A study by Dr Claudia Cooper (UCL Psychiatry) found that dementia patients in England’s poorest areas are 27 per cent less likely to be prescribed anti-dementia drugs than those in richer places. Read more in the Sun.

Over 800,000 people in the UK have dementia and numbers are growing as people live longer. There is no cure but drug treatments can help, for example by slowing memory loss among some people. The 2009 National Dementia Strategy made fair access to these treatments a priority.

We investigated how likely it is that people living with dementia get these drugs. We looked at primary care records from 6% of the UK population, including 75,000 people with dementia, from 2002 to 2013. In England people from least deprived areas (generally the richest) were 25% more likely to be started on ‘anti-dementia’ drugs than people in the most deprived areas. This did not change over time despite the National Dementia Strategy and other government policies. By contrast, in Scotland, how deprived the area where people lived did not affect whether they got this treatment.

It is striking that people with dementia living in more deprived areas get less treatment in England but not Scotland. Scotland spends more on health than England and the countries have different health policies. One reason for this difference in dementia prescribing may be that from 2006 to 2009 NICE restricted prescribing of these drugs to people with moderate dementia but the Scottish Intercollegiate Guidelines Network did not. We think that people from more affluent areas may be more likely to ask for and get treatments not endorsed by guidelines. In addition, younger people with dementia were more likely to be treated than older people, and men were more likely to be treated than women.

More research is needed to help ensure that dementia treatment in England is fair and meets equalities targets. We should be aware that policies to restrict treatment availability probably affect people in deprived areas most and make sure that changes benefit everyone.

This work was supported by The Dunhill Medical Trust [grant number R296/0513].

Have you ever missed a lecture, workshop or seminar you really wanted to attend? Perhaps you’ve been wandering around UCL glued to your phone, desperately trying to google the location of an event. If so, a group of UCL students have created Houndly – an events app that could mean you never have to miss another event on campus… including Division of Psychiatry events! Read more here or visit www.houndly.co.

Thursday 26^th November, 12.30pm to 2pm

Chadwick Building, room G07

Professor Anthony Finkelstein, Dean of the Faculty of Engineering Sciences, will be talking about the challenges of caring for ageing parents and balancing work with caring responsibilities.  There will be an opportunity afterwards for Q&A and networking.  Light refreshments will be provided but attendees should also feel free to bring lunch.

More information on this event can be found on the UCL staff webpages (http://tinyurl.com/owos823)

PACT is a social network that aims to support UCL staff members who are balancing ongoing caring responsibilities with work.  More information and contact details can be found on the UCL equalities webpages   http://www.ucl.ac.uk/hr/equalities/gender/pact.php.

Announcement made at the Royal College of Psychiatrists Award ceremony

Dr Michael Bloomfield is an Academic Clinical Fellow at the Medical Research Council and University College London. In 2014 he completed his PhD thesis and passed his MRCPsych examination. He published six papers. He won several awards, including the British Association of Psychopharmacology’s Junior Clinical Psychopharmacologist prize. A lecture of his was viewed over 11,000 times on YouTube. He has contributed to BBC Radio 4’s Today programme as well as a number of broadsheets on topics related to Psychiatry.

The judges said: “We were incredibly impressed by what Dr Bloomfield achieved in a year. He clearly has a bright future ahead of him and we are delighted he has chosen to specialise in Psychiatry.”

Three months ago, five researchers woke up at 4am to walk 26 miles and climb three mountains in just 12 hours. Why? I asked myself the same question clambering up towards the third summit.

As Research Assistants on the MARQUE project, we had decided to try and do more to support dementia research by fundraising for the Alzheimer’s Society.

MARQUE is not funded by the Alzheimer’s Society, it is funded by the NIHR and the ESRC, but we wanted to fundraise for them for a number of reasons. The Alzheimer’s Society is the UK’s leading dementia support and research charity and we have benefitted from their existence in a number of ways. The Alzheimer’s Society support MARQUE by running our community of interest meetings and attending the steering groups and managers groups.

Throughout the project, they have always been there to provide us with valuable PPI input. As Research Assistants, we have always been able to reach and gain insights from their ever-helpful research engagement manager. As researchers, we have enjoyed attending their annual research conference as part of a diverse and inclusive audience. Here, we can talk with people affected by dementia as well as other researchers looking into the care, cure and prevention of dementia. In our day to day work, we rely on being able to refer our participants to the dementia helpline following potentially distressing discussions about quality of life.

For these reasons, we travelled to the Yorkshire Dales to climb Pen-y-Ghent (694m), Whernside (736m) and Ingleborough (723m) on, allegedly, the only sunny day in Yorkshire in 2015.

The journey itself was complete with equal measures of hilarity and misery. We arrived late due to a necessary detour off the motorway to get a cooked breakfast and coffee. This presented two additional challenges. We started roaming behind the main group along grass that we hoped was the “official path” because with a walk that long we couldn’t really afford to take the scenic route. Our late start also meant that we couldn’t afford to really take a break at the top of each peak as we risked not being at the final check point by 4pm and being carted off in the mini bus with those not able to finish…

For the first 10 miles:  we walked, we talked, and we laughed. The view was absolutely breath taking (so was the climb) and we were really enjoying the trip out of the congested city of London. I honestly remember, naively, wondering why I didn’t do this every weekend.

As the journey continued and our mobility decreased we gained a new basis for empathy with some of our participants. We ploughed on, however, with an awareness of the investment that kind people had made into the completion of the task.

The final 3 miles were definitely the hardest. We completely lost the ability to talk; which, if you know any of us, you will appreciate is quite out of character. Nevertheless, we continued to drag our heavy, battered limbs through fields lined with pain until we reached the finish line and received our medals. We rewarded our exhaustion with several cups of tea and fish and chips.

The day was a huge success and we managed to raise £1,535 in total for the Alzheimer’s Society! One of the ways we did this was by hosting a bake sale with no fixed prices for cakes. We received amazing support fundraising within our division. We found that people gave generously and we raised £267.55 on just one day within the division. Even Shanlee’s courgette and raisin cakes managed to sell.

I want to say a big thank you to all those who donated and share our story.

I also wanted to acknowledge another fundraising success within the division this year. On the 19^th October the CORE team raised £750 for the charity Basmeh & Zeitooneh, a charity committed to serving Syrian refugees in Lebanon and Turkey. Liberty and Monica raised the money in creative and exciting ways. They approached local business for donations to add to a raffle. They also organised a silent auction and approached local colleagues to donate their time and offer experiences. This provided a fabulous auction that included everything from: a day out sailing for two; to hot drinks made by Monica for a week. These events were orchestrated around a highly enjoyable and well attended pub quiz!

I really wanted to write this piece so that we could celebrate these successes and say thank you to everybody that donated. I also want to actively encourage other research teams to do the same.

Fundraising events within the department are a great means to multiple good ends. They can bring research teams together and get people talking across the department – all whilst raising money for really good causes!

I would, therefore, encourage everybody to think about how we could do this more within the department: whether that’s up Pen-y-Ghent or down at the pub.

Written by: Sarah Robertson, PhD Student & Research Assistant on the MARQUE Project

Email: sarah.robertson@ucl.ac.uk

Twitter: @1SarahMae

 

 

 

Progress to Date

Dementia directly affects about 820,000 people in the UK with numbers increasing rapidly as the population ages. Our study team has  learnt from previous research that agitation is extremely common in people with dementia and causes distress to themselves, family carers and paid carers; incurring significant costs and leading to the break down of relationships.

The MARQUE Project is an ongoing five year long study currently taking place all over England, led by our research team at UCL.

MARQUE was funded in response to the government’s “Challenge on Dementia” in 2012(1). Professor Gill Livingston was awarded over £3 million of funding by the ESRC and NIHR to conduct this study to increase knowledge about dementia, agitation and personhood with the ultimate aim of improving quality of life of people with dementia(2). Agitation has previously always been tackled at an individual level, but in this project, we aim to tackle agitation at an organizational level.

There are 6 streams of MARQUE. Please see www.ucl.ac.uk/psychiatry/marque for full details of these streams. Below is an update of where we are at.

Stream 1 – Theoretical understanding of personhood and agitation

The conceptual stream of MARQUE is active. Professor Paul Higgs is conducting a theoretical investigation into the concepts of person and personhood and their application to care practises for people with dementia.

Stream 2 – Longitudinal study of agitation, quality of life and coping strategies in care homes.

This stream has been active since April 2014 when recruitment began.

We have made fantastic recruitment progress to date:

We have recruited 97 care home clusters nationally – the map to the right shows the spread of our recruitment nationally.

We currently have 4193 people consented to the study:

• 1649 staff
• 1456 residents
• 1088 relatives

Stream 3 – Development and testing of intervention in care homes

We are in the process of finalising a manual based training programme for care staff to test in a randomised control study with 20 care homes.

The manual has been developed based on the our previous systematic review of non pharmacological interventions in dementia (Livingston et al 2014), the START manual(3) for family carers and has been informed by multiple interviews with care homes staff about the barriers and facilitators of managing agitation in care homes.

We plan to begin piloting the intervention in one care home in January 2016.

Research Assistants are currently being trained to deliver the intervention to start mid 2016.

Stream 4 – Qualitative exploration of agitation and family carers coping at home.

Recruitment is active and 5 family carers have been interviewed so far.

Stream 5 – End of life and agitation: Ethnographic study of people with dementia, families and paid carers.

Recruitment is active and 4 full observations of agitation at the end of life in hospital have been completed so far.

Stream 6 – Pilot intervention at end of life

Stream 6 is planned to start following the completion of stream 5.

Ongoing PhD projects attached to MARQUE:

Quality of life: a comparison of the perspectives of paid staff, family relatives and individual’s with dementia in care homes.

Sarah Robertson:

This PhD is embedded into Stream 2 and compares and explores the perspectives of paid staff, family relatives and people with dementia in a care home setting. I am exploring these perspectives qualitatively and quantitatively to build a conceptual model of quality of life in this context. Supervisors: Prof Gill Livingston, Dr Claudia Cooper, Dr Juanita Hoe.

A longitudinal study exploring the prescription and administration of analgesic and psychotropic medication in UK care home residents with dementia

Francesca La Frenais

A prospective study embedded into Stream 2 exploring medication use in residents with dementia in UK care homes. The primary objective investigates whether taking a higher dose of analgesic medication means that a resident will receive more or less psychotropic medication. Supervisors: Dr Liz Sampson, Prof Paddy Stone, MCPCRD, and Prof Carmel Hughes, Queen’s University Belfast).

Development of an evidence based intervention to improve agitation for people with dementia in care homes

  Dr Penny Rapaport

 This PhD is embedded within Stream 3. The PhD will explore and describe: staff understanding of agitation; the barriers and facilitators to psychosocial intervention through staff training; the contributors to “care home culture” and what can facilitate a shift in these factors. This exploratory work will inform the development and piloting of the intervention. Supervisors: Prof Gill Livingston, Dr Claudia Cooper.

Written by Sarah Robertson, PhD Student & Research Assistant on the MARQUE Project.

Email: sarah.robertson@ucl.ac.uk 

Twitter: @1SarahMae

References

1. https://www.gov.uk/government/publications/prime-ministers-challenge-on-dementia
2. https://www.ucl.ac.uk/ion/articles/news/20150223
3. http://www.ucl.ac.uk/psychiatry/start/