Where dementia treatment meets your NEETS

A recent study has suggested that just ten minutes of social interaction is enough to mitigate the loss of quality of life in dementia sufferers.

A survey among care homes in south London, north London and Buckinghamshire found that dementia sufferers who had chats with care workers for a prolonged period of time – the average amount of interaction is estimated to be as little as two minutes a day in comparison – faired better when it came to measuring reduction in neuropsychotic symptoms and agitation. The chats were about areas of interest such as family, or the social interaction was extended to activity like sport.

Dementia sufferers in care home were divided into two groups – the first received conventional treatment while the second group received an hour of personal interaction over the week. Those in the second group demonstrated the benefits more prominently.

The difficulty with social interaction in many care homes is that the activities are limited to ones such as bingo, where people are together, but not really interacting, or that the interaction is on a one-to-many level, leaving many sufferers actually disengaged or bored, and more withdrawn in many respects. Interaction – if it can be called that – is very passive, and measured more by presence rather than participation. For example. sitting together in a bingo hall and doing “mental” activities such as bingo, or sitting with others to watch the soaps, occasionally piping up to say “What’s gawin on?” is unlikely to do much for one’s mental faculties.

Dr Doug Brown, director of research at the Alzheimer’s Society, said: “This study shows that training to provide this type of individualised care, activities and social interactions can have a significant impact on the wellbeing of people living with dementia in care homes.

“It also shows that this kind of effective care can reduce costs, which the stretched social care system desperately needs.”

The problem is that while this interaction may be perceived as cost-saving, because it relies less on medication, having paid carers on minimum wage, paid “conversers” is actually more expensive. But it is a method that seems to work.

The unfortunate state of the healthcare is not that it is based on what works, but what is the cheapest. The base line is not the quality of care, but because it would exceed a threshold that the NHS cannot afford, the cost takes priority.

Perhaps what would be an effective method would be for NEETS – young persons not in education, employment or training to do such work. It would give dementia sufferers someone to talk to, and the NEETS could actually learn something from observing life experience, and it would keep government happy because their unemployment figures would go down. And with recent mental health studies suggesting that only 1 in 5 young people have someone to talk to when they are down, would it not be conceivable that at least getting young people who may be on the verge of being depressed due to lack of employment to talk with someone else, for a bit of wage, might actually be an intangible way of reducing their likelihood of depression?

Getting the young unemployed to be befrienders in care homes – is that worth a thought?

Why health articles in newspapers should be retired

What is it that people look forward to? Most want time to pursue their interests and doing things they love. Some people have managed to combine all this by the traditional interest-led approach, doing things they love, starting up a blog, gaining readership, and then selling advertising space on their blog, or affiliate marketing and other things associated with making money from a website. For others, this lure for things they like is compromised by the need of having to make a living, and hence this is shelved while having to earn a living and put off until retirement.

For most people, retirement would be when they would be able to have the time and money to indulge in things they put off earlier. Some people have combined the starting of a blog and retirement, and made a living by blogging (and gaining a readership) about how they have or intend to retire early.

Retirement. Out of the rat race. All the time in the world. For most people, retirement is the time to look forward to.

A recent study however suggests that retirement is not all that wonderful. Despite it being seen as the time of the life where financial freedom has been achieved and time is flexible, it has been suggested that the onset of mental decline starts with retirement.

The Daily Telegraph reported that retirement caused brain function to rapidly decline, and this information had been provided by scientists. It further cautions that those workers who anticipate leisurely post-work years may need to consider their options again because of this decline. Would you choose to stop work, if this meant your mental faculties would suffer and you would have all the free time in the world but not the mental acuity?

Retired civil servants were found to have a decline in their verbal memory function, the ability to recall spoken information such as words and names. It was found that verbal memory function deteriorated 38% faster after an individual had retired than before. Nevertheless, other areas of cognitive function such as the ability to think and formulate patterns were unaffected.

Even though the decline of verbal memory function had some meaningful relevance, it must be made clear that the study does not suggest anything about dementia or the likelihood of that happening. There were no links drawn with dementia. Just because someone retires does not mean they are more likely to develop dementia.

The study involved over 3000 adults, and they were asked to recall from a list of twenty words after two minutes, and the percentages were drawn from there. The small sample size, not of the adults, but of the word list, meant the percentage decline of post-retirement adults may have been exaggerated.

Look at this mathematically. From a list of twenty words, a non-retiree may recall ten. A retiree may recall six. That difference of four words is a percentage decline of 40%.

Ask yourself – if you were given a list of twenty words, how many would you remember?

It is not unsurprising if retirees exhibit lower abilities at verbal memory recall because the need for these is not really exercised post-retirement. What you don’t use, you lose. We should not be worried about the decline, because it is not a permanent mental state, but it is reversible; in any case the figure is bloated by the nature of the test. If a non-retiree remembers ten words, and a retiree makes one-mistake and remembers it, that would be promoted as a 10% reduction in mental ability already.

Furthermore, decline is not necessarily due to the lack of work. There are many contributing factors as well, such as diet, alcohol and lifestyle. Retirement is not necessarily the impetus behind mental decline. Other factors may confound the analyses.

The research did not involve people who had retired early. For example, hedge fund managers might have retired in their forties. But you would struggle to think that someone in their forties would lose 38% of verbal memory recall.

Would a loss of 38% of verbal memory have an impact on quality of life? It is hard to tell if there is the evidence to support this. But the results point to a simple fact. If you want to get better at verbal memory, then practice your verbal memory skills. If you want to get better at anything, then practice doing it.

Was this piece of news yet another attempt by mainstream media to clog paper space with information – arguably useless? You decide.

The bigger issues that come with preventing hearing loss

Is there cause for optimism when it comes to preventing hearing loss? Certainly the latest research into this suggests that if positive effects experienced by mice could be transferred to humans and maintained for the long term, then hereditary hearing loss could be a thing of the past.

It has always been assumed that hearing loss is always down to old age. The commonly held view is that as people grow older, their muscles and body functions deteriorate with time to the point that muscle function is impaired and eventually lost. But hearing loss is not necessarily down to age, although there are cases where constant exposure to loud noise, over time, causes reduced sensitivity to aural stimuli. Over half of hearing loss cases are actually due to inheriting faulty genetic mutations from parents.

How do we hear? The hair cells of the inner ear called the cochlea respond to vibrations and these signals are sent to the brain to interpret. The brain processes these signals in terms of frequency, duration and timbre in order to translate them into signals we know.

For example, if we hear a high frequency sound of short duration that is shrill, our brain interprets these characteristics and then runs through a database of audio sounds, an audio library in the brain, and may come up with the suggestion that it has come from a whistle and may signify a call for attention.

What happens when you have a genetic hearing loss gene? The hairs on the inner ear do not grow back and consequently sound vibration from external stimuli do not get passed on to the brain.

With progressive hearing loss too, the characteristics of sound also get distorted. We may hear sounds differently to how they are produced, thereby misinterpreting their meaning. Sounds of higher and lower frequency may be less audible too.

How does that cause a problem? Imagine an alarm. It is set on a high frequency so that it attracts attention. If your ability to hear high frequencies is gradually dulled then you may not be able to detect the sound of an alarm going off.

As hearing gradually deteriorates, the timbre of a sound changes. Sharper sounds become duller, and in the case of the alarm, you may hear it, but it may sound more muted and the brain may not be able to recognise that it is an alarm being heard.

Another problem with hearing loss is the loss of perception of volume. You may be crossing the road and a car might sound its horn if you suddenly encroach into its path. But if you cannot hear that the volume is loud, you may perceive it to be from a car far away and may not realise you are in danger.

The loss of the hairs in the inner ear is a cause of deafness in humans, particularly those for whom hearing loss is genetic. Humans suffering from hereditary hearing loss lose the hairs of the inner ear, which result in the difficulties mentioned above. But there is hope. In a research experiment, scientists successfully delayed the loss of the hairs in the inner ear for mice using a technique that edited away the genetic mutation that causes the loss of the hairs in the cochlea.

Mice were bred with the faulty gene that caused hearing loss. But using a technology known as Crispr, the faulty gene was replaced with a healthy normal one. After about eight weeks, the hairs in the inner ears of mice with genetic predisposition to hearing loss flourished, compared to similar mice which had not been treated. The genetic editing technique had removed the faulty gene which caused hearing loss. The treated mice were assessed for responsiveness to stimuli and showed positive gains.

We could be optimistic about the results but it is important to stress the need to be cautious.

Firstly, the research was conducted on mice and not humans. It is important to state that certain experiments that have been successful in animals have not necessarily had similar success when tried on humans.

Secondly, while the benefits in mice were seen in eight weeks, it may take longer in humans, if at all successful.

Thirdly, we should remember that the experiment worked for the mice which had the genetic mutation that would eventually cause deafness. In other words, they had their hearing at birth but were susceptible to losing it. The technique prevented degeneration in hearing in mice but would not help mice that were deaf at birth from gaining hearing they never had.

Every research carries ethical issues and this one was no different. Firstly, one ethical issue is the recurring one of whether animals should ever be used for research. Should mice be bred for the purposes of research? Are all the mice used? Are they accounted for? Is there someone from Health and Safety going around with a clipboard accounting for the mice? And what happens to the mice when the research has ceased? Are they put down, or released into the ecosystem? “Don’t be silly,” I hear you say, “it’s only mice.” That’s the problem. The devaluation of life, despite the fact that it belongs to another, is what eventually leads to a disregard for other life and human life in general. Would research scientists, in the quest for answers, eventually take to conducting research on beggars, those who sleep rough, or criminals? Would they experiment on orphans or unwanted babies?

The second, when it comes to genetics, is whether genetic experimentation furthers good or promotes misuse. The answer, I suppose, is that the knowledge empowers, but one cannot govern its control. The knowledge that genetic mutation can be edited is good news, perhaps, because it means we can genetically alter, perhaps, disabilities or life-threatening diseases from the onset by removing them. But this, on the other hand, may promote the rise of designer babies, where mothers genetically select features such as blue eyes for their unborn child to enhance their features from birth, and this would promote misuse in the medical community.

Would the use of what is probably best termed genetic surgery be more prominent in the future? One can only suppose so. Once procedures have become more widespread it is certain to conclude that more of such surgeons will become available, to cater for the rich and famous. It may be possible to delay the aging process by genetic surgery, perhaps by removing the gene that causes skin to age, instead of using botox and other external surgical procedures.

Would such genetic surgery ever be available on the NHS? For example, if the cancer gene were identified and could be genetically snipped off, would patients request this instead of medical tablets and other external surgical processes? One way of looking at it is that the NHS is so cash-strapped that under QALY rules, where the cost of a procedure is weighed against the number of quality life years it adds, the cost of genetic surgery would only be limited to more serious illnesses, and certainly not for those down the rung. But perhaps for younger individuals suffering from serious illnesses, such as depression, the cost of a surgical procedure may far outweigh a lifetime’s cost of medication of anti-depressant, anti-psychotics or antibiotics. If you could pinpoint a gene that causes a specific pain response, you might alter it to the point you may not need aspirin, too much of which causes bleeds. And if you could genetically locate what causes dementia in another person, would you not be considered unethical if you let the gene remain, thereby denying others the chance to live a quality life in their latter years?

Genetic editing may be a new technique for the moment but if there is sufficient investment into infrastructure and the corpus of genetic surgery information widens, don’t be surprised if we start seeing more of that in the next century. The cost of genetic editing may outweigh the cost of lifelong medication and side effects, and may prove to be not just more sustainable for the environment but more agreeable to the limited NHS budget.

Most of us won’t be around by then, of course. That is unless we’ve managed to remove the sickness and death genes.

A smart person thought up the mental improvement products

The trail of human evolution is littered with gadgetry that have outlived their usefulness. We can add devices such as the fax machine, walkman, mini-disc and tape recorder to the list of machines which seemed clever at the time but have now before obsolete. Those of us of a certain age will remember newer additions such as the PocketPC, a palm sized screen which was used with a stylus that tapped out letters on screen, and the HP Jornada, a slightly bigger tablet sized keyboard and phone. And who could forget the Nintendo Brain Training programmes for the DS and Fitness Programmes for the Wii?

Launched in 2005, Nintendo’s Brain Training programmes claimed to increase mental functioning. Nintendo’s premise was that the concentration required in solving a variety of puzzles, involving language, mathematical and reasoning, increased blood flow to the frontal cortex of the brain, which at least maintained brain functioning or helped improve it. After all, since the brain is a muscle, exercising it by bombarding it with mental exercises would keep it active and healthy, right?

It is the idea of keeping the brain active that leads many to attempt their daily crossword or Sudoku. The latter in particular has seen an surge in interest over the past decade and is now a feature in newspaper back pages and magazines. There are even publications exclusively filled with Sudoku puzzles, and even more complex versions where each traditional puzzle forms a square in a bigger and complex three by three grid. If you thought doing a Sudoku puzzle was hard, imagine having to work on it in relation to eight others. It would be absolutely mind-boggling!

Is there any truth about the positive enhancements to the human life that these objects or activities bring? Nintendo’s claims about the Brain Training programmes were doubted by leading neuroscientists, who doubted the tenuous links between the increased blood flow to the brain and the vaguely described positive effects to life. It is akin to making a blanket statement saying chess grand masters or academics are the happiest people around. Unfortunately it is yet another case of a company creating a product and then engineering the science around it.

Manufacturers of beauty products do it all the time. Whether it is skin care or facial products being flogged, you will find an aspirational theme within the first five seconds of the advertisement (“Look beautiful! Stay young!”) which is then followed by a pseudo-scientific claim, preferably involving percentages (sounds more authoritative) and a small sample size (easier to corroborate, or disclaim, depending on the need).

“Live young forever. XX skin lotion is carefully formulated to retain your natural moisture, so you look and feel twenty years younger. 86% of 173 women noticed a change in skin density after using it for three months.”

There you have it. The secret of beauty product advertising.

Unfortunately, if there was any display of mental acuity, it was by the marketing team of Nintendo. In pitching a product to adults, using the retention and improvement of mental agility as a plus point, they not only convinced adults to buy what was essentially a toy, but to buy one for their children as well. The DS alone has since sold over 90 million units worldwide, and when you take into account the cost of games and all that, you will have to concede that someone at Nintendo had the smarts to produce a tidy little earner.

(For those who were more concerned with retaining their physical functioning, the Nintendo Wii Fit programmes performed that function and filled in the gap in that market.)

The improvement of mental functioning is always a good basis for marketing any product. You can find a whole plethora of products huddling behind it. Multi vitamins, activity puzzles, recreational activities involving multi-tasking – all supposedly give the brain a workout, but more importantly, tap into the fears of missing out or the loss of mental function in the human psyche, that makes people buy not out of potential gain, but fear of lost opportunity and potential regret.

The loss of mental function can lead to Alzheimer’s disease, for which there is currently no cure. With 30 million people worldwide suffering from it, this presents an endless river of opportunity for people researching the disease, as well as people developing products to improve mental function in the hope that it can stave off the disease. Like the Nintendo Brain Training developers realised, it is not so much about whether these scientific products work that makes people buy them – the evidence that is produced is biased and not independent – but it is the fear of missing out and retrospective guilt that compels people to make the purchase. Buy first, examine the evidence later, is the apparent dogma.

Unfortunately we are at the stage of modern society where it is not just the product that needs scrutiny, but whether the scrutiny itself needs scrutiny for evidence of bias, either in the form of financial ties or expected research outcomes.

Mental improvement is an area that product developers – whether the products be vitamins, books or applications – will continually target because human beings will always seek to improve mental prowess, both in themselves and their children, in the hope that somewhere down the line it offers an advantage, or prevents the mental degeneration associated with the aging process. And the compelling reason to buy lies somewhere in the meeting points of being seduced by the aspirational ideals the product offers, the fear of missing out, and the assumption that the underlying evidence is empirical. The greatest mental sharpness has been displayed by the one who has understood the sales psychology of mental health improvement products and used it to his or her advantage.

Set aside time and space for your own mental health

Work places huge demands on modern living. It goes without saying that over generations work demands have increased. For example, generations ago the concept of a traditional job for most people was a five-day working working week. The song “9 to 5” by Dolly Parton more or less captured the essence of work at the time. (Unfortunately, it is still fairly often played, to the point that people in non-Western societies assume we still only work eight hour days, five times a week, and spend our free time sunning ourselves on the beach.) Nowadays people have to work longer hours, and travel further for work. The total time spent each day traveling and working each day could easily amount to twelve hours, and it is not like the commute is down time – we still have to catch up on emails, admin, and type away busily on the laptop. We could easily spend sixty hours doing work-related things.

And the weekends? Forget the weekends. These days there is no distinction between a weekday and a weekend. Work has steadily grown its talons and where an hourly-rated individual used to get 1.5 or two times the normal rate for working on a weekend, these days it is the same. Employers realise that in an economy with job shortages, they can get away with offering less rates but will not be short of takers.

The problem with all this is that we don’t really have much of a choice when it comes to establishing our work boundaries or exercise or rights when we realise we are being pushed beyond our work boundaries. We’re made to feel that in these times, we are lucky to hold down a job, and if we complain about the increasing demands of it, and how higher managers try to force more work on us without increasing our pay, we might get told to take a hike and end up in a more difficult situation of having no job, commitments to uphold and having to start out again. There are lots of people trapped in jobs where they have to take on more and more as the years go by, and have every ounce of work and free hour extracted from them for little pay. This places increasing mental demands on the individual not just in having to cope with work demands, but the possibility of being made redundant if he or she shows weakness by having to admit an inability to cope any more. It is a no win situation.

Is it a surprising statistic that mental health illness is on the rise? Hardly.

Nowadays people are working more to live and living to work more.

What can you do to preserve some semblance of mental health?

The first thing you can do for yourself is to establish boundaries within the home. Establish a space where work does not intrude. A good idea is often the bedroom, or even have a rule that you will not work on the bed. If you end up working on your laptop in the bed, it will not do you any good – keep at least a certain physical space for yourself.

Also try to set aside a time each day for yourself if possible. It is possibly unrealistic to say an hour each day in the modern life climate, but something like twenty minutes to half an hour would be a good idea. Use this time to wind down in your personal space doing something you enjoy, that is different from work. You may think you cannot really afford that time, but it is important to disassociate yourself from work for the sake of your long-term longevity. Think of it as enforced rest. If it works better for you, take your enforced in the middle part of the working day. You don’t necessarily have to be doing something, use it to rest or catch a power nap.

Every now again, such as on a weekend, do something different from work. Do a yoga class, learn an instrument like the piano, or play a game of tennis. The possibilities for leisure are endless. But don’t bring your work approach to your leisure. Don’t start charting your tennis serve percentage, or do anything that makes your leisure activity appear like work in a different form. The only thing you must do with a businesslike approach is to meet this leisure appointment so that your life does not revolve around a continuous stretch of work.

We can moan about it but the nature of work will never revert back to how it was in the past. Those of us who long for the good old days will only make our own lives miserable with wishful thinking. Those of us who insist on working five-day weeks will find it is insufficient to maintain modern living in the twenty-first century. We will all end up working longer and harder in the current economic climate, and even if times improve, employers will be unlikely to go back to pre-existing forms of remuneration if workers have already been accustomed and conditioned to work at a certain level, because it is more cost effective to hire fewer employees who do more work than have the same work done by more employees. Employees have to recognise that adapting to increasing work loads are a working life skill, and that taking steps to negate increasing pressures will also be an essential part to maintaining our own mental health and well-being.

The quest for fitness may be detrimental to your long term mental state

We are often told how we should aim to have, and maintain, a healthy lifestyle. After all, being physically fit allows your body to function both in physical and mental aspects. Healthy body, healthy mind, right?

The only difficulty, if you can call it that, with exercise is that the first thing that we would normally consider is running, but it is not for everyone. Going forward for a certain distance or time has little meaning for some people, especially children.

The thing about running is that it has to have some appreciable meaning, so unless you have some derivative inner joy of measuring your progress using statistics, it is unlikely to hold your interest for the long term. A better form of exercise is though group sports, as the mental boredom of tracking fitness levels is negated in favour of the social dynamic.

Common group sports such as football¬† have a large following in England. The football season for example lasts from August to May and provides a welcome distraction during the cold winter months. It is also a simple game that can be improvised using other materials and played on all surfaces. No goalposts? Use bags or some other markers. No football? Use a tennis ball. It is often interesting to see children turn up at a field, establish the boundaries of play using trees and creates goalposts using caps or other loose materials and these are often sufficient for the game; at least until there is discussion about whether the “ball” hit the post or went in the goal after it flies over a set of keys intended to represent the goalpost.

There is increasing concern about the link between dementia and football. The pounding of the ball against a soft surface of the brain, when the ball is headed, over time can cause the destruction of cells and cell function. This is of particular concern in the case of children, whose brains and bodies are developing. This has been of significant interest as members of England’s 1966 World Cup winning squad have found to have developed dementia in their later years. Some of them cannot even remember being there in 1966!

It is not just the impact of ball on head that is concerning, but when the head is moved through a range of motion too quickly. Even though there is no impact on the head externally, internally there is damage as the brain is hitting the sides of the skull supposed to protect it.

It is not just football that we have to be concerned about. There is plenty of head and neck related impact in rugby and American football. In fact, in American football, the head related injuries for offensive and defensive linemen, who every forty seconds start a play by ramming into the player on the opposite side of the line,  and the list of dementia sufferers is growing continually. Some players have even sued the NFL for injuries suffered during the game.

Will the rules of football change so that heading the ball is banned? Don’t bet on it. That would change the fabric of the game so much as to ruin it. When the ball is swung in from a corner, what would you do if you couldn’t head it? The game will not change, but also don’t rule out a consortium of players in the future filing lawsuits for work-related injuries. Perhaps in the pursuit of fitness, it may be wiser to choose less impactful activities for the sake of long term health.