Improving quality of life for the elderly

Is pain treatment in dementia patients good enough?

In a thought-provoking paper primarily about pain management in patients with dementia, researchers question whether patients are actually receiving the right pain treatment at the appropriate dosage at the right time? They underline that current guidelines and protocols for pain assessment, particularly in patients with little or reduced abilities to communicate, may not be enabling health care professionals to optimally manage patient pain.

Read more in the paper, Treating Pain in Dementia-Are We Good Enough? by researchers Elisabeth Flo and Bettina Husebø.

Using mixed-method approaches gives more comprehensive understanding

Suffering refers to human existence as a whole entity, including mental and physical health, as well as social well-being. IGS Professor, Jorunn Drageset, was first author among a group of authors who recently wrote a study that stated that there are too few studies that consider associations between these different factors. They underline that exploring these associations requires more than one specific research approach and that mixed-method approaches are necessary to determine ways to decrease the experience of “suffering” that patients living in nursing homes and having no cognitive impairment may have, as well as to increase their health-related quality of life. Drageset explains that this is a very vulnerable group.

The results published in this paper highlighted that psychosocial aspects and the phenomenon of suffering are related to painful experiences during life, such as “traumatic experiences from the war”, “feeling like a prisoner”, “difficult childhood experiences”, etc.. They found that symptoms of anxiety and depression were negatively associated with mental health, while symptoms of anxiety were associated with bodily pain. In addition, the results showed that attachment and social integration were associated with both vitality and social functioning.

The authors note that their study’s conclusions imply challenges for health care providers. Among other things, they need to:

• understand how an individual’s suffering is related to anxiety, depression and relationships;
• spend increased time to listen to patients and better understanding the patient’s individual experience;
• help patients build strategies for better understanding their own suffering, engage in meaningful activities and interactions.

Read more in the paper, Suffering and mental health among older people living in nursing homes-a mixed-methods study, by IGS researchers Jorunn Drageset, Gerd Karin Natvig and others.

Improving interactions with dementia patients

Eva Gjengedal from IGS was involved in a 5-month, action-oriented study that aimed to improve caregivers’ interactions with people living with dementia. In the study, clinic personnel used Marte Meo Counselling (MMC) as well as being given continuous opportunities for reflective discussions about the experience. The objective of MMC is to change a caregiver’s focus from challenging behaviours (as symptoms of a disorder) to challenging interactions; as well as from generalised skills to contextualised relational care; and from personal challenges to a being a member of a professional community. The paper authors’ conclusion and suggestion for practice was that combining MMC with continuous reflection improves healthcare providers' interactions with people who live with dementia.

The researchers had hoped that the study experience would motivate caregivers at clinics to continue the improvement process and to be responsible for sustaining and developing improved interactions. According to Gjengedal, they have achieved some success as the clinical personnel involved have continued to use MMC after the study period was over, and that a number have taken further training so as to be MMC mentors and resource persons for both internal and external colleagues. In addition MMC-training is now being offered in several regions and in some college programmes.

Read more from the paper, ‘On one's own strength' Healthcare providers' experience with introducing Marte Meo Counselling in dementia care. by Eva Gjengedal and others.

Can calcium in drinking water help reduce hip-fracture rates?

Hip-fractures have an enormous health impact, as one in four patients die within a year of the fracture and many survivors experience severe pain and loss of function. Norway has the highest rates of hip-fracture in the world, but this rate varies across the country, why? A recent large, prospective study covering two thirds of the Norwegian population and including 19,000 hip fractures has shown that variations in the amount of copper included in the drinking water may play a role. The study showed that the beneficiary effect of calcium in drinking water is dependent on what other minerals, particularly copper, are also present.

Read more in the paper, Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study, where Cecilie Dahl and Grethe Seppola Tell were authors.

In a private communication, Dahl explains that drinking water regulations in Norway have traditionally been based on EU-guidelines. She underlines that in most of the EU, drinking water is “hard” and high in concentrations of calcium and magnesium, whereas in Norway most drinking water is low in these minerals due to geological characteristics and the fact that much of the drinking water is actually surface water. This means two things, says Dahl. First, that people in the EU and many other countries with harder water have long been benefitting from drinking water with higher mineral levels. Second, that there are no reported side-effects from drinking the harder, more mineralised water. However, there is not enough empirical data on this, so Dahl would like to see future research involving gathering evidence in in the form of a randomized study or a cross-over study (comparing disease in the population before and after raising the mineral levels in water). More information about the public health measures relating to drinking water can be read in  Dahl’s thesis (page 71).

Papers mentioned in this news article:

• Treating Pain in Dementia-Are We Good Enough?
  Flo E, Husebø B.; J Pain Palliat Care Pharmacother. 2015 Aug
• Suffering and mental health among older people living in nursing homes-a mixed-methods study.
  Drageset J, Dysvik E, Espehaug B, Natvig GK, Furnes B. PeerJ. 2015 Jul 30
• On one's own strength' Healthcare providers' experience with introducing Marte Meo Counselling in dementia care.
  Lykkeslet E, Gjengedal E, Skrondal T, Storjord MB. Int J Older People Nurs. 2015 Jul 29.
• Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study.
  Dahl C, Søgaard AJ, Tell GS, Forsén L, Flaten TP, Hongve D, Omsland TK, Holvik K, Meyer HE, Aamodt G. Bone. 2015 Jul 17