An article recently in the Daily Mail highlighted the importance of seeing your GP to discuss health concerns and to look beyond the obvious when treating incontinence and dementia.

When Carole Smith started tripping over more often, she started to worry. ‘ ‘I’d often bruise myself quite badly, but I never mentioned it to anyone. My walking had become more laboured and slower, too.’

There was another problem as well in that often she couldn’t reach the toilet in time.

‘It started ten years ago. I was so embarrassed and upset. I didn’t tell anyone — not even my GP.’

Then in 2006, when she was 67, Carole tripped on a kerb while carrying some shopping home and broke her ribs. She was taken to hospital, badly bruised and after that, a team of six physios came to my house for a week. She realised while they were there that the assumption was that dementia was setting in.

‘They were quite patronising and started trying to tell me things like how to cross roads safely and how to step up kerbs, as though I’d forgotten how to do it. But as far I was concerned, I still had all my marbles and was perfectly able to navigate around my house.’

Three months after the physio, Carole went to her GP to seek an explanation who asked to see her walk across the room. ‘She commented on the fact that my gait was wide and I was unable to keep my knees near each other and said she wanted to refer me to a neurologist for further tests.’

Her GP told Carole she thought the problem was hydrocephalus and said the incontinence and the way Carole was walking and falling were classic signs.

Hydrocephalus is an abnormal increase of cerebrospinal fluid in the brain.

When this fluid builds up it starts to affect the brain’s function, causing symptoms such as gait disturbance (a wide, slow, shuffling gait with unsteadiness, particularly when turning); cognitive impairment such as memory loss, confusion and urinary incontinence.

‘The result was instantaneous. ‘I was in (hospital) for three days having the fluid drained off through a small tube in my back,’ said Carole, who was diagnosed with normal pressure hydrocephalus.

‘Of these three symptoms, the gait disturbance is the one that always appears,’ says Richard Edwards, consultant neurosurgeon at Frenchay Hospital, Bristol. ‘The cognitive problems and incontinence usually accompany it, but not always.’

Carole was diagnosed with normal pressure hydrocephalus (NPH), where the cause of the build-up is unknown.

Acquired hydrocephalus is caused by damage to the brain after a head injury or after conditions such as stroke, brain haemorrhage, brain tumour or meningitis. The condition is most common in people aged 60 or older and its trio of symptoms are also classic signs of other conditions, such as Alzheimer’s or Parkinson’s disease, so it often goes misdiagnosed.

Incredibly, it’s estimated that 2 per cent of all people over 60 who’ve been diagnosed with dementia actually have normal pressure hydrocephalus, which equates to about 10,000 people in the UK.

‘One study showed that NPH affects about five people per 100,000,’ says Mr Edwards, ‘which means we should be treating about 3,000 new cases  a year. Instead, we’re treating about 300.’ He stresses the need for better awareness and testing, so fewer people are misdiagnosed. With a proper diagnosis, the symptoms of this kind of hydrocephalus can be alleviated.

For GPs and the public alike, there can be other indications to watch out for. ‘For example, if a person has been diagnosed with Parkinson’s, but they’re not responding to medication, then hydrocephalus should be considered,’ says Mr Edwards. Carole is thankful her GP spotted the signs so quickly.

The full article can be found at: http://www.dailymail.co.uk/health/article-2097376/How-dementia-beaten-drain-brain.html#ixzz1lnHYT7nL

Issue Codes Incontinence Accessories and Hygiene

Wales’ older people’s commissioner has expressed concerns about the treatment received by elderly people, including those with adult incontinence, when staying in NHS hospitals.

Ruth Marks published a damning report earlier this year, entitled ‘Dignified Care?, which found many older patients were receiving “shamefully inadequate” care in Welsh hospitals.

Ms Marks has now told the Western Mail that she remains unconvinced that patients are being treated with dignity.

She said that health boards and the Welsh government had responded to the report, but that “more does need to be done”.

“There is good and even excellent work in some areas, but there are inconsistencies and some absolute basics are still not there,” she revealed.

Earlier this year, Welsh ministers announced that the watchdog Healthcare Inspectorate Wales would be asked to carry out spot checks to ensure elderly patients are receiving a good standard of care in hospital.

These checks are likely to look at a number of issues, including dementia and the treatment of people with adult incontinence.

Issue Codes Incontinence Accessories and Hygiene

The charity Age UK has teamed up with the NHS Confederation and Local Government Group (LG Group) to set up a new commission focusing on dignity in care provided to older people in hospitals and care homes, many of whom are reliant on incontinence pads and pants.

The move follows recent reports on patient complaints from the Health Ombudsman and the inquiry into circumstances at Mid Staffordshire NHS Foundation Trust.

Experts will research what people expect in terms of dignity in care and establish ways to improve the situation across health and social care services.

Age UK chair Dianne Jeffrey explained: “This commission aims to build understanding of why and how older people’s essential care is going wrong and to set out practical solutions for getting it right in the future.”

Cllr David Rogers, chairman of the LG Group’s community wellbeing board, observed that public concern about the experiences of some patients and care home residents was “widespread and legitimate”.

He added: “The LG Group is very keen to play our part in finding practical ways in which we can raise standards and eliminate bad practice.”