I caught a programme recently on Health before the NHS which was a very interesting look at what was essentially private health care in the UK. There was a definite lack of research around then with more trial and error approaches to finding a cure – if you were lucky enough to afford it. If you were not you were either looked after by family members at home or in the workhouse. Some hospitals that are probably in decline now around the country were originally workhouses and I remember the fear some of the older people I worked with had of them. There was a fear that if you went into the workhouse you never came out and that you would die in there. Home care was therefore preferable but this was usually carried out by family members or neighbours who are also known as lay people. They may have a lot of experiences in caring but they have learnt this on the job, often through trial and error finding out what works and what doesn’t. Often this is a very person centred way of providing care in that you are trying to find out what works the best for that individual person. It can also be a little risky in that we cannot be sure that some methods employed might also cause harm to the person. The only way of being sure is by seeking professional help who can advise and support lay people in making safe decisions. Professionals are also expected to be registered with a professional body and to base their practice in a sound evidence base that they can share with others. Lay people also known as carers, represent a large part of current health and social care and without them the system would probably collapse. It is important therefore to take their concerns very seriously and to help them gain professional support in the very important role that they have in our caring society.
Diagram from Almeida OP, Yeap BB, Alfonso H, Hankey GJ, Flicker L, et al. (2012) Older Men Who Use Computers Have Lower Risk of Dementia. PLoS ONE 7(8):
e44239. doi:10.1371/journal.pone.0044239 (Creative Commons Attribution License)
An interesting Australian study published in PLOS One recently by Almeida and colleagues suggests that computer use is associated with a reduced incidence of Dementia. However this is not the same as saying that computer use reduces the risk of Dementia. That would imply causality. This study establishes a relationship and the authors draw caution in their conclusions.
So what were the key points of the study?
- 5506 older adult men (age 69 to 87 years) were followed-up in the community
- Mean age was 75.5 years
- They were followed up for 8.5 years
- The primary outcome was the incidence of Dementia (using ICD-10 diagnostic criteria)
- If diagnoses were made before 1996, ICD-9 was used
- Computer use…
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There are so many different types of care to choose from how do you know which is the best? Well there should always be some evidence that whatever type of care you are provided with or providing should be effective and not do any harm. Research is often carried out to find out how effective some treatments are and this might include medication, surgery, counselling or other therapeutic interventions. Fortunately we no longer need to go looking for the evidence as the two main health and social care organisations will do it for us. The National Institute for Health and Clinical Excellence (NICE) and The Social Care Institute for Excellence (SCIE – pronounced SKY) -see links on the right -make recommendations for best practice and also produce easy read guides. A very useful and free resource. If you are looking for more hard core evidence go to the Cochrane Library that identifies and reviews only the most rigorous research, usually in the form of randomised controlled trials (RCTs) Meta Analysis and Systematic Reviews.