The series is described thus:

“Businessman Sir Gerry Robinson tries to improve three struggling care homes. Can Gerry change a culture of stagnant lounges, poor quality of life and a lack of specialist staff?”

That description alone sums up the deficiencies of the entire present regime.

The major flaw in the system is that most dementia sufferers end up in care homes in the first place (although actually nursing homes too in many cases), where in most instances, the logistics of providing a decent standard of care are fatally compromised by the sheer cost of doing so.

In other words, the overheads in such institutions are already so onerous that it can become a critical extra expense to significantly improve on the care delivered, the increasing cost of complying with ill-conceived and ever burgeoning Health and Safety regulations in particular (to which Sir Gerry refers) being a major element of those overheads.

Let us dwell for a moment on what the present standard of care actually is.

I quote from Sir Gerry’s commentary on the first program in the series:

“The average time a dementia resident is actually engaged in any form of contact with anyone is two minutes in every six hours”.

So for a total direct engagement time with their carers and other staff of just 56 minutes in every week, the average dementia sufferer in the average care home is being charged up to £750. As only a few pounds out of that figure is spent on the carers’ wages per se, then the rest is overhead, which as that is already now becoming unmanageable for many care homes (and is the reason why many are already now failing of course), means that any extra cost in improving the standard of care (such as the dementia mapping that Sir Gerry talks about) will simply send yet more of them over the edge into bankruptcy.

And that in a nutshell is why the average standard of care in UK care homes is so poor – the overheads are simply too prohibitive to enable all but a relative handful of them to provide decent care.

There is ultimately only one practicable solution to this problem and that is to abandon the whole concept of trying to care for dementia sufferers in care homes at all, and simply look after them in their own homes instead.

There they can receive more like sixty HOURS of direct contact with their carers per week as opposed to 60 minutes, and in that setting there is obviously no limit on the time their carers have available to give them all the help and support they need.

I would be interested to see other contributors’ views on the same issue.

For some this may only be small things such as appointments but in other cases it can be worse, such as forgetting the faces of loved ones or precious memories. This can be extremely distressing for those who are close to the sufferer.

There are a few things that can be done to help remember the appointment or perhaps even jog the memory into remembering some of those past events or faces.

Having a white board with the date and the events that are due to happen that day such as doctor’s appointments or friends visiting will be very useful.

Also, regularly looking through photos, letter or perhaps scrap books from the past may help bring back some of the memories that have been lost. Visiting as often as possible and asking questions about past homes, friends and pets may also help.

Also, music is a very powerful memory jogger and there are certain songs that will always take us back to a time when the same song meant something to us. It has also been discovered that music can be a help to dementia and Alzheimer’s sufferers.

Alzheimer’s is a form of Dementia and in the UK alone there are over 700,000 dementia sufferers! It has been shown that exercise can hold back the advance of Alzheimer’s, US researchers have established.

You won’t usually get a definite diagnosis at your first visit, especially if you are in the early stages. Your GP may follow your progress for several months to make a more definitive diagnosis.

Your GP is likely to ask about your medical history, as well as that of your family. He or she will probably give you a physical examination and may do blood and urine tests to rule out the possibility of other conditions that could be causing your dementia symptoms. Your GP may carry out memory tests – one that is often used is the mini mental state examination.

Depending on the outcome of the tests, your GP may refer you to a specialist doctor, psychiatrist or psychologist. He or she may do more detailed tests and suggest that you have a brain scan (either a CT, MRI or SPECT scan) to provide more information.

It’s difficult for doctors to diagnose what type of dementia you have as the symptoms are very similar for all of them. However, as medicines advance, it’s important to find out what is causing your dementia as some types can be treated and the symptoms slowed down.

The preconception is that dementia only affects the elderly but research shows this not to be the case. According to the Alzheimer’s Society website there are over 11,500 under 65 year olds in the UK who also suffer from this.

Dementia is a disease of the brain. When someone has dementia their brain cells die faster than they normally would.

Dementia is not curable and memory loss and confusion are often the first symptoms. It may be useful to keep a diary with keys dates in for the sufferer to refer to if necessary. Gradually over time sufferers may also lose the ability to do tasks they would normally carry out without hesitation. Tasks such as washing, eating and toileting can be become increasingly difficult as the symptoms progress.

Caring for someone with dementia can be very difficult as sufferers may feel vulnerable and require a great deal of reassurance and support. It is essential that sufferers remain as fit and healthy as is possible. A nutritional diet will help the sufferer to feel happier.

There are many different types of dementia with Alzheimers being the most common. Symptoms vary depending on the type of dementia.

One woman, who helps care for her husband at home, talks about her fight for help.
Freddie was 64 when he was diagnosed with dementia

Freddie Smith was just 64 when he was diagnosed with a form of dementia brought on by a series of mini-strokes.

“It suddenly became clear,” says his wife, Angela.

“For a while he had been asking me what the time was or keeping bags of change in his pocket – he didn’t know what they were worth so kept paying with notes.”

That was 11 years ago and ever since his condition has been deteriorating, so that now he struggles to move and cannot communicate.

The 49-year-old, from Kent, said she soon found herself asking for help caring for her husband.

But despite his diagnosis, she was told she would have to pay for the help he needed dressing, eating and going to the toilet.

“Mrs Smith, who works as an exercise instructor and in a post office, says: “In the end all my wages, about £200 a week, was going on paying for his carers. What gets me is that this is a medical condition, he was diagnosed, and yet he did not get the help he needed” Angela Smith

“I even had to rely on my mother, who was in her 80s, to help him out, make him drinks and drive him to the day centre.

“What gets me is that this is a medical condition, he was diagnosed, and yet he did not get the help he needed from the NHS. My life was a nightmare.”

However, that has now changed. Four years ago, after many years of battling, she finally convinced the NHS to fund Freddie’s care.

He now has what is called a continuing care package, which means carers are now funded to look after him at home.

Mrs Smith even gets respite care meaning she can put him in a home while she goes on holiday.

“It has made the world of difference. Like many people, I would not want him to go in a home full-time, but to do that you do need help.

“I am getting that now, but I know I am one of the lucky ones. So many people don’t get what I do and I think that is wrong.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

Alzheimers Research Trust
Alzheimers Society

Dutch researchers found Alzheimer’s was 2.5 times more likely in people with a history of depression.

Similarly, US researchers, examining Catholic clergy, found those with signs of depression were more likely to go on to develop Alzheimer’s.

The Dutch appears in the journal Neurology and the US study in Archives of General Psychiatry.

The Dutch study was small – 486 people over an average of six years, with just 33 people developing Alzheimer’s.

But it found that people who showed signs of depression before the age of 60 were four times more likely to develop Alzheimer’s.

“We don’t know yet whether depression contributes to the development of Alzheimer’s disease, or whether another unknown factor causes both depression and dementia” Dr Monique Breteler Erasmus University Medical Center

The researchers, from the Erasmus University Medical Center in Rotterdam, said more work was needed to fully understand the link between Alzheimer’s and depression.

Lead researcher Dr Monique Breteler said: “We don’t know yet whether depression contributes to the development of Alzheimer’s disease, or whether another unknown factor causes both depression and dementia.”

One theory is that depression leads to the loss of cells in two areas of the brain, the hippocampus and the amygdala, which then contributes to Alzheimer’s disease.

However, the latest study found no difference in the size of these two brain areas in people with depression and people who had never developed the condition.

Second study

The findings were echoed in a second study by Rush University in the US published in Archives of General Psychiatry.

The researchers followed more than 900 members of the Catholic clergy for up to 13 years during which time 190 developed Alzheimer’s.

They found that those with more signs of depression at the start of the study were more likely to develop Alzheimer’s.

But there was little evidence of an increase in depressive symptoms during the early stages of disease.

Even after the diagnosis of Alzheimer’s was made there was no general increase in depression, but rather an increase that was confined to individuals with certain personality traits.

The researchers said their findings suggested that depression was a risk factor for Alzheimer’s disease – rather than a subtle early sign of its underlying pathology.

Researcher Dr Robert Wilson said: “Depressive symptoms may be associated with distinctive changes in the brain that somehow reduce neural reserve, which is the brain’s ability to tolerate the pathology associated with Alzheimer’s disease.”

Rebecca Wood, of the Alzheimer’s Research Trust, said the research was interesting, and potentially useful.

She said: “Identifying people at higher risk could lead to ways to reduce the number of people who develop dementia, help researchers to understand more about dementia and create new avenues of research.”

Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said: “More research is needed to clarify the relationship between dementia and depression and determine whether depression causes changes in the brain that make dementia more likely.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

A study of 900 people aged over 60 found early onset was most likely in those who also had a high-risk gene.

A second US study found people with high cholesterol in their early 40s are one and a half times more likely to develop Alzheimer’s.

The research was presented at an American Academy of Neurology meeting.

It has been estimated that a delay in the onset of Alzheimer’s disease by five years would lead to a 50% drop in the number of cases.

“It’s possible that if we can reduce or eliminate heavy smoking and drinking, we could substantially delay the onset of Alzheimer’s disease for people and reduce the number of people who have Alzheimer’s at any point in time” Dr Ranjan Duara

The researchers said their findings showed heavy drinking and smoking were two of the most important preventable risk factors for the condition.

Those taking part in the study had been diagnosed with possible or probable Alzheimer’s disease and smoking and drinking history was obtained from family members.

Risk factors

Heavy drinking, defined as more than two drinks a day was found to lead to an almost five-year earlier onset of Alzheimer’s.

And those who smoked more than 20 cigarettes a day developed the disease two years sooner.

People with a specific gene – APOE variant 4 – developed Alzheimer’s disease three years earlier than those without the gene variant.

All three risk factors together were associated with onset of the disease 8.5 years earlier than those with none of the risk factors.

Study leader, Dr Ranjan Duara, from Mount Sinai Medical Center in Florida said: “It’s possible that if we can reduce or eliminate heavy smoking and drinking, we could substantially delay the onset of Alzheimer’s disease for people and reduce the number of people who have Alzheimer’s at any point in time.”

In the second study, 9,700 men and women were followed from the age of 40.

Those with cholesterol levels higher than around six millimols per litre (mmol/L) had a one and a half times higher risk of developing Alzheimer’s than those with low cholesterol.

“High mid-life cholesterol increased the risk of Alzheimer’s disease regardless of diabetes, high blood pressure, obesity, smoking and late-life stroke,” said researcher Alina Solomon.

Dr Susanne Sorensen, head of research at the Alzheimer’s Society said the research added to the weight of evidence on drinking and smoking habits and the risk of developing dementia.

“The best way to reduce your risk is to eat a balanced diet rich in antioxidants and vitamins and to exercise regularly.

“Not smoking, drinking only in moderation and getting your blood pressure and cholesterol checked regularly throughout life are also important ways people can reduce their risk of dementia.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

Two studies support a link between high blood pressure and dementia risk – with one by an Imperial College London team suggesting treatment could cut this.

This study, by published in the Lancet Neurology journal, found blood pressure drugs reduce dementia by 13%.

The Alzheimer’s Society said better control could save 15,000 lives a year.

“Only half of people over 65 receive effective treatment, yet we know treatment works” Professor Clive Ballard Alzheimer’s Society

As many as one in four people has high blood pressure, in many cases undiagnosed or untreated.

The precise reasons why high blood pressure might increase the risk of dementia are not fully understood although many scientists believe that it can starve the brain of bloodflow and the oxygen it carries.

Patients suffering this restricted bloodflow are often described as having “vascular dementia”, and account for approximately a quarter of dementia patients.

Other types of dementia, such as Alzheimer’s disease, have no obvious link to bloodflow, but some experts think that blood pressure may still be somehow contributory in some cases.

The Lancet Neurology study looked at a trial of elderly patients with high blood pressure to see if those who were receiving treatment were less likely to develop any form of dementia compared with those left untreated.

Clear benefit

The trial was stopped early after the benefits of treatment in terms of reducing strokes and heart disease were so obvious it became unethical to deny them to everyone.

Although this meant that no benefits in terms of dementia could be found, when these results were combined with other similar studies in different age groups, the incidence of dementia was 13% lower in the treated groups.

Dr Ingmar Skoog, from the Institute of Neurosciences at Sweden’s Goteburg University, said that the need to treat high blood pressure, reducing heart attacks and strokes, was clear, even without the additional results on dementia.

Rebecca Wood, from the Alzheimer’s Research Trust, said the finding was an “exciting development”, which, if repeated, could offer hope to the 700,000 people in the UK with dementia.

Healthy living

The Alzheimer’s Society, however, stressed the need to try to prevent the disease.

Its own unpublished research suggested that vascular dementia was six times more likely to develop in people who had high blood pressure in their 40s and 50s.

If “best practice” in blood pressure treatment was applied to the UK population, it said, with every case detected and treated appropriately, this would save 15,000 lives a year.

Professor Clive Ballard, its director of research, said: “Only half of people over 65 receive effective treatment, yet we know treatment works.”

The charity’s chief executive, Neil Hunt, urged everyone, even those in middle age, to have regular blood pressure and cholesterol checks.

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

Who’s affected?
The older a person is, the greater the chance they will develop a disease that harms the brain. Diseases that damage the areas that control thinking, memory, reasoning and language can lead to dementia.

It’s rare in people under the age of 60, but affects one person in 20 over the age of 65 and one in five over 80.

What causes it?

In a small number of cases the disease is reversible

When someone is diagnosed with dementia it’s vital the cause is established as far as possible because in a small number of cases the disease is reversible.

Even when the cause is not reversible, a clear diagnosis is important as different drugs are recommended in different types of dementia.

Causes include:

– Diseases resulting in progressive degeneration or death of nerve cells. These include Alzheimer’s (which accounts for more than half of all cases), Parkinson’s disease, Huntington’s disease, Creutzfeldt-Jakob disease and a group of conditions referred to as frontotemporal dementia (FTD). Another condition, called Lewy Body dementia, affects 20 per cent of people with dementia.
– Conditions, such as atherosclerosis, that harm the blood vessels supplying the brain. This type of dementia is known as vascular dementia and accounts for about 20 per cent of dementia cases.
– Conditions producing a dementia that can be reversed with treatment. These include hypothyroidism (underactive thyroid), vitamin B12 deficiency, folate deficiency, syphilis of the nervous system, subdural haematoma (a blood clot round the brain, usually following a blow to the head), hypercalcaemia (abnormally high calcium levels), undiagnosed diabetes, brain tumours or infections, and a condition called normal pressure hydrocephalus.
– Some medicines can interfere with concentration and memory, producing dementia-like symptoms. These include tranquilisers and sleeping pills, antidepressants and certain drugs with an anticholinergic effect (for example, some hayfever and cold remedies, some stomach ulcer drugs and treatments for diarrhoea).

What are the symptoms?
People with dementia often don’t look ill, especially in the early stages, and may have no particular symptoms. But family and friends may notice a change in the person’s personality, or that they seem to have problems remembering things.

The condition usually progresses slowly, and three types of symptoms may appear:

– Cognitive problems – a disturbance of understanding, memory, thinking, calculation, learning capacity, language and judgement.
– Functional problems – difficulty carrying out complex tasks and, as the condition progresses, difficulty with daily living activities, such as personal hygiene and dressing.
– Emotional problems – changes in mood, loss of emotional control and a withdrawal from previous interests, activities and social interactions.

Different types of dementia show slightly different patterns of disease. For example, in Lewy Body dementia, severity varies markedly from day to day, while in Alzheimer’s there is only slight variation from day to day.

In frontotemporal dementia (including Pick’s disease), shrinking of the frontal and temporal lobes of the brain typically causes problems with either behaviour and/or language but not with memory.

People with FTD often become disinhibited and irritable, rude, aggressive or apathetic. They may change their normal habits, become more interested in sex and neglect basic personal hygiene.

At the same time, they lose insight and don’t understand why their behaviour’s causing distress. Alternatively, or at the same time, they may progressively struggle to speak or understand speech. FTD tends to affect younger people (average age of onset is 60), has a strong inherited pattern and is usually relentlessly progressive with behaviour that’s difficult to control.

How is it diagnosed?
There’s no single test that can identify dementia, although a range of blood tests and sophisticated brain scans can help and are important in ruling out reversible causes.

Diagnosis is made by an assessment of symptoms and the use of brief questionnaires that test ability to remember facts, or draw simple diagrams.

What’s the treatment?
Most types of dementia progress slowly. People may live with the condition for ten years or more, requiring increasing levels of support as they become less independent. By carefully planning the person’s environment, and giving structure to their day with supportive activities, it may be possible to reduce the impact of the symptoms.

While there is no treatment that can cure progressive dementia, drugs (especially a type known as cholinesterase inhibitors) play an important part in controlling symptoms and can enable a person with dementia to live independently in the community for longer.

These treatments may also help behavioural symptoms such as restlessness or agitation, and improve the quality of life for the person with dementia and their carers. Some people don’t respond to any existing treatments.

Possible future treatments
Scientists are investigating the use of stem cell therapy, antioxidants and vaccination to stop plaque build-up in the brain.

It’s unclear how beneficial the herb Gingko biloba is in delaying the progression of Alzheimer’s and vascular dementia, and relieving their symptoms. There’s some evidence suggesting it may help.

Mental activity is believed to slow the progress of certain types of dementia, so keeping the brain active by doing puzzles and crosswords, for example, is recommended.

Depression is common among people with dementia and antidepressants can also help to improve symptoms.

This article was last medically reviewed by Dr Rob Hicks in January 2008

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society