receptors which triggered a reaction by the animals’ immune systems, and primed them to fight cancer.

The researchers also used an agent that, for a while, suppressed the activity of regulatory T cells, which normally keeps the immune system from over-reacting.

In the absence of regulatory T cells, the immune system responded much more strongly to the vaccine.

Then, when the researchers implanted HER2-positive breast tumours in the animals, the cancer was eradicated.

There were no sign of any side-effects.

Lead researcher Professor Wei-Zen Wei said: “The immune response against HER2-positive receptors we saw in this study is powerful.

“Both tumour cells that respond to current targeted therapies and those that are resistant to these treatments were eradicated.

“This may be an answer for women with these tumours who become resistant to the current therapies.”

The researchers have previously developed a similar vaccine which is currently in early clinical trials.

They say this time they have fine tuned the process, and hope the new vaccine will be more effective.

However, Dr Sarah Rawlings, of the charity Breakthrough Breast Cancer, said: “This is very early research that has only been carried out in mice so we don’t actually know if it could be used in women.

“Much more research is needed to find out if it works, to either treat HER2 positive breast cancer or prevent the disease, and if there are any side effects.”

Several other groups are also working on breast cancer vaccines that target HER2.

News reported by The BBC

Every cardiac rehabilitation service in the UK is understaffed, the British Heart Foundation has warned.

The programmes are reckoned to boost five-year survival rates by about 26% by giving medical and lifestyle advice.

But a national audit found that no service was meeting minimum staffing levels - and three out of five patients who need rehab could not access it.

The NHS Confederation, which represents managers, said the report would help local areas provide a better service.

“We will continue to fail heart patients unless the government and health professionals prioritise funding for this life-saving treatment” Professor Bob Lewin, report author

Cardiac rehabilitation programmes last for around 12 weeks and involve nurses, physiotherapists, dieticians, psychologists and occupational therapists.

Patients are offered advice and support in areas such as how to increase physical activity levels safely, how to return to normal daily activities and work and how to tackle risk factors such as high blood pressure and cholesterol, smoking, obesity and diabetes.

It is designed for patients who have experienced a range of cardiac disease including heart failure, heart attacks, heart bypass and angina.

Heart experts estimate that around half a million patients could benefit from cardiac rehab each year - but less than half that figure do so.

‘Below target’

In 2000, the government said 85% of patients who had heart attacks or a heart bypass in England should be offered cardiac rehabilitation, which costs around £600 per person.

The audit found London has the lowest rate of cardiac rehab for heart attack patients, treating only 31%, while in the best performing area - the north east - the audit found the figure was still only 52%.

And it found that the average patient receives just 79% of the recommended nursing time, 36% of the physiotherapy and just 16% of the professional dietetic support required to meet health service guidelines.

“Primary care trusts have the difficult job of balancing priorities” NHS Confederation spokesman

Professor Bob Lewin at the BHF Cardiac Care and Education Research Group who compiled the report, said: “Cardiac rehab allows people to have longer and better quality lives.

“We will continue to fail heart patients unless the government and health professionals prioritise funding for this life saving treatment.”

Mike Knapton, director of prevention and care at the British Heart Foundation, said: “Cardiac rehabilitation saves lives but the majority of patients don’t get the service.

“We are only making minimal progress towards national targets set over eight years ago.

“The health service needs to give cardiac rehabilitation the same priority they give to treating people with acute heart attacks.”

A spokesman for the Primary Care Network of the NHS Confederation said “real progress” had been made in improving coronary heart disease treatment and in cutting deaths since 2000.

But he added: “The report helpfully identifies local areas where more progress needs to be made in the development of cardiac rehabilitation programmes.

“Primary care trusts have the difficult job of balancing priorities for investment in healthcare but they will want to review this report in setting their local health investment plans.”

News reported by The BBC

Thousands of elderly people are having their life-savings, possessions and homes stolen by members of their own family, a charity has claimed.

The scale of the problem was “huge and terrifying” with cash and property worth tens of millions of pounds taken last year, Action on Elder Abuse said.

Solicitors say the rise in financial abuse is partly due to substantial rises in property values.

Charities say a lack of awareness of the problem makes such crimes easy.

‘Widescale problem’

Action on Elder Abuse says it has seen a rise in the number of people who contact its helpline because of financial abuse.

But Daniel Blake, policy manager at the charity, believed that the cases it was aware of were only the tip of the iceberg.

“I was rather disgusted to be honest. I hadn’t expected it. It shook me at the time” ‘Donald’

“What we know is that this affects hundreds of thousands of older people,” he said.

“The amounts of money are in the tens of millions of pounds being taken, stolen or defrauded from older people.

“We’re not saying this happens in every family, but this is a widescale problem involving massive amounts of money that actually mean a lot to older people and has a severe impact on their quality of life.”

The charity found that financial abuse can include:

The direct theft of money and/or other possessions from an older person
Benefits belonging to the older person being withheld by family members

Older people being forced to sell their homes

Financial worries

Calls to the charity’s helpline suggested that where property was involved, about a quarter of victims had their homes sold or taken without their consent.

And in 3% of cases, the house had been remortgaged by the abuser.

Other cases involved direct theft of money, possessions, and benefits.

Donald, not his real name, has discovered the cost of putting his trust in a close family member.

He and his wife have had around £85,000 stolen, and although around half of the money has been returned he said it has made him worry about his financial security.

“Some money was taken from the sale of the house, which is probably the major item. But there was also small bank accounts and building society accounts and allowances such as carer’s allowance, that sort of thing,” he told the BBC.

“I was rather disgusted to be honest. I hadn’t expected it. It shook me at the time. It was very unfortunate. It should never have happened.”

‘Not recognised’

Last autumn the government strengthened protection for older people who suffer from dementia or other illnesses that affect their mental capacity.

But charities say that the problem of financial abuse has been allowed to grow because many people do not believe it can happen.

“If someone was being physically abused you’d expect to see bruises so you’d know what to look for” Kate Jolin Help the Aged

The number of older people who become victims was almost certainly underestimated, said Kate Joplin of Help the Aged.

“Many aged people are too embarrassed to say what has happened, or perhaps do not realise what has happened because of their mental decline,” she said.

Social workers and other staff who deal with older people are trained to look for physical evidence of abuse, but not to enquire about their finances, Ms Joplin added.

“Elderly financial abuse is not recognised as an issue so it’s not picked up,” she said.

“If someone was being physically abused you’d expect to see bruises so you’d know what to look for.

“We need to create a culture in which people can blow the whistle when they find something suspicious because we can’t allow so may older people to be defrauded.”

Take seriously

Helen Freely, a solicitor who specialises in working with older people, said that theft involving property had been fuelled by years of rising house prices.

“It’s largely because elderly people bought their properties many years ago and they have increased in value. Many elderly people are sitting on a pot of money.

“Also dementia is on the increase - we are an aging population - so that makes them vulnerable. ”

Charities have warned that until the problem is taken seriously, the levels of financial abuse will not come down.

News reported by The BBC

More people than previously thought could be at higher risk of having a stroke caused by their antipsychotic drugs, say UK scientists.

Previous research suggested only some types of the drug increased the risk, particularly for people with dementia.

However a study published in the British Medical Journal says all forms of antipsychotics boost the risk, in all patients.

A mental health charity said patients on the drugs must be closely monitored.

“This is another warning that all antipsychotics should be prescribed with great thought and care” Marjorie Wallace Sane

Antipsychotic drugs are generally used to control psychotic symptoms in patients with disorders such as schizophrenia, and some severe forms of depression.

They are also thought to be widely used to control symptoms of dementia such as aggression, leading to accusations they were being used unnecessarily as a “chemical cosh” in some circumstances.

They fall into two types - newer “atypical” and older “typical” antipsychotics.

When the first concerns were raised in 2002, these focused on the “atypical” drugs.

These worries led to a recommendation from drug safety watchdogs in the UK that they not be given to people with dementia, and the government has been urged to strengthen this in England in its forthcoming dementia strategy.

The latest findings, from researchers at the London School of Hygiene and Tropical Medicine, confirm the fears over dementia patients, but raise wider concerns.

They identified 6,700 patients from a GP database, all with an average age of 80, and concluded that there was more than a tripling of risk for dementia patients taking any sort of anti-psychotic drug.

Patients without dementia taking any sort of antipsychotic had a 40% increase in risk.

The researchers repeated the recommendation that patients with dementia should not be prescribed these drugs.

‘Last resort’

Neil Hunt, from the Alzheimer’s Society, said that doctors now needed to heed these warnings.

“The over-prescription of antipsychotics is a serious breach of human rights, these drugs should only be a last resort.

“The forthcoming National Dementia Strategy is a crucial opportunity to stop this dangerous over-prescribing and we look forward to its launch in the autumn.”

Marjorie Wallace, the chief executive of the mental health charity Sane, said that while the drugs were capable of transforming lives, different patients reacted differently to their side-effects.

“This study should remind us all that antipsychotics are powerful drugs which can both be essential for some people, while carrying other risks.

“This is another warning that all antipsychotics should be prescribed with great thought and care and be subject to rigorous follow-up.”

News reported by The BBC

Gene therapy has the potential to restore hearing in mice, offering hope for humans too, US scientists suggest.

An Oregon team discovered gene transfer produced functioning hair cells that are essential for the inner ear to interpret sounds, Nature reports.

In people with normal hearing, cochlear hair cells convert sound into electrical signals, which are ultimately transmitted to the brain.

Once the cells are lost or damaged, they cannot be replaced naturally.

“Although still a long way from the clinic, the work shows that gene therapy is a potential treatment to combat some forms of congenital deafness” Professor Andy Forge Deafness Research UK

According to the Royal National Institute for Deaf People (RNID), there are about nine million people who are deaf or hard of hearing in the UK.

Most of them have lost their hearing gradually with increasing age, partly due to the loss of hair cells in the cochlea.

Repair and replace

Prolonged exposure to loud noise is another culprit, damaging the hair cells.

John Brigande and his team from Oregon Health and Science University showed, at least in unborn mice, gene therapy can be used to encourage other cells to become hair cells.

Gene therapy uses a harmless virus to insert copies of the key gene into cells which then replicate.

The key gene used by the Oregon team was Atoh1 which is essential for hair cell development.

The cells “treated” with Atoh1 functioned exactly like original hair cells.

“This capability is a crucial first step in defining translational therapies to ameliorate the effects of inner-ear disease in humans,” the researchers said.

Work in humans is still a way off, but the findings point to a way to repair the damaged cochlea without using a mechanical or electrical device.

Currently, people can have a cochlear implant which works by bypassing the damaged cochlear hair cells and stimulating the auditory nerve directly.

An implant cannot restore hearing to normal but it does give the sensation of sounds.

Andy Forge, Professor of Auditory Cell Biology and advisor to Deafness Research UK, said: “Although still a long way from the clinic, the work shows that gene therapy is a potential treatment to combat some forms of congenital deafness.

“With one in 2,000 children born deaf because of genetic defects, such a therapy would clearly be of value.”

Dr Mark Downs, of the RNID, said: “This is an exciting development which completes another important piece of the jig-saw in understanding how we might use gene therapy to eventually restore hearing loss.”

News reported by The BBC

Apparently “normal” cells may carry cancer to new sites long before a tumour develops, lying dormant until key genes are activated, experts say.

US researchers say their findings, published in Science, could explain why some breast cancers lead to new tumours long after the disease is treated.

Secondary, or metastatic, cancers are responsible for the majority of deaths from the disease.

UK experts said it was essential to know more about how the cancer spreads.

“These are important but early results” Liz Baker, Cancer Research UK

It has traditionally been thought that the spread of cancer to another site in the body was a late event that only occurred when a disease was advanced.

Cancer cells had been thought to have stayed in place until they had undergone a series of genetic alterations making them more aggressive.

They have to be able to survive the journey through the bloodstream and be able to initiate malignant growth in their new environment in the new site.

Lying in wait

In this latest research, by a team at the Memorial Sloan-Kettering Center in New York, mice were injected with normal breast tissue cells which had been manipulated so the scientists could “switch on” cancer genes (oncogenes).

It was found that the cells were capable of travelling in the bloodstream to the lungs and surviving there for up to 16 weeks without expressing any oncogenes.

The cells did not begin growing aggressively in the lungs until the oncogenes had been turned on.

The researchers say that examining each step of the process by which cancer metastasizes, including those involving normal cells, it might be possible to work out ways to destroy the cells responsible for the disease’s spread through the body.

Writing in Science the researchers, led by Dr Katrina Podsypanina, said: “The finding that metastatic disease can arise from untransformed mammary cells in the circulation refines our conception of cancer progression.”

Liz Baker, senior science information officer for Cancer Research UK, said: “Learning more about the spread of cancer - or metastasis - is essential because it’s harder to treat the disease once it has spread.

“These are important but early results in mice - it will be interesting to see whether this can one day help the outcome of people affected by cancer.”

News reported by The BBC

The government must give more money to help Britain’s six million unpaid carers, MPs have said.

The Commons work and pensions committee said people who looked after friends and relatives saved the taxpayer £87bn.

It recommended income replacement for those unable to work and compensation for extra costs of “intensive” caring.

Carers say the current £50.55-a-week allowance is “insultingly low”. Ministers say they are working to give carers more “balance”.

In its report the committee said more state help was of “critical importance” and the current system was “outdated”.

‘Disappointed’

It recommended a “two-tier” approach combining income replacement and pension protection for carers who were unable to work or only able to work part-time, and compensation for extra costs incurred by “intensive” caring.

It also said the government should help carers who want to return to work to do so.

The MPs said they were “disappointed” the government had not directly addressed financial help for carers in its Carers Strategy launched earlier this year, and that the group was identified as a long-term priority only from 2011.

“Carers need a separate benefit which recognises that they are not unemployed but are making an important contribution to society” Imelda Redmond, Carers UK

Carers struggled to stay in work and often found their vocational skills became rusty and out of date, they said.

The committee’s chairman, Labour MP Terry Rooney, told the BBC: “The average, if there is such a thing, carer is aged between 35 and 55. That’s normally a prime earning period for people, so they lose out in terms of employment opportunity, earnings, future pensions.

“And that group, I think, especially, truly needs to be recognised and recompensed in a better way.”

‘Valuable contribution’

He said 2011 was “too far away” and he hoped the report would bring changes more quickly.

The £50.55-a-week is the lowest income-replacement benefit and amounts to £1.44 an hour, assuming a minimum 35-hour week.

Imelda Redmond, chief executive of campaign group Carers UK, said the existing Carer’s Allowance was “insultingly low”.

“It’s not just about the benefits side. It’s looking at support” Anne McGuire Minister for disabled people

“The two-tier benefit recommended by the committee would be a major improvement to the current system,” she said.

“Carers need a separate benefit which recognises that they are not unemployed but are making an important contribution to society.”

Anne McGuire, minister for disabled people, said she welcomed the report as a “valuable contribution to the debate” and said the government was working with employers to help carers get a better balance between their work and caring responsibilities.

She said a review of the care and support system would take place as part of a wider welfare reform programme.

But she told BBC Radio 4’s Today programme: “It’s not just as straightforward as it might appear that you just up the amount of money - there are all sorts of ramifications to that.”

She added that the government had already provided extra resources to allow carers to take short breaks.

News reported by The BBC

Running on a regular basis can slow the effects of ageing, a study by US researchers shows.

Elderly joggers were half as likely to die prematurely from conditions like cancer than non-runners.

They also enjoyed a healthier life with fewer disabilities, the Stanford University Medical Center team found.

Experts said the findings in Archives of Internal Medicine reinforced the importance that older people exercise regularly.

Survival of the fittest

The work tracked 500 older runners for more than 20 years, comparing them to a similar group of non-runners. All were in their 50s at the start of the study.

Nineteen years into the study, 34% of the non-runners had died compared to only 15% of the runners.

Both groups became more disabled with age, but for the runners the onset of disability started later - an average of 16 years later.

The health gap between the runners and non-runners continued to widen even as the subjects entered their ninth decade of life.

“If you had to pick one thing to make people healthier as they age, it would be aerobic exercise” Lead author Professor James Fries

Running not only appeared to slow the rate of heart and artery related deaths, but was also associated with fewer early deaths from cancer, neurological disease, infections and other causes.

And there was no evidence that runners were more likely to suffer osteoarthritis or need total knee replacements than non-runners - something scientists have feared.

At the beginning of the study, the runners ran for about four hours a week on average. After 21 years, their weekly running time had reduced to around 76 minutes, but they were still seeing health benefits from taking regular exercise.

Lead author Professor James Fries, emeritus professor of medicine at Stanford, said: “The study has a very pro-exercise message. If you had to pick one thing to make people healthier as they age, it would be aerobic exercise.

“The health benefits of exercise are greater than we thought.”

Age Concern says many older people do not exercise enough.

Figures show more than 90% of people in the UK over 75 fail to meet international guidelines of half-an-hour moderate intensity exercise at least five times a week.

Gordon Lishman, director general, said: “This research re-confirms the clear benefits of regular exercise for older people.

“Exercise can help older people to stay mobile and independent, ensure a healthy heart, keep weight and stress levels under control, and promote better sleep.

“While younger people are barraged with encouragement to lead healthier lifestyles, the health needs of older people are often overlooked.”

News reported by The BBC