Dementia Monitoring Report: 16 November 29 November MEDIA PRINT Doctors failing to diagnose half of all cases of dementia; Minister

er warns stigma surrounding disease hampers search for cure (The Daily Telegraph) Alz sport link hope (The Sun) Sign a pledge to the elderly (The Daily Mail) Man of 80 is accused of murder (The Daily Express) Exercise can make you a 'healthy ager' (Daily Express) Care homes come under fire for charging after resident deaths (Sunday Express) Doctors say the elderly resent dementia tests (Daily Mail) Alzheimer's woman 'lost' after hospital discharge (The Daily Mirror) 500,000 elderly sent to A&E every year because of failures in care (The Daily Mail) Dementia patients let down; Shame (The Daily Telegraph) Health: Watchdog uncovers hospital understaffing (The Guardian) Economic slump may leave people with slower brains (The Times) THE healthometer (The Sun) How work can help you stay young for longer (The Daily Mail) Carers 'at risk' as they save public 7bn (The Daily Express) Edna has dementia. So why do staff at her local RBS keep letting her take out 300 cash? (The Daily Mail) Comment: Will your GP choose you?: Jeremy Hunt is to scrap doctors' catchment areas. Sounds like a great plan - until you think it through (The Guardian) Statins 'lower your risk of developing dementia' (The Daily Express) Calling carers on dementia (The Daily Mirror) Try It, Ditch It, Switch It (The Daily Mail) Speedy Saviour (The Daily Mail) Having two parents who lived to a ripe old age may reduce the risk of Alzheimer's (The Daily Telegraph) Something to chew on for Alzheimer's (The Daily Telegraph) Care worker tied down frail 88-year old with dressing gown while she went out to smoke (The Daily Mail) Massive NFL pay-outs send shockwave through sport (The Mail on Sunday) The New Review: DISCOVER: HEALTH: BRAINWAVES: Research on other fronts (The Observer) The New Review: DISCOVER: HEALTH: Could arthritis drug combat Alzheimer's?: It affects 35 million people worldwide and billions have been spent on research - to little avail. But an unconventional approach based on a 30-year-old evolutionary theory may provide a way forward (The Observer)

MEDIA WEB SOURCES Taking a stand in the battle against Alzheimers (Victoria Macdonald, Channel 4 Blog) Poetry breaks through fog of Alzheimer's sufferers (Beatrice Debut, Medical Xpress) BMA wary about refreshing NHS mandate every year (BMA) Care Show Birmingham achieves 28% visitor increase (Exhibition News) Cognitive function improved by intranasal insulin in patients with type 2 diabetes (Medical News Today) 'A robot is my friend': Can machines care for elderly? (Alex Hudson, BBC) POLITICAL MONITORING NHS Innovation Challenge Prize for Dementia: winners announced (Department of Health) Dementia care and support (Department of Health) Parliamentary Monitoring SOCIAL MEDIA Tweets MEDIA - PRINT Doctors failing to diagnose half of all cases of dementia; Minister warns stigma surrounding disease hampers search for cure (The Daily Telegraph) FEWER than half of people suffering from dementia are being formally diagnosed with the condition because doctors are put off by the stigma attached to it, the Health Secretary says today. Jeremy Hunt will disclose a "dementia map" of England showing that in some areas, fewer than four in every 10 dementia sufferers have their condition recognised by the NHS. The Government is launching a major campaign to boost diagnosis rates, which will include Britain leading a Group of Eight conference on the issue next month. The Department of Health estimates that 670,000 people in England are currently suffering from dementia. However, only 319,000 have been formally diagnosed, NHS figures show. Overall, 48 per cent of all the estimated dementia cases in the country are being formally recognised by the NHS. In some areas, the diagnosis rate is as high as 75 per cent. But in the worst performing areas, it falls to 39 per cent. Mr Hunt said he was disclosing the diagnosis rates in an effort to drive up standards and end what campaigners have called a postcode lottery in the treatment of dementia sufferers. Ministers suspect that in many cases, doctors are declining to make a formal diagnosis of dementia because they believe that doing so will cause undue distress to patients and relations. The sense of stigma surrounding dementia means that many sufferers are not properly treated, holding back the search for a cure, Mr Hunt said.

He called for dementia to be treated as a "normal" disease. In an attempt to change attitudes towards the disease, the minister is launching a "social movement" to encourage people to discuss dementia more freely. The movement, independent of government, will unite media, business and charity leaders. The minister also wants to expand the Alzheimer's Society's Dementia Friends scheme, which aims to educate people about the condition. By 2015, a million people should be taking part in the scheme, he suggested. Writing for The Telegraph's website Mr Hunt compared contemporary attitudes towards dementia to previous generations' approach to conditions such as cancer and HIV/Aids. "In the 1960s people were too scared to talk about cancer," he wrote. "In the 1980s the same happened with HIV/Aids. After a long and painful journey, we are now much more open about both and better able to tackle them. We now need to do the same with dementia." It is estimated that as many as one in three people will eventually suffer from dementia. Although there is no cure for the condition, Mr Hunt said better management can make life easier for sufferers and save money for the NHS. "It is a truly horrible disease," he said. "But with early diagnosis and proper help for families living with dementia we can help people live healthily and happily at home for much longer." THURSDAY 28TH NOVEMBER Lifestyle factors key as dementia strikes later (Jo Willey, The Daily Express) DEMENTIA is affecting people much later in life, giving millions hope of longer, healthier lives. Experts said last night that the risk of dementia may also be falling thanks to better education and prevention of key risk factors such as high blood pressure and cholesterol. Lead researcher Dr Kristine Yaffe, a professor of psychiatry, neurology, epidemiology and biostatistics at the University of California, San Francisco, said: "This is a fascinating example of personal health changes earlier in life having an impact on personal and public health in late life." Dr Yaffe and Dr Eric Larson, who is executive director of the Group Health Research Institute, reviewed several recent studies that show how rates of dementia in ageing populations have declined for people born later in the last century. The article, published in the New England Journal of Medicine, also cites other factors affecting this trend. Dr Yaffe and Dr Larson have previously shown that regular exercise may help delay dementia. In an article published earlier this year in the same journal, Dr Larson's team reported that people with lower blood sugar levels tend to have less risk of dementia. And Dr Yaffe and her team have focused on other lifestyle factors that have the potential to reduce risk. Dr Yaffe said: "We need to be aware that recent increases in obesity and diabetes threaten to reverse these gains because of the impact these conditions can have on the ageing brain." Dr Larson added: "People are tending to live longer, with worldwide populations ageing, so there are many new cases of dementia. But some seem to be developing it at later ages and we're optimistic

about this lengthening of the time that people can live without dementia. We must focus on exercise, diet, education, treating hypertension and quitting smoking." Alz sport link hope (The Sun) REPEATED blows to the head from sports such as rugby and boxing could trigger Alzheimer's, scientists said yesterday. Cambridge University experts found clusters of a malfunctioning protein on brains of people who died from the disease. They noticed possible links between it and damage to neurons potentially caused by head injuries. The protein, called tau, is also found in healthy cells. Dr Simon Ridley, head of research at Alzheimer's Research UK, said: "It is a risk factor for dementia that needs to be investigated further." WEDNESDAY 27TH NOVEMBER Sign a pledge to the elderly (The Daily Mail) Rebuffed, the old man slowly made his way back to his table. The day before I'd felt the same pang when I witnessed the bus conductor drumming his fingers as an elderly woman struggled to get off. And again, when another octogenarian was met by indifference as she tried to exchange pleasantries with a supermarket cashier. Most of the time we are too wrapped up in our own lives to notice this kind of exchange. But when an elderly person close to you becomes dependent - as my mother did when she developed dementia you realise how lonely old age can be. And how frightening. Social isolation in old age is no trivial matter. Recent studies indicate that lack of social interaction is as likely to cause early death as smoking 15 cigarettes a day. That's why the NHS Winter Friends campaign is so valuable: it reminds us there are plenty around us for whom a friendly face and an offer of help is hugely important. It could even mean the difference between life and death. Like most modern families, we didn't think of moving my mother in with us when she was diagnosed in 2008. We tried to supply all her needs by regularly visiting her and hiring her a carer. But, even with this, she was often at risk alone, and it was easy to see how losing any of those props would have resulted in isolation. Before her illness, I - like most of us with busy jobs - was guilty of not giving elderly neighbours enough thought. Not only do you become more aware when a loved one is in the same boat, you also begin to realise the value of the small acts of kindness. I saw the huge difference some people made to my mother's life - neighbours who checked up on her, a caretaker for her block of flats who stopped to share a joke. These tiny deeds cost nothing but make a huge difference. Of course, those who are still able to get out and about are relatively fortunate. There are plenty more who are housebound. I have elderly neighbours who do not have family nearby, who can no longer get out and cannot access even the fairly minimal help available. There is one couple in their 90s who, although they have each other, rely on one or two neighbours to do their shopping. Ivy was another. She is now dead but for many years she was my next door neighbour and eventually could not get down her steps. Sadly, she spent most of her last years alone in front of the television. A

recent survey reveals that 51 per cent of all people over 75 live alone and five million elderly say the television is their main form of company. There are plenty who are entirely isolated - and this becomes all the more difficult when winter grips. Like many of her thrifty generation, my mother was prone to turning off all the radiators in her house except the one she was sitting beside. Ivy did the same, often barricading herself into one room and remaining static by her gas fire. Thankfully there were neighbours to check on them both, but what if there hadn't been? By signing up to Winter Friends, you can help make sure that that is not the case for vulnerable elderly people living near you. And you're not burdening yourself with an unachievable commitment - you'll simply be doing your bit when the weather is cold by looking in on an elderly friend or neighbour, checking radiators are on and food is in the cupboards. I believe the impulse to take care of others is still there - we just need to nurture it. After all, one day it might be you. TUESDAY 26TH NOVEMBER Man of 80 is accused of murder (The Daily Express) AN 80-year-old man appeared in court yesterday charged with murdering his wife. Peter Beaver is accused of killing Annie, 81, who is believed to have been suffering from Alzheimer's. Her body was discovered at the weekend in their three-bedroom home in Gosport, Hants, where they have lived for more than 40 years. Beaver spoke only to confirm his name and address during the short hearing at Portsmouth magistrates court. He was remanded in custody to appear at Winchester Crown Court tomorrow. Exercise can make you a 'healthy ager' (Jo Willey, Daily Express) PEOPLE who take up regular exercise in later life are up to seven times more likely to stay healthy than their inactive peers, new research suggests. Proving it is never too late to start to get fit, research has shown even pensioners who become physically active are likely to reap "significant health benefits" by staving off major ill health or dementia. A study found those who regularly indulge in moderate or vigorous physical activity at least once a week were three to four times more likely to be "healthy agers" than those who did no exercise. And those who sustained regular physical activity over an entire eight-year study period were seven times as likely to be healthy agers as those who had consistently remained inactive. Doireann Maddock, senior cardiac nurse at the British Heart Foundation, which funded the lead researcher in the study, said last night: "It's well worth getting into the habit of keeping active, as we know it can help reduce the risk of heart disease along with many other conditions.

"This research shows us that, even if you don't become active until later in life, your health will still benefit. "However, although it's never too late to get active, there's no need to wait until retirement to get started. Adults should try to be active daily and aim for 150 minutes of activities that get you breathing harder and feeling warmer each week. "Every 10 minutes counts, so even hopping off the bus a couple of stops early or taking a brisk walk on your lunch break will help." The researchers, led by Dr Mark Hamer at University College London, wrote that: "Sustained physical activity was prospectively associated with improved healthy ageing - absence of disease, freedom from disability, high cognitive and physical functioning, good mental health. "Significant health benefits were even seen among participants who became physically active relatively late in life. The results support public health initiatives designed to engage older adults in physical activity." The study, published in the British Journal of Sports Medicine, tracked the health of 3,500 people with an average age of 64 for more than eight years. The researchers wanted to quantify the impact of physical activity on the risk of developing long term conditions, depression, and dementia, and on the likelihood of "healthy ageing". This is usually taken to mean not only an absence of major disease and disability, but also good mental health, the preservation of cognitive abilities, and the ability to maintain social connections/activities. There is a growing body of evidence to suggest regular physical activity is essential for maintenance of good health, while across the developed world inactivity is ranked alongside smoking, excess drinking, and obesity as a leading cause of reduced life expectancy. SUNDAY 24TH NOVEMBER Care homes come under fire for charging after resident deaths (Paula Murray, Sunday Express) PRIVATE care homes are being urged to provide greater "clarity" on the controversial policy of charging after residents have died. The practice, often in the small print, means families may have to pay thousands of pounds in extra costs following a loved one's death. One of the largest service providers, Bupa, charges for an additional 14 days after death - stating that a fortnight's notice is needed before an account can be closed - while others bill for between a week and a month. With care home fees now at record levels, especially for people with dementia or other special needs, the sums involved can be substantial. In cases where people receive financial support from their local council, the funding is stopped after three days, with relatives left to pick up the rest of the tab.

Nicholas Treppass is one of many people to have been taken by surprise by the practice. When his mother, Margaret, died last Hogmanay, he was expecting a full refund of January's fees from Bupa-run Victoria Manor, in Edinburgh. Margaret, 86, who was originally from Islay, suffered from dementia and the family paid more than 4,500 a month for a special care package. However, Mr Treppass, a lawyer from Dublin, said he was astonished when Bupa refunded only half of the monthly payment. He said: "They do have small print that says you must give 14 days' notice of departure if you intend leaving. I expected that not to apply when somebody dies. "My mother had dementia, she was 86 and there was no question of her leaving that care home other than by death so I did protest. "They refused to waive the charge. It was fairly surprising, but that's what they said. "So we were charged for the first 14 days for the month because we had failed to give this notice. "We are all going to die, but you cannot give 14 days notice of it. Clairvoyance is not a skill set my mother had. "I did not take the matter any further although we could have sued and were debating it. But in the end it did not seem worth it. "However, I felt it was bad. There's been a number of exposures on Bupa Scotland, so it feels appropriate to highlight our experience." Care homes insist the payments are necessary to cover the practical costs of preparing the empty rooms for new clients. They also argue the notice period means there is no pressure on the relatives to quickly remove their loved one's belongings. Leading charity Age Scotland said all charges should be agreed at the time the contract for the residency is signed, adding there should be no surprises in store. A spokesman added: "Clarity and certainty for both residents and their relatives is crucial, and we would urge providers to ensure customers are fully aware of their liabilities and the company's practices. "Any attempt to implement arbitrary fees which do not appear to have any relation to the direct expenses incurred by care homes would be unacceptable at a time of distress and grief for families." Vivienne Birch, director of partnerships at Bupa Care Services, said all fees are made clear in their terms and conditions. She added: "Charging for two weeks of fees after someone has passed away is standard practice across the sector in order to ensure that during the immediate grieving period, friends and family are not

rushed to remove furniture, pictures and other belongings, and also to ensure a deep clean and removal of specialist equipment before a new resident moves in." SATURDAY 23RD NOVEMBER Doctors say the elderly resent dementia tests (Sophie Borland, Daily Mail) MANY elderly patients resent being told to have new dementia checks, a poll of GPs has found. Family doctors fear the initiative will cause more harm than good by making patients unnecessarily anxious. GPs have been urged by ministers to refer patients for screening as part of measures to improve the diagnosis of the disease announced last year. But there are concerns it will lead to hundreds of older patients who simply have slight memory lapses being wrongly labelled as having dementia and referred for further tests. Many doctors warn this will just cause unnecessary worry for patients and their relatives. It could also result in even longer queues at memory clinics, delaying help for those who actually have the illness, they fear. A survey of 501 GPs by Pulse magazine found that 21 per cent - just over a fifth - said patients had complained about or resented being offered the tests. Dr Ian Greaves, a GP in Stafford who specialises in the care of dementia patients, described the policy as a 'blunt tool'. 'Some people don't like being asked, so you do have to be sensitive, even kind, and pick your moment when asking patients questions - not just be doing it in order to meet targets,' he said. 'At the moment, it's just a Government policy which doesn't make much sense without doctors getting behind it and making it work in the way they support patients after diagnosis.' Dr Zishan Syed, a locum GP, said patients and relatives felt the tests were pointless because of the lack of treatments available for dementia. 'A lot of GPs share this worry - that there seems to be a political drive to push up prevalence levels for the sake of numbers and the care of patients suffers as expectations of treatments do not match the results of the treatments currently available,' he said. Dr Alan Sykes, a GP in Beverley, East Yorkshire, said: 'Why screen for more cases when there is nowhere to assess and treat them? Total madness.' As part of the policy, GPs offer patients a test involving 20 to 30 questions, such as the date, names of basic objects and telling them to follow simple instructions. If this shows patients are likely to have dementia, they are referred to memory clinics, usually at a hospital, where more extensive tests and possibly scans are carried out. Two months ago, specialists from the UK and Australia warned in the British Medical Journal that the checks would do more harm than good.

They said two out of three people over 80 would end up being diagnosed with Alzheimer's. But 70 per cent never develop full-blown dementia and some people's brain function will improve. Last night Alistair Burns, clinical director for dementia for NHS England, said the policy aimed to tackle the 'stigma and great public fear about dementia'. He added: 'Less than half of people with dementia have a formal diagnosis which means they and their families may not be able to access the practical, financial and emotional support a diagnosis can bring.' FRIDAY 22ND NOVEMBER Alzheimer's woman 'lost' after hospital discharge (Jilly Beattie, The Daily Mirror) A FRAIL pensioner suffering from Alzheimer's was feared missing by her family after an ambulance crew took her to the wrong home address, it had emerged. They had out-of-date details for Maura Gillen, 89, including her next of kin and GP name, in a situation her loved ones described as harrowing. Now the NHS trust has launched an investigation. Mrs Gillen's daughter Deirdre Burns said: "The ambulance crew were completely lost." Mrs Gillen was diagnosed with Alzheimer's two years ago and lives in Park Manor Nursing Home, Dunmurry. Earlier this month she was admitted to the Royal Victoria Hospital in Belfast for a hip operation. Just five days later, Mrs Gillen's family were shocked to be told she was to be discharged in the evening at around 7.30pm. But by 9pm the pensioner had not made the 15-minute journey to the home, sparking deep distress among her family. Mrs Burns said: "It looked to me they had lost her." A Belfast Health Trust statement said: "We are sorry that Mrs Gillen's discharge did not go according to plan and that she arrived at her home so late in the evening. "Her family has raised a number of concerns with us and we are investigating the detailed circumstances of her discharge." 500,000 elderly sent to A&E every year because of failures in care (Daily Mail) HALF a million elderly patients are taken to casualty every year because they are not looked after properly at home, according to the care watchdog. Many are suffering from malnourishment, infections or broken bones having been failed by their doctors and care home staff. The Care Quality Commission says the number of needless admissions among the elderly has soared by 40 per cent in five years, piling further pressure on A&E units.

The watchdog's inspectors found records were not being kept of whether elderly people in care homes needed help with meals, if they had lost weight or if they needed to be rolled over to prevent bedsores. In one home, they came across five bedbound patients left alone in their rooms without drinking water. The CQC calculates that one in ten of the over-75s and one in five of those over 90 are being admitted to casualty unnecessarily - some of whom will never return home. Many elderly patients quickly deteriorate in hospital and become confused, reluctant to eat or develop chest or urinary infections. The CQC is particularly concerned about dementia sufferers who are 37 per cent more likely to die in hospital than all other patients. David Behan, chief executive of the watchdog, said: 'GPs, care homes, home care agencies, community health services and hospitals, with local commissioners, must plan effectively to make sure our older and more vulnerable people are cared for in the way they deserve. 'Where care can be provided for people outside of hospitals, it is better for them and eases pressures on hospital services.' Caroline Abrahams, charity director at Age UK, said: 'The numbers of older people being admitted to hospital when with the right care they could stay at home is distressing and a sad consequence of a social care system that so often fails to help the people who need it.' Care minister Norman Lamb said: 'We want to make the whole health system work together around the patient.' Dementia patients let down; Shame (The Daily Telegraph) Dementia sufferers are more likely to die in hospital than similar patients without the condition, the report found. Charities said the findings from the Care Quality Commission (CQC) were "a national disgrace" and showed that patients suffering from conditions such as Alzheimer's disease were being let down. The CQC report found that patients with dementia had poorer outcomes than other patients, regardless of the reason for their admission. Deaths in hospital among those with dementia were over a third higher than those of similar patients in 201213. The average length of stay for such patients was more than a quarter longer. Experts said NHS staff were not giving the right help to those with dementia, while care homes were failing to look after residents with the condition. Vulnerable patients faced an increased risk of being admitted to hospital in a state of crisis. The figures show that emergency hospital admissions from avoidable conditions were 30 per cent higher for pensioners with dementia, compared with patients of the same age. George McNamara, of the Alzheimer's Society, said: "It is a national disgrace that people with dementia are being let down so profoundly.

"With a quarter of people in hospitals and 80 per cent of people in care homes living with dementia, caring for them should be core business."

THURSDAY 21ST NOVEMBER Health: Watchdog uncovers hospital understaffing (Denis Campbell, The Guardian) New in-depth inspections of four hospitals by the Care Quality Commission have uncovered understaffing, problems in A&E, inadequate care of older people and long waits for treatment. The CQC found cause for concern at Croydon University hospital in south London. Although a new management team has made improvements, the CQC found significant numbers of older patients being discharged in the evening. "Inspectors were concerned about low staffing levels affecting patient care, especially in wards for older people," said the CQC. The vacancy rate among A&E nurses will have fallen from 49% to 19% by January, the hospital said. Older patients are also being affected by a lack of staff at New Cross hospital in Wolverhampton. Inspectors were "concerned that older people's care, surgical and dementia wards were not sufficiently staffed, particularly at night". The CQC said Musgrove Park hospital in Taunton had too few senior doctors overnight and at weekends. At Airedale general hospital, Yorkshire, older people sometimes had inadequate care because of staff shortages. Economic slump may leave people with slower brains (Chris Smyth, The Times) People who live through recessions in middle age are more likely to have slower brains in later life, a study suggests. Men were most at risk from experiencing recessions in their late forties, while for women, cognitive decline in old age was linked to recessions experienced between the ages of 25 and 44. Being laid off or forced into lower status part-time work could make the brain less resilient, researchers said. Policies that soften the blow of recessions could help to prevent dementia in the future, they argued. The study looked at 12,000 people aged 50-74 in 11 European countries who were given tests for memory, verbal fluency and numeracy, as well as questions about their work history. The results were then linked to data on recessions since 1959. Men's cognitive scores declined for every recession they experienced between the ages of 45 and 49, while for women the effect came from recessions earlier in life. "Among men, recessions at ages 45-49 influenced risk of being laid off, whereas among women, recessions at ages 25-44 led to working part-time and higher likelihood of downward occupational mobility, which were all predictors of worse later-life cognitive function," the scientists wrote in the Journal of Epidemiology and Community Health. Previous studies have found that people who left school during a recession earned less throughout their careers, and the researchers argued that "cohorts affected by negative, unanticipated shocks at vulnerable points in their life" could have less ability to build up brain resilience. "For older workers, job loss in the late stages of their working career may become an involuntary 'pathway to retirement'," wrote a group led by Anja Leist of the University of Luxembourg.

They added: "If replicated in future studies, findings indicate that policies that ameliorate the impact of recessions on labour market outcomes may promote later-life cognitive function ... Policies that encourage women to enter and remain attached to the labour market through early adulthood and midadulthood, such as policies on schooling, maternity leave and childcare support, may have unanticipated positive effects on female cognitive function." Simon Ridley, of Alzheimer's Research UK, said: "This large study suggests that the work people do throughout their life may affect their cognition in later life, but this research doesn't tell us that recessions cause cognitive decline. These findings lend more weight to the theory that mental activity may help people maintain their cognitive abilities as they grow older, but it's not clear what other factors may have played a part in these results. "One drawback of this research is that the people involved only had their cognition measured once, and only in later life, meaning that it's not possible to know how far their abilities declined. "The people in this study did not have dementia, but understanding factors linked to cognitive decline could be important for finding ways to prevent the condition." THE healthometer (The Sun) EYES - peering into a patient's eyes could provide Anew way to diagnose Alzheimer's disease. US scientists say they could detect changes in the retinas of mice that had been genetically engineered to develop the disease. How work can help you stay young for longer (Fiona Macrae, Daily Mail) The daily grind of work may feel like it's harming your health - but in fact it could be keeping you young. A study has shown that being unemployed, particularly in early adulthood, could trigger premature ageing in men. It is thought that the financial and emotional stress of being out of work damages the body's DNA. The scientists made the link by studying blood samples and unemployment records of more than 5,500 men and women aged 31. They used the blood to test for damage to tiny structures called telomeres, which are found at the ends of chromosomes and protect the DNA, much like the caps on the ends of shoelaces prevent fraying. As we age, our telomeres get shorter leading to DNA becoming damaged and raising the odds of agerelated illnesses such as Alzheimer's, diabetes and heart disease. Shorter-than-average telomeres are seen as an indicator of ill health and premature death. The study found that men who had been out of work for at least two of the three years before the tests were more than twice as likely to have short telomeres as those who had been in continuous employment.

The link held even when other factors associated with ageing, including illness and lifestyle, were taken into account. Jessica Buxton, of Imperial College London, said this suggests the financial and emotional stress associated with being out of work was to blame. The team didn't find a link between unemployment and premature ageing in women but said this may be because not enough jobless females were studied. It is also possible that men, traditionally viewed as the breadwinners, are hit harder by unemployment. Writing in the journal PLoS ONE, Dr Buxton said: 'Stressful life experiences in childhood and adulthood have previously been linked to accelerated telomere shortening. 'We have now shown that long-term unemployment may cause premature ageing too.' She said unemployment in early adulthood may be particularly damaging, as those trying to provide for a young family may find being jobless more stressful than those who are close to retirement. In Britain, almost a million under-25s are unemployed. The researchers want further study to find out if the damage was permanent. WEDNESDAY 20TH NOVEMBER Carers 'at risk' as they save public 7bn (Sarah OGrady, The Daily Express) MORE than half a million people care for loved ones with dementia and the pressure is pushing many to breaking point. The 550,000 unpaid carers save the taxpayer 7billion a year but are left to cope with too little support from health and social services, according to a damning report by the Dementia Action Alliance. This is a false economy, the coalition of charities and experts warned, and will lead to far greater longterm costs which will worsen as the dementia care crisis grows. Rachel Niblock, of the DAA, said: "Carers who are left to fend for themselves without support often become unwell as a result of the exceptional strain experienced in caring for somebody with dementia. "Ongoing support for carers will mean the state can save money and reduce the need for much more expensive care from the NHS and social services." The alliance is today launching a campaign, fronted by TV presenter Jennie Bond at its annual conference in London, to get health bosses to sign up to its Carers' Call To Action. The aim is to recruit every one of the 152 new health and wellbeing boards to develop standards for excellence in carer support. There are about 670,000 people living with dementia in England today with the number set to double in the next 30 years. Professor Graham Stokes, DAA co-chairman, said: "As the world population ages, improving dementia care and support will be one of our greatest healthcare challenges. The traditional system of informal care by family and friends will require much greater support. "We need to ensure that people living with dementia, both now and in the future, have a good quality of life.

"And those caring for them must receive the support and advice they need to carry out what can be a difficult and demanding role." Edna has dementia. So why do staff at her local RBS keep letting her take out 300 cash? (Ruth Lythe, The Daily Mail) UP to three times a week for the past year, 91-year-old dementia sufferer Edna Brown has gone to her local bank branch and taken out 300. She then puts her purse stuffed with notes into a plastic carrier bag and walks home. Mrs Brown doesn't need the money she often can't even remember what it is for. Frequently, the bundles of notes turn up in her house, hidden in a lampshade or drawer. Sometimes they just disappear altogether. Her family want to stop her from withdrawing cash and have legal powers to run the account. They've taken away her debit card, but relatives claim that staff in the Royal Bank of Scotland allowed Mrs Brown to keep taking out money because they recognised her. And the branch staff say all they can do is call the family after each transaction. Daughter Beverley Owens says: 'We are incredibly worried about mum. I don't understand why RBS can't just stop her from taking money. 'Last week the bank telephoned to tell me she had been in and withdrawn 300. 'Within 30 minutes there was another call to say she had returned to the branch to ask whether the staff had given her the money because she couldn't find it. In a short space of time it had gone.' Mrs Brown, a once lively and sociable former canteen manager, began withdrawing money when she developed a fear that state-backed Royal Bank of Scotland would snatch her savings. So she regularly visited her local branch in Cheshire to take out cash from the account into which her modest pension is paid. Time and again her daughter begged RBS to stop money being withdrawn. All they would do, though, is call every time she came in. Mrs Owens lives in the same small town and her brother has a house next door to their mother. But despite this, they were not always able to dash out every time she went to the bank. Staff said stopping Mrs Brown would infringe her customer rights. In desperation, the family has resorted to fitting electric sensors on her purse so they can trace it. But still, many times, the cash disappears altogether the family believe 1,000 has gone missing. Around half a million people over 65 suffer from Alzheimer's disease. Like many families, Mrs Brown's relatives have paid more than 100 to set up a Lasting Power of Attorney, which gives them authority to manage, among other things, her finances. The purpose of this legal arrangement is that family members can step in when their loved one is no longer capable of looking after their own affairs.

Legal experts say it is supposed to give appointed attorneys the same powers as the person to whom the account belongs. But in reality, complex bank rules and a lack of understanding among branch and call-centre staff leave many struggling. Two legal experts and a spokesman for the Financial Ombudsman Service told Money Mail that there is no reason why Mrs Owens can't limit the amount her mother withdraws. But families are often given the wrong rules because branch staff don't understand them. According to the Ombudsman, relatives are routinely locked out of accounts because workers refuse to accept official documents. Others face lengthy delays or are told to send in original forms, when a copy signed by a solicitor should suffice. And some banks have even demanded that infirm or elderly people come into the branch to fill in forms when the whole point of the attorney document is to avoid this. Banks know there is room for improvement. Lloyds, for example, has promised to train its staff to better serve people with dementia. Ros Altmann, former director general of over-50s campaign group Saga, says: 'We need to have a real rethink about how Power of Attorney works. 'The whole point is to make sure people's money is managed properly when they are too ill to do it themselves and to protect them for their cash being frittered away. 'At the moment, the situation is completely inflexible, meaning that thousands of families are forced to jump over ridiculous hurdles at one of the most difficult times in their lives.' Guidelines from trade body the British Bankers' Association state customers with Power of Attorney should have the same power to manage the account as the customer. However, the rules say this depends on the account's terms and conditions and security procedures. It means there can be huge differences between how banks treat families of the ill and infirm. This can be particularly frustrating for relatives who may have to speak to several banks and building societies all with different rules. For instance, HSBC will not issue debit cards to relatives with Power of Attorney, although it is reviewing its procedure. Nationwide will not let attorneys manage current accounts online. However, it will allow families to use savings accounts online if there is evidence of mental or physical incapacity. Tesco Bank's terms and conditions state it will not let relatives do any online banking. Santander will not allow an attorney to hold a debit card if the infirm or elderly person has one, too. Barclays will only issue a debit card and allow online or telephone banking for one attorney at a time. A spokesman for the BBA trade body says: 'We have been working with the Law Society, the Office of the Public Guardian and charities to produce guidance for bank staff that will enable them to help customers better in these difficult circumstances.'

After Money Mail asked RBS to investigate, it confirmed that a restriction could be placed on Mrs Brown's account that would limit her to withdrawing just 50 a time. An RBS spokesman says: 'We want to put our customers at the heart of everything we do. We apologise for the inconvenience caused and we've placed a marker on Mrs Brown's account to limit daily counter withdrawals to 50. 'We are developing an upgraded training programme for our staff who deal with customers. 'This will improve their knowledge and skills in identifying and responding to the specific needs of our customers with dementia and their carers.' TUESDAY 19TH NOVEMBER Comment: Will your GP choose you?: Jeremy Hunt is to scrap doctors' catchment areas. Sounds like a great plan - until you think it through (Simon Wessely, The Guardian) Patients will be able to pick a GP wherever they like next year, Jeremy Hunt has announced. It could be where you live, near your work or your child's school, or miles away because you have heard that one practice offers something you particularly like - extra health checks, perhaps, or late hours. The health secretary says it's about improved patient choice and healthy competition - the better GPs will attract more patients, get more income, and be able to invest more in their practice. What's not to like? For some, rather a lot. The link between general practitioners and the population they serve has been fundamental to the running of the NHS. Health services are planned around the GP as the patient's "medical home": community and mental health services, district nurses and much more are linked to the local surgery. GPs act as the eyes and ears of local communities. But what now? You decide to register with a well-known doctor who understands why working people like you need to see a GP early (before the commute) or late in the evening - and is into holistic wellbeing. But everybody for miles around has the same idea. So the practice can't say yes to everyone - it hasn't the staff or space, and it would defeat the object of delivering the personalised care that so attracts you. So, far from you choosing your doctor, it will be the doctor who chooses you. And who will GPs choose? Those who are likely to bring in the best return for the least work; those who won't "burst the budget". In other words, healthy people. Not the disabled, not those with learning difficulties, not drug users or anyone with complex health or social problems. Why take anyone with long-term chronic diseases such as diabetes, or someone who is housebound? But most of all, why take those with chronic mental disorders? They take longer in the surgery, and also have multiple physical disorders - those with severe mental illness die on average 20 years earlier than those without. And that matters. General practice has been efficient in delivering healthcare because it is based on a simple principle. GPs get paid a fixed amount for having a patient registered (about pounds 60 to pounds 100 per patient per year). They don't have money taken away if the patient never visits: healthy, low-attending patients subsidise elderly, chronically sick and mentally ill ones. If you are lucky and healthy, you might think this unfair; but it's an insurance policy for when you fall into the more problematic categories, as in time you probably will.

It is hard to think of a single policy that will do more to extend the health gap between rich and poor than Hunt's latest plans. GP practices are going to be rated on a scale of one to four. Guess who won't be seen by the top-scoring practices: those who can't travel very far, because of a medical condition or because they don't have transport; those ill-informed about how to play the system; those mentally troubled, or with learning difficulties or dementia. Guess who will be seen: the affluent, informationrich and mobile. And there will be other casualties. At the moment GPs know a lot about families, especially problem ones. That's why the GP is so vital to child protection. But what if you don't want anyone to know much about your family - to make a link between the troubled behaviour of a child, the bruise on the mum's arm and the smell of alcohol on the father's breath? Simple, register them all with different GPs separated by reasonable distance. And if you think the NHS's IT services will solve this problem, then you don't know much about NHS IT. I have a patient who, when he gets ill, is very demanding and aggressive, and is known to make "scenes" in the surgery. Getting him well again takes a lot of time and effort. Will he be taken on by the trendy, four-star practice? Doubt it. Another patient I have been seeing for years has poor health, lots of unpleasant symptoms and is in constant pain. The problem is that no doctor can find very much physically wrong with her. She herself doesn't think that her traumatic early life, coupled with longstanding depression, might be a factor. The new euphemism for patients like her is "frequent flier". She uses up a lot of resources and, frankly, many doctors find her irritating. Where on the scale of one to four do you think her GP will be? The Royal College of Psychiatrists has been making great progress with its campaign to ensure those with mental health problems do not lose out in resources and care. The new system seems designed to ensure the opposite. Statins 'lower your risk of developing dementia' (Jo Willey, The Daily Express) HEART pills taken by millions of people every day could save thousands more lives a year by protecting against dementia. Experts who set out to examine fears of a link between statins and memory loss found the cholesterolbusting drugs can lower the risk of developing the killer brain disease. They found the tablets that can cost as little as 4p a day can lower the risk of dementia by 13 per cent. And for Alzheimer's - the most common form of senility - the risk is lowered by 21 per cent while there is a 34 per cent lower risk of mild cognitive impairment. They found no link with memory loss. Statins are taken daily by at least eight million Britons to protect against heart disease and stroke. Researchers from the University of Pennsylvania School of Medicine, in the largest review to date, examined 57 studies. Their findings are in the journal Annals Of Internal Medicine. Calling carers on dementia (The Daily Mirror) TRINITY College researchers want to recruit 300 participants for a study on the wellbeing of partners who care for dementia sufferers. The three-year project will study the stress levels and cognitive function of Irish dementia caregivers.

Prof Brian Lawlor said: "We want to improve the quality of life of the person with dementia and their caregiver, allowing the person with dementia to be able to stay at home with a good quality of life for as long as possible." Try It, Ditch It, Switch It (Daily Mail) TRY IT: GET on your bike to improve your memory. In a U.S. study of adults aged 57 to 75, those who exercised on a stationary bike or treadmill for an hour three times a week for 23 weeks had improved memory. This was linked to improved blood flow to the area of the brain affected by Alzheimer's. Speedy Saviour (Helen Wright, Daily Mail) Quick tricks to help you live longer. This week: Spend five minutes writing a letter or reading a book. Keeping mentally active helps protect the ageing brain, research from the Rush University Medical Center in Chicago suggests. In a six-year study of 294 people, those who kept the brain active by carrying out small tasks that require memory and thinking, such as writing letters, had an estimated 15 per cent slower rate of cognitive decline than those who didn't. This was seen when their brains were examined for physical signs of dementia, such as lesions and plaques, after death. Bristol-based GP Gill Jenkins says letter-writing may be more beneficial than typing an email. 'It requires a higher level of concentration because you can't simply delete mistakes at the touch of a button. 'It also strengthens social bonds.' MONDAY 18TH NOVEMBER Having two parents who lived to a ripe old age may reduce the risk of Alzheimer's (The Daily Telegraph) People with two parents who live long into old age have significantly less risk of suffering dementia in their later years, a study suggests. Brain power declines around 40 per cent more slowly in those with a mother who lived to at least 91 and a father who lived to at least 87, scientists found. Adults with parents who lived beyond these ages were also far less likely to have been diagnosed with memory problems by a doctor, further supporting the connection. The British, American and French authors said their study was the first large-population research to link parental longevity with a slower rate of cognitive decline and memory loss. Further studies might identify key biological markers that are involved, which could lead to preventive treatments, they wrote. The authors, led by scientists at the University of Exeter's Medical School, also said children of parents who live long lives may experience a lower risk of diabetes, cardiovascular disease and cancer because of "deceleration of biological ageing". The study is published in Alzheimer's & Dementia, the journal of the Alzheimer's Association.

Something to chew on for Alzheimer's (The Daily Telegraph) CHEWING spearmint gum or adding aromatic rosemary to meals could help to stave off Alzheimer's disease, research suggests. Antioxidant extracts from the herbs reduce oxidative stress, a hallmark of age-related decline in the part of the brain controlling learning and memory. Scientists from the Saint Louis University School of Medicine carried out the tests on animals and said the herbs should benefit humans as well. Dr Susan Farr, professor of geriatrics, said: "These proprietary compounds reduce deficits caused by mild cognitive impairment, which can be a precursor to Alzheimer's. This probably means eating spearmint and rosemary is good for you." Care worker tied down frail 88-year old with dressing gown while she went out to smoke (The Daily Mail) A CARE home assistant used a dressing gown cord to tie an 88-year-old woman with dementia to a chair while she went outside to smoke a cigarette. A court was told that Sussanah Carr, 43, restrained the pensioner because she had been wandering around the care home. She told a colleague what she had done and was reported to police, but denied it when interviewed by officers. However, she later went back to the police station to admit her crime after being questioned by care home bosses at an internal inquiry. When she was finally brought before a court, she pleaded guilty to a charge of ill-treating and wilfully neglecting a person without capacity. Carr was spared a jail sentence, however, when Judge Michael Addison gave her a 12-month supervision order. When the offence came to light, she was dismissed from her job at Sutton Lodge, a Bupa care home in Weybridge, Surrey, where she had worked for about ten years. Guildford Crown Court was told the victim had been repeatedly getting out of bed and walking around when Carr arrived during an overnight shift earlier this year. Prosecutor Flora Page said the incident was over 'in a matter of minutes'. Miss Page added: 'The victim had been wandering around . . . and Miss Carr had been chasing after her and following her around. However, a time came when she sat her down in her chair and, using the cord of her dressing gown, tied it on the chair.' Summing up later, Judge Addison said a key detail was the fact that it was secured around her waist in such a way that the woman would have been able to untie herself. He told Carr, of Shepperton, Surrey: 'You were in charge of looking after an old lady suffering from dementia.

'She was sat in the chair and you put the dressing gown cord around her waist. It was tied in a bow. She could have undone it. 'I sentence you on the basis that she was only tied to the chair for a number of minutes. 'It is a serious matter to ill-treat someone who lacks mental capacity in a home, but it does seem that this offence is right at the bottom of the scale.' Judge Addison said there was no evidence that the woman suffered any distress and he did not understand why the case had not been dealt with at an earlier hearing at North Surrey Magistrates' Court in Staines. Elaine Stapleton, defending, said Carr had lost her livelihood and record of previous good character because of one incident in many years of caring for people with dementia. Miss Stapleton said: 'She has a long history of caring for vulnerable people in that home. What happened means she has stopped taking her medication. She has had a number of difficulties with her health.' In a statement after sentencing, Graham Brittain, of Bupa Care Services UK, said: 'The behaviour of Sussanah Carr was clearly unacceptable. 'We immediately suspended her and reported her to the appropriate authorities to ensure that vulnerable older people are protected. The court has now taken appropriate action.' SUNDAY 17TH NOVEMBER Massive NFL pay-outs send shockwave through sport (Sam Peters, The Mail on Sunday) SPORTS governing bodies across the world are urgently reviewing their approach to head injuries over fears they could face potentially crippling legal action following a multi-million dollar settlement in the NFL. It is increasingly clear the $765million (475m) payout to the families of ex-gridiron stars who had either died or are suffering early onset dementia caused by repeated concussions has sent shockwaves through sport. Every single contact sport, including football, is urgently reviewing their approach to concussion as a result of the NFL pay out, a well-placed FA source told the Mail on Sunday. The size of the payout has got everyones attention. The Mail on Sunday has been calling on rugby unions authorities to improve their management of concussion for months after a string of high-profile incidents where concussed stars played on following perfunctory examinations. There are indications of progress in rugby, where concussion is now the most common injury suffered at elite level, with plans to introduce mandatory awareness training for all players and coaches by the start of next season. But, as US researchers continue to unearth cases of early onset dementia in former players " following years of denial by the NFL " all contact sports are now aware of the massive financial risks.

The furore surrounding the decision of Tottenham manager Andre Villas-Boas to allow goalkeeper Hugo Lloris to return to the field after being knocked unconscious a fortnight ago further focused public attention on footballs mismanagement of head trauma. The issue highlighted the pressures that can be exerted on medical staff by coaches keen to keep their best XI on the field. Sometimes pressure is applied and thats why its so important to have good doctors around you, said Dutch football legend Edgar Davids. They may play professional sport but first and foremost they are human beings and that is how they should be treated. The threat of legal action is always there. The decision always has to be in the hands of the medical department. Davids is manager at forward-thinking Barnet (see above). Their director of football, Paul Fairclough, who as manager of the England C team, is also concerned with the grass-roots game, said: We pay scant regard [to concussion] in football. At the moment its a case of the physio coming on and saying follow my finger, then Oh, youre all right, son, get back on. Its criminal. There will be fatalities if we carry on the way we are. Its going on all over the country, managers bullying physios to keep players on the pitch and available. I see things going on at lower-level football that frighten the living daylights out of me. Weve got to take it so much more seriously than we are. Were in that culture where there is blame there is a claim and it will happen eventually [litigation] and it would devastate a club. Forget whether they are multi-million pound or if theyre lads playing on the parks on a Sunday afternoon. We have got to have a system in place where they come off, no matter what, if they have concussion. Last week three more former NFL stars, including Hall-of-Famer Tony Dorsett, revealed they are living with Chronic Traumatic Encephalopathy " formerly known as dementia pugilistica " and experts believe there are likely to be many more cases. Barnet chairman Tony Kleanthous believes UK governing bodies must invest widely in independent research to avoid similar litigation. It seems ridiculous that we are not doing any research to see what effect this has to somebody who may, over a period of 20 years, have probably headed a football a million times, Kleanthous said. The New Review: DISCOVER: HEALTH: BRAINWAVES: Research on other fronts (Josh Davis, The Observer) Liraglutide People with type 2 diabetes are twice as likely to develop Alzheimer's. Researchers at the University of Ulster found that in mice the drug liraglutide, already used to treat type 2 diabetes, enhanced brain cell growth and reduced levels of amyloid plaques, the protein thought to be responsible for Alzheimer's, while also protecting against inflammation of the brain. Now, a team at Imperial College London is starting a three-year project testing the drug on patients in the early stages of Alzheimer's. Each patient will be treated with either liraglutide or a placebo for one year and then

have their brain scanned for changes in brain glucose, inflammation and brain volume, all indicators of Alzheimer's. Stem cells Within bone marrow, there are a small amount of stem cells that could be harnessed for new therapies. They are already used to treat a variety of conditions and recent reports suggest they may be able to repair damaged brain cells. In 2012, the University of Nottingham started a pounds 1.3m project to study the formation of brain stem cells and whether bone marrow can be manipulated to produce them. The New Review: DISCOVER: HEALTH: Could arthritis drug combat Alzheimer's?: It affects 35 million people worldwide and billions have been spent on research - to little avail. But an unconventional approach based on a 30-year-old evolutionary theory may provide a way forward (Dara Mohammadi, The Observer) At the beginning of next year, Clive Holmes will attempt to do something remarkable. But you'd never guess it from meeting this mild-mannered psychiatrist with a hint of a Midlands accent. In fact, you could be sitting in his office in the Memory Assessment and Research Centre at Southampton University and be unaware that he was up to anything out of the ordinary - save for a small whiteboard behind his desk, on which he's drawn a few amorphous blobs and squiggles. These, he'll assure you, are components of the immune system. As a psychiatrist, he's had little formal training in immunology, but has spent much of his time of late trying to figure how immune cells in the body communicate with others in the brain. These signals into the brain, he thinks, accelerate the speed at which neurons - nerve cells in the brain - are killed in latestage Alzheimer's disease and at the beginning of next year he hopes to test the idea that blocking these signals can stop or slow down disease progression. If he shows any dent on disease progression, he would be the first to do so. Despite the billions of pounds pumped into finding a cure over the last 30 years, there are currently no treatments or prevention strategies. "Drug development has been largely focused on amyloid beta," says Holmes, referring to the protein deposits that are characteristically seen in the brains of people with Alzheimer's and are thought to be toxic to neurons, "but we're seeing that even if you remove amyloid, it seems to make no difference to disease progression." He mentions two huge recent failures in drugs that remove amyloid. The plug has been pulled on bapineuzumab by its developers Johnson & Johnson and Pfizer after trials showed its inability to halt disease progression; and the wheels seem to be coming off Eli Lilly's drug solanezumab after similarly disappointing results. Other drugs in the experimental pipeline are a long way off. Few make the jump from efficacy in animals to efficacy in people. Fewer still prove safe enough to be used widely. Holmes's theory, if true, would have none of these problems. He's been testing etanercept, a drug widely used for rheumatoid arthritis. It blocks the production of TNF-alpha, one of the signalling molecules, or cytokines, used by immune cells to communicate with each other. In the next few months, he expects the results of a pilot trial in people with Alzheimer's. If they are positive, he'll test the strategy in people with only the mildest early forms of the disease. "If we can show that this approach works," says Holmes, leaning forward in his chair, "then since we already know a hell of a lot about the pharmacology of these drugs, I'm naive enough to think that

they could be made available for people with the disease or in the early stages of the disease and we can move very quickly into clinical application." It seems too good to be true. Why, then, has the multibillion-pound drug industry not at least tested this theory? There are roughly 35 million people in the world with this devastating, memory-robbing disease, and with an increasingly ageing population, this number is expected to rise to 115 million by 2050. It's not as if there is no financial incentive. The answer might be because the idea that Holmes and his colleagues are testing took an unconventional route to get to this point. It started life as an evolutionary theory about something few people have even considered - why we feel ill when we are unwell. The year was 1980. Benjamin Hart, a vet and behavioural scientist at the University of California, Davis had been grappling with how animals in the wild do so well without veterinary interventions such as immunisations or antibiotics. He'd attended a lecture on the benefits of fever and how it suppresses bacterial growth. But fever is an energy-consuming process; the body has to spend 13% more energy for every 1deg. C rise in body temperature. "So I started thinking about how animals act when they're sick," says Hart. "They get depressed, they lose their appetite. But if fever is so important, what they need is more food to fuel the fever. It didn't stack up." After a few years of mulling this over, Hart published a paper on what he termed "sickness behaviour" in 1985. Lethargy, depression and loss of appetite were not, as people thought, a consequence of infection, but a programmed, normal response to infection that conferred a clear survival advantage in the wild. If an animal moves around less when ill it is less likely to pick up another infection; if it eats or drinks less, it is less likely to ingest another toxin. "The body goes into a do-or-die, make-or-break mode," says Hart. "In the wild, an animal can afford not to eat for a while if it means avoiding death. It allows the immune system to get going. You do this - and this is the important bit - before you're debilitated, when it's still going to do you some good." The next crucial step came from across the Atlantic in Bordeaux. In a series of experiments published between 1988 and 1994, Robert Dantzer, a vet turned biologist, showed three things. First, that inflammatory cytokines in the blood, even in the absence of infection, were enough to bring about sickness behaviour. Second, that these cytokines, produced by immune cells called macrophages, a type of white-blood cell, signal along sensory nerves to inform the brain of an infection. And third, that this signal is relayed to microglial cells, the brain's resident macrophages, which in turn secrete further cytokines that bring about sickness behaviours: lethargy, depression and loss of appetite. Dantzer, who has since moved to the University of Texas, had thus dispelled one of the biggest dogmas in neurology - that emotions and behaviours always stemmed from the activity of neurons and neurotransmitters. He showed that in times of trouble, the immune system seizes control of the brain to use behaviour and emotions as an extension of the immune system and to ensure the full participation of the body in fighting infection. In late April 1996, he set up a meeting in Saint-Jean-de-Luz, on the Bay of Biscay in the southwest of France, to gather together researchers interested in cytokines in the brain. It was there, in a chance meeting over breakfast in the hotel lobby, that he met Hugh Perry, a neuroscientist from Oxford University. Perry is now at Southampton University. Sitting in his office, surrounded by framed pictures of neurons, his eyes light up as he recounts that meeting with Dantzer. "I remember as he told me about this idea of sickness behaviour thinking, 'Wait a minute, this is a really interesting idea'. And then when

he said that the innate immune cells in the brain must be involved in the process, a bell rang." He puts down his coffee and rings an imaginary bell above his head. "Ding, ding, ding - so what if instead of a normal brain, it was a diseased brain. What happens then?" Perry had just started working on a model of neurodegenerative disease in mice. He was studying prion disease, a degenerative disease in the brain, to see how the brain's immune system responds to the death of neurons. He had switched laboratories from Oxford to Southampton the year after meeting Dantzer and the idea had travelled with him. He injected his mice with a bacterial extract to induce sickness behaviour, and instead of a normal sickness behaviour response, he saw something extraordinary. His mice with brain disease did substantially worse than those with otherwise healthy brains. They were very susceptible to the inflammation and had an exaggerated sickness behaviour response. They stayed worse even though his healthy mice got better. This, Perry explains, is because one of the microglial cells' many roles is to patrol the brain and scavenge any debris or damaged cells, such as the misfolded proteins in prion disease. "When there's ongoing brain disease, the microglial cells increase in number and become what's called primed," he says, referring to the procedure by which the immune system learns how to deal better and more efficiently with harmful stimuli. "When primed, they make a bigger, more aggressive response to a secondary stimulus." When the signal of peripheral infection came into the diseased brains of the mice, their microglial cells, already primed, switched into this aggressive phase. They began, as they usually would, to secrete cytokines to modulate behaviour, but secreted them at such high concentrations that they were toxic, leading to the death of neurons. "But you never really know how your findings will translate to humans," Perry adds. "So all this mouse stuff could be great, but is there any real importance to it? Does it matter? And that's when I called Clive." Perry hadn't met Clive Holmes at that point, but had heard of him through Southampton University's Neuroscience Group, which brings basic researchers and clinicians together. He'd called him in 2001 to ask whether people with Alzheimer's disease got worse after an infection. The answer was a categorical yes. "And then Perry asked me if there was evidence to show this," remembers Holmes. "And I was sure there must be. It was so clinically obvious. Everybody who works with Alzheimer's just knows it. But when I looked into it, there was no evidence - nobody had really looked at it." In several ensuing studies, Holmes and Perry have since provided that evidence. Patients with Alzheimer's do indeed do worse, cognitively, after an infection. But it's not only after an infection. Chronic inflammatory conditions such as rheumatoid arthritis or diabetes, which many elderly patients have, and which also lead to the production of inflammatory cytokines, also seem to play an important part. Holmes and Perry speculate that it's the presence of the characteristic amyloid beta deposits in the brains of these individuals that primes the microglial cells. And that when signals of inflammation come in, be it from an infection or low-grade chronic inflammatory condition, the microglial cells switch into their aggressive, neuron-killing mode. This, they think, is why removal of amyloid beta might not be working: the damage, or in this case the priming of the microglial cells, might have already been done, meaning that the killing of neurons will continue unabated.

"So next year if these initial results look promising," says Holmes, "we're hoping to try and block TNFalpha in people with the early stages of Alzheimer's to block this peripheral signal before the disease fully takes hold. We want to see what kind of a dent on disease progression we can get. I don't know what that's going to be, but that's what we're going to find out." If all goes according to plan, and he can secure funding to start the trial at the beginning of next year, Holmes will, by mid-2017, find out for sure whether he can stop the disease taking hold. But the results of his trial in people with late-stage disease, due in the next few months, will give him a strong indication of what to expect. MEDIA - WEB SUNDAY 24TH NOVEMBER Taking a stand in the battle against Alzheimers (Victoria Macdonald, Channel 4 Blog) It is being described by charities as a once in a lifetime opportunity. The dementia summit called by Prime Minister David Cameron takes place on December 11 and for the first time, the health ministers from the G8 countries will gather at Downing Street to discuss a global and united approach to tackling the disease. And on Monday, Alzheimers societies from the G8 nations will each hand a letter to their respective health ministers begging them not to squander this opportunity. The Alzheimers Society in the UK said it was a unique opportunity for international leaders. It is calling for a collaborative global action plan on dementia research, a significant increase in funding for that research, and help in attracting, developing and retaining the best scientists, clinicians and care professionals. It is certainly the first time a prime minister has used the presidency of the G8 to take action on a single disease. And it follows his Challenge on Dementia in England campaign which has pledged major improvements in dementia care and research by 2015. There is, of course, no cure for dementia and the few treatments that do exist have limited value. All of this at a time when dementia is on the increase. By 2020, it is estimated one million people in the UK will be diagnosed with the disease. And there is an even more startling fact - so high now is the global cost of caring and treating those with dementia that if it were a country it would be the 18th largest economy in the world. For those affected by the disease, this summit represents a step forward not least in raising awareness. We spoke to Jill Batty and her husband Dominic, who was diagnosed with Alzheimers 10 years ago. Mrs Batty, of north London, says there is a stigma attached to it. She compares it to the way people thought of cancer 20 years ago.

Breast cancer wasnt talked about so much, she says. It was almost as if people feared catching it. But now most people know someone who has had it, they are likely to survive and this is because so much effort and money has been put into research and treatment. We need that for dementia, she said. Mr Batty was once a dentist. An intelligent, witty man. His cognitive decline has been relatively slow but it has still been hard for the family. Some people call it dead but living. The man you fell in love with is not there anymore, Mrs Batty said. Just occasionally, during a time with the couple, you did get a glimpse of the man he once was. With the words in front of him, he sang Winter Wonderland for Us. Later, at a respite centre in Kentish Town, run by the Alzheimers Society with the help of volunteeers, he played the piano. It was not faultless but it was somehow beautiful because of the mistakes. We were able to have a conversation of sorts, a chat about the weather and how much he preferred cooler to warmer temperatures. He told me how humid it had been in Malaya where he was posted for his National Service. Later, though, he would not remember that conversation. And that is the way it always is now. He could recite a Shakespearian sonnet, but he could not remember what he had had for breakfast. He can no longer watch films or read a book but now and then he will dip into Pride and Prejudice and read a few paragraphs. It is not, Mrs Batty says, how they had planned their retirement. You never think it is going to happen to you, she said. Link to view online here FRIDAY 22ND NOVEMBER Poetry breaks through fog of Alzheimer's sufferers (Beatrice Debut, Medical Xpress) The teenager's voice breaks the silence that hangs over the dozing, grey-haired figures. "If you can keep your head when all about you are losing theirs and blaming it on you," she recites "you'll be a man, my son", finishes one of the pensioners, with a burst of recognition. Alzheimer's has stolen most of Margaret's memories, but she can still remember the line from Rudyard Kipling's famous poem that she learnt years ago, a rare moment of clarity in the fog of the cruel disease. This retirement home in central England is one of many institutions and hospitals across the country turning to poetry to provide some respite from the symptoms of dementia, such as the loss of memory, communication and basic skills. While it provides no cure, the rhythm and pace of well-known verse can act as a trigger for memories and speech, according to Jill Fraser, whose charity "Kissing it Better" organises reading sessions for the elderly.

If patients "hear one word that they can remember from poetry, it brightens their day up," adds Elaine Gibbs, who runs the Hylands House retirement home in Stratford-upon-Avonfittingly, the home of William Shakespeare. Miriam Cowley, elegant in a flowered dress and her grey hair tied up into a bun, listens attentively as a teenager reads her "Daffodils" by William Wordsworth. "I did know the poem but I've forgotten it. I learnt it when I was a kid at school, a long time ago," said the retired teacher, who suffers from short-term memory loss. "It brings back good memories. I will have some good dreams after that, dreams of daffodils, of trees." 'The poetry broke open the dam' The home can be a sombre place because of the prevalence of residents with Alzheimer's, dubbed 'the long good-bye' because of the way it slowly steals away everything that makes a person who they are. But as a woman bashes a plate incessantly against a table at one end of the room, seemingly oblivious to her surroundings, one of the teenage volunteer readers says spending time there "gives you a real buzz". "You come in here and everyone is sitting there by themselves," says Hannah Ciotkowski, 15. Then when someone starts reading a poem aloud "you can immediately see life in them, they are smiling". "It's wonderful when suddenly they join in with a line," adds Anita Wright, an 81-year-old former actress with the Royal Shakespeare Company who also reads poetry at Hylands. She recalls how one patient with advanced dementia broke down in tears when she heard a poem about a man bidding farewell to his lover, and started recounting how her fiance had died. "She had not said a single word since she had been to this home and the poem just broke open the dam," Wright said. Lyn Darnley, head of voice at the RSC, says poetry can be very powerful. "These rhythms run deeply inside of us and poetry can touch and spark memories of not just emotions but the deep senses of language," she told AFP. Experts caution that poetry will not halt the onslaught of dementia, which affects 800,000 people in Britain. "Poetry does not cure dementia," says Dave Bell, a specialist nurse with Dementia UK, a charity which works to improve the quality of life for people affected by the disease. "But there is a sense of achievement and self-esteem for the person because they can remember something," he says, adding that it also helps them connect with other people. Fifteen-year-old Hannah is certainly convinced: "I hope that when I am old, people will come visit me, read to me and sing to me." MONDAY 18TH NOVEMBER BMA wary about refreshing NHS mandate every year (BMA)

The BMA has warned that refreshing the NHS mandate with new policy initiatives every year could make it unachievable. The association supports the principles behind the recent update, which include improvements for older peoples care and mental health but is concerned about the ever -changing goalposts. Created as part of the Health and Social Care Act 2012, the mandate sets out the governments ambitions for the NHS and the funding available for the work, and must be refreshed annually. The updated mandate for 2014/15 includes a plan to develop care for vulnerable older people and those with complex needs. BMA council chair Mark Porter (pictured) said the NHS mandate provided an encouraging vision, but success would depend upon having fewer and more strategic objectives and how that was implemented. Difficult to achieve Dr Porter said: We believe the consistency shown through the mandate is broadly positive and allows NHS England to settle into its role. We support the principles behind the vulnerable older peoples plan and improvements in the treatment of mental health, although much work is needed if we are to deliver on these objectives. We are concerned, however, that refreshing the mandate so quickly and adding a new set of priorities could make it difficult to achieve against the original objectives and creates ever-changing goalposts for staff. Adding a raft of recent policy initiatives to it each year means it will quickly become unachievable. Health secretary Jeremy Hunt said changes had been kept to an essential minimum to ensure the refreshed mandate remained strategic, outcomes-focused and affordable. Parity for mental health Chair of NHS England Sir Malcolm Grant welcomed the mandate and said his organisation shared the ambition of putting mental health on a par with physical health. Our vision is for a real change in attitude towards mental health and the way services are d elivered so people experience a holistic approach to their care, he said. We also fully support and continue to work with the Department of Health in finalising proposals for the vulnerable older peoples plan. Chief executive of the Mental Health Foundation Jenny Edwards welcomed a commitment to develop waiting times for talking therapies. For too long, people have been waiting months to access psychological therapies on the NHS, said Ms Edwards. We also welcome the governments renewed focus on parity of esteem and look forward to seeing how this parity will translate into practice.

The Alzheimers Society said it was good that diagnosing dementia was now hard-wired into the NHS and that there was an aim to provide appropriate post-diagnosis support. Link to view online here Care Show Birmingham achieves 28% visitor increase (Exhibition News) UBM Live has claimed that nearly 3,000 people came to The NEC for Care Show Birmingham, a rise of more than a quarter. The exhibition saw a new section - the Dementia Care Show - which provided advice tailored to care providers, social services, GPs and NHS professionals that are involved in delivering dementia care. In all, 2,946 visitors came to the show on 12-13 November, up 28 per cent from 2012. We are delighted with this years visitor figures and feedback as it proves that this is a growing industry, and with the introduction of the Dementia Care Show, Care Show Birmingham provided visitors with a wide range of content to ensure best practise covering the entire care sector, said event director James Samuel. We are fully committed to continuing the promotion of the need for dementia care and be seen as the leading event in the marketplace within this topic and the wider care industry. The show has already seen an 80 per cent rebook for next year. Link to view online here SATURDAY 16TH NOVEMBER Cognitive function improved by intranasal insulin in patients with type 2 diabetes (Medical News Today) In recent years, the link between type 2 diabetes and dementia has become widely recognized. Older individuals with diabetes develop Alzheimer's disease at an earlier age, and are more likely to develop vascular dementia than people who do not have diabetes. Now, a small proof-of-concept study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) offers promise of a new treatment for this widespread problem. Currently published on-line in the journal Diabetes Care, the study results show that a single dose of intranasal insulin can help improve cognitive function in patients with diabetes. "We know that diabetes accelerates brain aging," explains first author Vera Novak, MD, PhD, an investigator in the Department of Neurology at BIDMC, who conducted this research as a faculty member in BIDMC's Department of Medicine. "If we consider that there are more than 45 million people with diabetes in the U.S. alone and that older adults are the fastest growing segment of the diabetes population, we realize what an extremely serious problem we're facing." In the brain, insulin helps to regulate signaling and connections among neurons and also regulates vascular functions. Central insulin receptors are abundant and yet are mostly dependent upon insulin transport through the blood-brain barrier. Therefore, inadequate insulin delivery may affect perfusion and cortical activity in brain regions associated with high-energy demands, such as cognitive networks.

"Previous studies had suggested that augmenting cerebral insulin may enhance cognitive function," says Novak, an Associate Professor of Neurology at Harvard Medical School. Intranasal administration delivers insulin directly to the brain, bypassing the blood-brain barrier and reaching receptors in multiple brain regions within minutes after administration. In this pilot study, the authors tested whether similar effects would be observed in patients with diabetes. Fifteen patients with diabetes and 14 healthy older adults, average age 62, were administered a single 40-unit dose of insulin or saline in a randomized order on two subsequent days. Measurements of brain function were then made using regional perfusion and vasodilatation with 3 Tesla MRI and neuropsychological evaluation of learning and memory. "We observed in both the healthy subjects and the patients with diabetes that there was an improvement in both verbal learning and visual-spatial learning and memory after they received the insulin," explains Novak. Through imaging tests, the investigators also learned that these improvements were dependent on the brain's vascular function. "Our findings provide preliminary evidence that intranasal insulin administration appears safe in older adults, and does not lead to low sugar levels," says Novak. "Intranasal insulin may potentially improve learning and memory in older adults with and without diabetes, through vascular mechanisms. However, larger and longer duration studies are needed to determine whether intranasal insulin may provide long-term benefits for memory in older patients with diabetes." 'A robot is my friend': Can machines care for elderly? (Alex Hudson, BBC) With the world's elderly population growing rapidly, scientists are suggesting that robots could take on some of the burden of providing care, support and - most surprisingly - companionship. A boy born today in Britain is expected to live on average to the age of 91, a girl to 94. Worldwide 1.5 billion people over the age of 65 are expected to be around in 2050. In Japan, which has the world's oldest population, Prime Minister Shinzo Abe has allocated 2.39bn yen (14.3m) in the 2013 budget to develop robots to help with care. Toyota is developing devices to help carry the elderly or provide mobility support and Toli Corp has created a mat with a wireless sensor that can track and deliver feedback if an elderly person is moving around. A special robot with 24 fingers has been developed for hair washing and head massage, useful if a person has limited arm movement. It is something Panasonic has also tried out in Japanese hair salons. The idea of using robotics to care for the elderly is being trialled everywhere from Singapore to Salford. Is the friendship between Frank Langella's character and his robot carer in the film Robot and Frank a sign of things to come? The Spatio-Temporal Representations and Activities for Cognitive Control in Long-term Scenarios handily referred to as the Strands project - at the University of Birmingham has received 8m euros (6.69m) in funding from the European Commission. The Strands robot will begin trials with an Austrian care provider in May, starting with simple things such as checking fire doors remain unblocked and defibrillators are always present and in the right place.

"We're trying to free up more of the staff time," says Dr Nick Hawes. He says: "One of the biggest complaints of care home staff members is that they don't spend enough time doing the human interaction and the caring part. "We're looking at porter-type tasks and assistance tasks. If the robot could fetch the tray of medicine while the human talks to the residents instead of getting the tray and just dishing out the medicine because they're short on time, it increases interaction." But some projects are hoping robots can take a more active, and personable, approach to care. Time for lunch? The Mobiserv project - a consortium of eight European universities and care companies - has just finished research on creating a "social companion robot". It could provide the elderly with everything from a health and nutrition coach that encourages them to eat healthily and exercise through to a device that lets them know they have not spoken to anyone for a while. A project in Salford is creating robots that "can help supervise people 24 hours a day", according to researcher Antonio Espingardeiro. The Carebot P37 S65 can, among other things, be programmed with speech therapy and object recognition exercises to help people with dementia. Mr Espingardeiro and his team are currently looking at the comparative advantages and disadvantages between robot care and human care, but he believes robots can provide meaningful interaction to supplement human contact. As with a lot of technology, reality is taking its lead from science fiction. In the recent film Robot and Frank, an elderly man is bought a robot rather than being put into a care home. There is evidence that robots offering companionship are popular with the elderly. The most popular robot used by the older generation in Japan is Paro, a robot that will not help with the dishes, carry heavy items or administer medication. But it does look cute, a cross between a seal and a Furby children's toy. The seal-like Paro has become the most popular robot used by the elderly in Japan It offers companionship rather than any tangible medical or physical support. "Paro is my friend," says Japanese care home resident Kazuo Nashimura, "I like it that he seems to understand human feelings." Some of the robotic community thinks that this is not strictly in the mould of providing tangible benefits to the elderly. "At no point is that a care robot," says Dr Hawes.

"There is really no benefit to having that except that it engages people, it facilitates conversation. If you're one on one with that robot, it's no more beneficial than having a Game Boy." And the emotional reliance on robots seems to go against current campaigns by various charities for the elderly. Academics from the University of Edinburgh argue numbers have actually been falling in Britain and the ratio of working adults to dependent pensioners is improving Age UK says half of all older people consider the television their main form of company and has set about a befriending service where people can volunteer to go around and chat with lonely people. It is a service that they think would make a big difference, in a way that robots cannot. "There is nothing wrong with making smarter use of technology to help people manage health conditions and possibly stay independent for longer," says Caroline Abrahams, charity director at Age UK. "However, it is always important to ensure technology is only used where it delivers real benefits and to recognise that it is no substitute for the human touch." Some see the robots as threatening to take the place of care staff or loved ones. But with so many lonely elderly people, robots are seen by scientists working on robot projects as a first step. "Some robotic device in a lonely person's life might improve it," says Dr Hawes. "But that shouldn't disoblige society from finding new ways to give them human contact. "The idea that we can say, 'Hey, let's give them a robot and we don't have to worry any more' is the scrapheap approach." Link to view online here POLITICAL MONITORING NHS Innovation Challenge Prize for Dementia: winners announced (Department of Health, 27/11/13) The winners of the NHS Innovation Challenge Prize for Dementia have been announced. The 80,000 top prize was awarded to Memory First, a new integrated dementia service, run by a consortium of 162 GPs across 41 practices in Staffordshire. Its pioneering joined-up approach to care has cut diagnosis times from 2 1/2 years to 4 weeks and led to major improvements in patient experience. Find out about how Memory First is working in Gnosall Surgery in Staffordshire: Dr Ian Greaves who led the development of the Memory First service said: With an ageing population the old models of dementia care are no longer sustainable. Keeping the patient under the responsibility of the GP, supported by secondary care expertise when needed, is a paradigm shift. The engagement of all 162 GPs across the 41 practices in the area was key.

The other 2 winning schemes, awarded prizes of 35,000 each, are the Greenwich Advanced Dementia Service, which is helping people in the borough remain in their own homes for longer, and the Early Intervention Dementia Service in Worcestershire, which has already helped 2,000 people in the county get a more timely diagnosis. Hear stories from carers, patients, doctors and nurses about the support they have received from Greenwich Advanced Dementia Service and Early Intervention Dementia Service: Jeremy Hunt, Secretary of State for Health said: With the G8 Summit in London on 11 December, its important that innovation sits at the very heart of the way health and care services work. We have seen some inspiring examples demonstrating how care for people with dementia can be transformed. Dementia is one of the biggest challenges we face both nationally and internationally, and I am delighted that the UK is leading the way forward for innovation to deliver better care. The prize, which is part of the NHS Innovation Challenge Prize programme, was designed with the input of more than 90 members of the dementia community. They concluded that a more integrated approach could radically improve quality and outcomes. The prize aims to recognise and reward forward-thinking approaches to joined-up care for the people with dementia. Link to view online here Dementia care and support (Department of Health, 29/11/13) The Department of Health has published its report on Dementia care and support. This report sets out what is known about dementia care, support and research. It highlights where improvements are being made and where progress can be seen - it also shows where improvements are needed, including where better data is necessary. It assesses the scale of the challenge of dementia and also looks at: prevention diagnosis living with dementia dementia education and training dementia friendly communities research The report supports an interactive map where people can see data about dementia care in their area and across the country. The full report is available here. PARLIAMENTARY MONITORING House of Commons Debate Extract Mid-Staffordshire NHS Foundation trust 19/11/13 Hazel Blears (Salford & Eccles, Labour): The Secretary of State is right to highlight the need for fundamental culture change, but it is still the case that some of the most vulnerable people in our hospitals todaythose with dementiastay longer and are more likely to be readmitted and more of them die. My local hospital, Salford Royal, has recently implemented the Royal College of Nursings system called the triangle of care, which fully involves patients, carers and their families in the care of

those with dementia. Will the Secretary of State take steps to ensure that that kind of system is implemented across the NHS? Jeremy Hunt (South West Surrey, Conservative): I absolutely want to encourage that. I know that the right hon. Lady has campaigned a great deal on the needs of people with dementia, and I share her desire to do much better for them. Salford Royal is one of the best hospitals in the country and we should always learn from what it does, but 25% of people in hospitals now have dementia. The tragedy of what happened at Mid Staffs and of many of the stories of poor care in other hospitals that we read about is that very often they involve people with dementia, because they are the kinds of people who have been deprioritised when hospital managements have decided, for example, that they want to cut nursing inappropriately. We absolutely have to change that culture. There is now a very good system at several hospitals. People with dementia, in particular, must be helped to eat and drink at meal times. Many of us have been shocked by the stories of full trays of food being taken away because someone is unable to eat unaided. That, in particular, we need to stamp right out. Link to view online here House of Commons Debate Extract Pharmacies in the NHS 20/11/13 Kevin Barron (Rother Valley, Labour): Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reasonthey may be forgetful as a result of other problems, such as dementianot adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more. Link to view online here House of Commons Written Questions NHS Training 25/11/13 Steve McCabe: To ask the Secretary of State for Health what (a) training and (b) guidance his Department gives to medical professionals working for the NHS on awareness of (i) disabilities and (ii) hidden disabilities when treating a patient. [176134] Dr Poulter: Disability awareness training is primarily a responsibility of employers, however the Government recognises the importance of lifelong learning for all staff working in health and social care. The National Institute for Health and Care Excellence (NICE) has produced guidance on a wide range of physical and mental health-conditions, many of which will affect disabled people. In addition, NICE is developing further guidance, including clinical guidelines on mental health problems in people with learning disabilities and disability, dementia and frailty in later life. NICE expects health and care professionals to take NICE guidance on the treatment of relevant conditions fully into account when deciding how to treat a patient. Link to view online here

Scottish Parliament Debate Extract Public Bodies (Joint Working) (Scotland) Bill 26/11/13 Aileen McLeod (Scottish National Party): I am delighted to be speaking in a debate on the general principles of a bill that will introduce a substantial and wide-ranging reform of the way in which we deliver adult health and social care. The cabinet secretary reminded us in his opening speech why the bill is so necessary. As a nation, we have larger numbers of people who are living longer than ever before. That is good news, but it means that we need to re-examine how we deliver and manage care in Scotland for our older people. The integration of health and social care services is needed to improve outcomes for individuals, particularly adults with multiple long-term conditions and complex support needs, and to improve the experiences of both those who use such services and those who provide them. As we know, key to delivering that vision is the principle of person-centred healthcare, whereby services are integrated around the needs of the individual. I want to highlight the representations that the committee received on the need to ensure that the housing sectors contribution to improved health and social care outcomes is recognised in the bill, and that the new integration authorities involve their strategic housing partners in joint commissioning to achieve person-centred quality care at home. Ultimately, our aim should be that everyone, no matter the complexity of their requirements, has an equal chance of a good life. We know that homes that are responsive to a patients needsparticularly if the patient has dementia, a learning difficulty or autismare needed to achieve that aim, as they make a significant difference to how care and support is delivered and the outcomes that it has. Another key issue that was raised with the committee was the need for the full involvement of the third sector at both the strategic partnership and local levels, as well as issues surrounding the involvement of a range of other key stakeholders, including our allied health professionals, service users, carers and disabled people and their representative organisations, all of whom have a wealth of collective experience, expertise and professionalism. They are huge assets in helping to achieve a person-centred and needs-led approach to the delivery of locally based quality health and social care services. Another key voice is that of our GPs. The evidence that the British Medical Association and the Royal College of General Practitioners submitted to the committee was helpful, as it allowed us to examine possible barriers to fully and successfully engaging GPs in the planning of local services. An excellent example of integration that is already workingand being driven by GPsis Kirkcudbright community hospital and its adjoining GP practice, which has developed strong working relationships with local social services staff. That is only one example. At the other end of the spectrum, the GPs at the deep end groups case in favour of having GP surgeries in our most deprived areas functioning as natural hubs for integrated care to tackle deep-seated health inequalities requires us to recognise that, in many of those communities, services may be the least integrated. That great variation in local experience reinforces the case for the bill and highlights how important integration at the locality level will be, how important the widest involvement of key stakeholders including GPs and our local professionalsand partners at that level will be, and how important it is to scale up the capacity of the third sector to ensure that those who work closest to individuals and communities can participate and engage fully in service design and service delivery. Fully involving our GPs, the third sector, local professionals, carers groups and disabled people at the locality level will

make a positive difference to the delivery of integration. The localities will be where many of the key decisions concerning service users will be made. In Dumfries and Galloway, the local authority and the NHS board are already clear that the way to implement integration is to focus on building up the service model at locality level first. Our region has a natural advantage, in that it has four well-established areas corresponding to the old district councilsa natural pre-existing delivery model. The NHS and the council have capitalised on that by commencing integration from the point closest to the service user through planning local integration in those four areas, rather than starting at the furthest way point with the top-level governance model. Of course, both those structures need to be right, but in considering the top-level arrangements we must not lose sight of the fundamental importance of integration in the localities, where the services will actually be delivered and the real difference made. I will close by saying that I fully support the general principles of the bill. I look forward to considering the amendments during stage 2, when I hope that we can work together to produce an act that will be regarded as a fundamental reform of the way in which we care for Scotlands people. House of Commons Written Questions Dementia 26/11/13 Jim Shannon: To ask the Secretary of State for Health how many people have been diagnosed with dementia in (a) England and (b) Wales by age group in each of the last three years. Norman Lamb: The number of people recorded on practice disease registers with dementia in England is shown in the following table. The data are not available by age groups. Diagnosis for dementia in Wales, Scotland and Northern Ireland is a matter for the devolved Administrations.
Prevalence of dementia in England in 2010-11 to 2012-13 Number of patients on dementia register 2010-11 266,697 2011-12 293,738 2012-13 318,669 Source: Health and Social Care Information Centre

Link to view online here House of Commons Prime Ministers Questions Dementia 27/11/13 Richard Fuller (Bedford, Conservative): The Tibbs Foundation provides uplifting support for people living with dementia in Bedfordshire and for their carers. Following his challenge on dementia last year, and ahead of the G8 summit that he will host in London next month, will my right hon. Friend send a message to my constituents about his commitment to achieving real progress on dementia research and care? The Prime Minister: I am grateful to my hon. Friend for raising this issue. For too long in our country people thought of dementia as a natural part of ageing, rather than what it is, which is a disease that we should be fighting with all the energy with which we are fighting heart disease and cancer. As part of the dementia challenge, we have said that we will double research funding over the lifetime of this

Government from 26 million to more than 66 million a year in 2014-15. But we also want to see an increase in diagnosis rates, because getting to grips with dementia early is vital, and we want the diagnosis rate to go from less than a half to two thirds. I think my hon. Friends constituents will welcome those pledges, and obviously, through our G8 chairmanship, we can galvanise action around the world as well. Link to view online here House of Commons Prime Ministers Questions Dementia 27/11/13 Hazel Blears (Salford and Eccles, Labour): Four weeks ago in Eccles, I met Joy Watson, who is 55 years old, a mum and married to Tony. For the past four years, Joy has had problems with her memory and on her 55th birthday she was diagnosed with early-onset dementia. Her family are devastated, but she is an inspirational woman and is now fighting for better services for people in similar circumstances. Will the Prime Minister ensure, at the G8 in London in two weeks time, that there will be a real push for an increase in research into the quality of care and support and prevention, as well as into the important search for a cure? The Prime Minister: The right hon. Lady is absolutely right. There is no one single thing we have to do: the research budget needs to go upand it isbut we also need to work within the health and social care sectors to improve standards. Frankly, we also need to make our communities more dementiafriendly. Something we can all do is become a dementia friend, which involves a simple, relatively short test and a bit of learning about how to help people with dementia in our communities. It is not just about the health and social care sectors, but about when people are trying to go on a bus, access their bank account or go down to the post office. How they actually live their lives is something we can all make a difference to. Link to view online here House of Commons Debate G8 Summit on Dementia 28/11/13 Tracey Crouch (Chatham and Aylesford, Conservative): I beg to move, That this House has considered the G8 summit on dementia. It is a pleasure to see you in the Chair, Madam Deputy Speaker; this is the first opportunity I have had to give you my warm congratulations on your election. I am incredibly grateful for the support of the right hon. Members for Salford and Eccles (Hazel Blears) and for Sutton and Cheam (Paul Burstow), and others, for helping to secure this debate. I thank the Backbench Business Committee for allowing Members time to contributealbeit brieflyto a debate on what many believe is one of the most important issues facing our health and social care system in the future. I shall keep my opening comments as brief as possible, as I know that others wish to speak, but it is important to congratulate the Prime Minister on using the opportunity of hosting the G8 summit on 11 December to focus on international efforts to prevent, delay and effectively treat dementia. The debate will allow parliamentarians an opportunity to shape discussions at the summit, following on from wider and commendable consultation with the public. Collaboration, which is at the heart of the conference, is the basis of my contribution to the debate. Before addressing the specifics, it is important to set out the global perspective. Dementia affects more than 35 million people worldwide and is now considered to be one of the greatest global health challenges of our time. It is estimated that, by 2050, more than 150 million people will suffer from dementia.

Hon. Members will have seen the devastating human cost of dementia if not in their families, then in their constituencies. We know of the suffering of those with the condition and those who become carers for their loved ones. However, we perhaps do not so obviously see the huge economic effects of dementia, the worldwide cost of which is estimated to be about 400 billion, which is the equivalent of 1% of world gross domestic product. Without urgent action, that figure will increase in line with the number of people who are anticipated to get dementia, which is why global collaboration is essential. The more we can do together globally, the better the outcomes we can secure nationally. Mr Simon Burns (Chelmsford, Conservative): My hon. Friend makes an extremely important point. Does she accept, however, that it is equally important to do more on seeking diagnoses? About 350,000 people in this country are undiagnosed and go without the help and support that those who have been diagnosed receive. Link to view the debate in full online here SOCIAL MEDIA Sky News 29/11/13 DAILY TELEGRAPH FRONTPAGE: National shame of dementia diagnosis #SkyPapers pic.twitter.com/DT8mKrnumb Labour Press Team 29/11/13 Under David Cameron's watch care for people with dementia is getting worse not better Alzheimer's Society - 29/11/13 Find out about the quality of dementia care in your area by using this interactive map from @DHgovuk #G8dementia http://ow.ly/rhUFO Jeremy Hunt 28/11/13 Today I visited one of the best dementia care homes Ive ever seen - congrats to the team @NGHHammerson for their pioneering approach Anna Hepburn, Department of Health 28/11/13 Video blog by @ABurns1907 - current position on #dementia & looking forward to #G8dementia summit http://bit.ly/1cyMrw4 Guardian Social Care 28/11/13 New on the network: How Uncle Arthur's #dementia sparked a more person-centred approach to care http://www.theguardian.com/social-carenetwork/2013/nov/28/uncle-arthurs-dementia-sparked-new-approach-care @HSAUK UK Prime Minister 27/11/13 PM: We've doubled #dementia research funding & want to see diagnosis rates increase. Through @G8 we can galvanise action around world #PMQs Dementia Friends - 24/11/13 What is dementia? This film explains and defines what dementia is, and how it affects the brain.... http://fb.me/24xzgSQI4
Alzheimer's Society 23/11/13

Is it best to keep encouraging a person with dementia to go to social groups when they seem reluctant? Read more: http://bit.ly/17P0sIv Alzheimer's Society 18/11/13 Dementia and aggressive behaviour factsheet - practical tips for carers to help prevent & manage aggressive behaviour http://ow.ly/qWcaz