This article has been provided and sponsored by Quality Compliance Systems.
Author: Jackie Pool, Dementia Care Champion at Quality Compliance Systems (QCS)
Breakthrough moments are very rare in science, but last month there were two. While the announcement by Pfizer – and later Moderna – that a Covid-19 vaccine will be licensed shortly – made headlines around the world, another quantum leap, by Swiss and Italian scientists, has the potential to be equally transformative for millions of people living with Alzheimer’s disease.
A ground-breaking study has proven that there is a link between Alzheimer’s disease and gut microbiota. The research, which was conducted over several years in hospitals and universities in Geneva, Naples and Brescia, confirmed a correlation between ‘an imbalance in the gut microbiota and the development of amyloid plaques in the brain,’1 which causes Alzheimer’s disease. What is particularly exciting is that this pioneering study lays the foundations for researchers to potentially develop a drug that one day may prevent Alzheimer’s disease.
In the meantime, however, this trailblazing research also reminds us of the great value of adopting a holistic approach to healthcare. As the Alzheimer’s Society says, ‘what is good for the heart is good for the brain’.
Working to this simple premise, to achieve even better outcomes there needs to be closer union between primary, secondary care and the care sector.
It’s fair to say that the needs of those with dementia, a condition which affects 850,000 people in Britain and costs the UK £23.6 billion each year2, does not receive the same recognition as, for example, cancer patients. It is a subject that Manchester mayor, Andy Burnham, is very passionate about. He said, ‘we won’t have a 21st century NHS until it supports people with dementia as well as it supports people with cancer.’3
As a leading specialist in dementia care for the last three decades – having worked for the NHS, in the care sector, in academia, and now for QCS – I largely agree with Mr Burnham’s comments. But the key question is, how do we best effect change?
In fairness to the NHS, it has already put the basic building blocks in place to promote a more joined-up culture of collaboration in the form of Primary Care Networks (PCNs). There are now 1,250 Primary Care Networks in England, each of which (on average) is providing between 30,000 and 50,000 patients with more integrated health systems.
But it is not enough to simply create PCNs. If they are to make good on their foundation principle of ‘…finally dissolving the historic divide between primary and community health services,’4 they must also make a profound difference to those living with dementia.
How to effect lasting change
There are many ways PCNs can effect change. Take the NHS Health Check, which is offered every five years to anybody between the ages of 40 and 74, for instance. Given that we now know what the scientific community has suspected for a long time, that there is a strong link between Alzheimer’s disease and gut microbiota, regular check-ups like these – especially for those with a family history of dementia – could prove invaluable.
The game-changing step, though, is not just about checking a person’s bloods, but carrying out regular prebiotics checks to understand gut health more in the context of the impact on brain health, as well as the digestive system. Collaboration is also crucial. So, it might be that practices explore partnerships with specialist nutritionists who would be able to devise the optimal diet for a person where there might be a strong family link to dementia. However, with the correlation between gut health and Alzheimer’s disease now proven, discussing in more detail and explaining the links around dietary habits in the health ‘MOT’ would seem to be a cost-effective and prudent preventative step.
In addition to addressing the gut microbiota, at a more basic level, PCNs could work together to support individuals to maintain a healthy diet, in order to reduce the impact of the dementia. This could include the identification of any potential malnutrition, under nutrition and dehydration which can be affecting an individual’s brain and body health. Simple lifestyle changes can make such a difference to cognitive function, including keeping sugar and salt intake low, drinking plenty of water, eating foods that are rich in omega 3, such fish, and also ensuring a good intake of fibre, vitamins and minerals in the diet.
I also think that future health assessments need to factor in sleep patterns, as a study in Taiwan revealed that those ‘with primary insomnia, especially those under 40, had a higher risk of developing dementia than those without primary insomnia’.5 Studies have shown that healthy adults need between seven to nine hours of sleep to refresh the brain. Healthcare professionals can ask basic questions such as ‘How are you sleeping?’; ‘When are you sleeping?’ and ‘How long are you are sleeping?’ For those presenting with more serious conditions, such as insomnia or sleep apnoea, PCNs can also enlist the help of sleep coaches and sleep hygiene clinics, if required.
For those living with dementia, the collaborative spirit forged by PCNs can also add great value to their quality of life. But, again, it requires all of the different partners involved to have an in-depth understanding of the daily barriers that those with dementia face, and then for everyone to pull in the same direction.
Understanding those challenges is far from easy. They are nuanced and interlinked. Take eating and drinking, for example. The question that GPs or other healthcare professionals will probably ask is how much is a person with advanced dementia eating or drinking? But a better question is: ‘What is getting in the way of that person eating and drinking? That requires collective insight from a care worker, an occupational therapist, a nutritional therapist and a speech and language therapist. Armed with this input, frontline workers – working in tandem with PCNs – can help improve the patient’s eating habits, which can go a long way to improving their quality of life.
The QCS PAL tool
With these foundation blocks in place, it is much easier to assess that person’s level of ability. With this in mind, I developed the QCS PAL Instrument in 1995. In 2008, the Instrument was validated by University College London, and it continues to provide a highly effective framework to assess clients with cognitive impairments caused by conditions related to dementia, strokes and learning disabilities.
Not only does the QCS PAL Instrument assess the cognitive functional level of ability of an individual, it also produces a bespoke guide as to how the person can be best supported at each specific level – of which there are four. This approach, which is being taken to the next level at QCS, can make a real difference to the life of an individual, and also to their carer or carers.
Perhaps, this provides powerful evidence that, while science has the potential to transform the world, it is people working together at ground level that really shape the future.
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[i] Eureka alert
Link between Alzheimer’s Disease and gut microbiota is confirmed
13, November, 2020
[ii] Both statistics taken from the Alzheimer’s Society website
[iii] Tomorrow’s Care
University of Salford, Manchester press release
[iv] NHS Confederation/NHS Providers
Primary Care Networks: a quiet revolution
[v] BMC Psychiatry. 2018; 18: 38.
Published online 2018 Feb 7. doi: 10.1186/s12888-018-1623-0 Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study