'Offer Baking and Gardening' for Dementia, NICE Says

Peter Russell

July 01, 2019

Helping people with dementia choose activities to promote their wellbeing, and draft guidelines on reducing indoor air pollution, were among announcements from The National Institute for Health and Care Excellence (NICE) this week.

Dementia Activities

Activities such as art, gardening, and baking should be offered to people living with dementia, NICE said this week.

People with dementia should be given the opportunity to talk about their life experiences, preferences, interests, and strengths with a healthcare professional. This would help them choose activities to promote wellbeing, it said.

The final quality standard said that exercise, aromatherapy, music therapy, mindfulness, and animal assisted therapy were also among activities that could help improve the lives of people with dementia.

"People with dementia can find it harder to take part in activities, to engage socially, to maintain their independence, to communicate effectively, to feel in control, and to care for themselves," said Prof Gillian Leng, deputy chief executive and director of health and social care at NICE. "Providing enjoyable and health-enhancing activities like music or reminiscence therapy can help with this.

"Understanding the activities that a person prefers and thinks are suitable and helpful, and adapting them to their strengths and needs, will make a person more likely to engage with the activities offered and therefore more likely to benefit from them."

The recommendations also underlined the importance of offering carers education and skills training, such as personalised strategies to help them provide care, and understanding how to respond to changes in behaviour of those they were caring for.

Dementia UK’s Director of Clinical Services, Paul Edwards, commented: "Activities fostering connection can make all the difference, which is why we welcome these recommendations wholeheartedly.

"In dementia care however, it’s important to offer tailored support as every diagnosis of dementia is as individual as those who receive it. Activities which take into account likes and past experiences of people with dementia can be discussed as part of a care and support programme with our dementia specialist nurses."

Indoor Air Pollution

NICE continued with work on drafting guidance on indoor air quality at home.

The guidelines covered exposure to air pollutants from building materials, furnishing and cleaning products, and activities such as cooking and smoking, as well as biological sources such as mould, house dust mites, bacteria, pests, and pet dander.

The guidance advised people to ensure rooms were well ventilated, by opening windows or using extractor fans when cooking, drying clothes inside, using household sprays, or solvents and paints.

Also, those with compromised immune systems such as pregnant women should reduce their use of aerosols and household cleaning sprays, which can all emit pollutants.

Architects and builders were also asked to adopt a 'whole-building' approach to heating and ventilation in their designs in order to minimise exposure to particulate matter. This included situating windows away from sources of outdoor air pollution, and using building materials that emit low levels of formaldehyde and volatile organic compounds (VOCs).

Indoor air pollution contributes to respiratory and other diseases, and to premature deaths.

NICE said the Department of Health and Social Care had commissioned guidance because of the 60% to 90% of time that people spent indoors, 60% of which is spent in the home.

Prof Jonathan Grigg, paediatric respiratory consultant from the Royal College of Paediatrics and Child Health said the guidance was a welcome step in the right direction. "Since children spend most of their time indoors, the potential for indoor generated pollutants to cause adverse health effects can no longer be ignored," he said.

Dr David Rhodes, director of environmental public health at Public Health England said: "We are asking local authorities to compare their current practice with our recommendations and to consider what changes may need to be made to put them into practice.

"In considering any changes, they will need to consider any extra costs they may incur. The speed at which these recommendations are adopted by local authorities will depend on the resources they have available and the other priorities they are dealing with."

A consultation on the draft guidance closes on 9th August, with final guidance expected in December 2019.

Listeria in Hospital Sandwiches Update

Public Health England (PHE) said it was testing all recent samples of listeria to check if they were connnected to an outbreak of cases linked to sandwiches at hospitals in England.

It said it had so far analysed 29 samples from people with listeriosis within the time frame the incident was thought to have occurred. As previously reported, there were nine confirmed cases and five deaths linked to the outbreak. Another 20 cases were not linked, PHE said.

An analysis suggested that individuals affected ate the sandwiches and pre-packed salads before the products were withdrawn from sale on the 25th May 2019.

Dr Nick Phin from the National Infection Service at PHE said: "Swift action to remove the affected products from the supply chain has ensured that there is a low risk to patients and the public.

"Public Health England is carrying out a thorough genomic analysis of all listeriosis cases reported in England and can confirm that so far, there are no further cases linked to this outbreak across the UK. Our investigations continue, and the public should be reassured that the risk to the public continues to be low."

Hypertension During Pregnancy

NICE updated clinical guidance on diagnosing and managing hypertension in pregnancy.

Guidance offered included:

  • Pregnant women with hypertension should be offered the right tests and treatments to keep their blood pressure within a safe range for them and their baby

  • Women who are taking medicine for blood pressure and want to try for a baby (or have found they are pregnant) should be given the best advice about the safety of different medicines for their baby

  • Women should have good advice and support, including how to spot signs of pre-eclampsia and what to do

  • Care teams should give women the right follow-up care and check-ups after they have given birth

Depression in Children

Final guidance on identifying and managing depression in children and young people aged 5 to 18 years was issued by NICE.

The guidance was based on the stepped-care model, and aimed to improve recognition and assessment, and promote effective treatments for mild and moderate to severe depression.

NICE said it wanted to ensure that:

  • Healthcare professionals know how to spot signs of depression in children and young people and know how to help

  • An assessment for depression covered not just their symptoms, but how these affect all areas of their life, including school, home, and friendships

  • Healthcare professionals know which therapies to recommend first for mild, moderate and severe depression, and when to think about medication

  • Talking therapies were offered to fit individual needs, either online, one-to-one with a therapist, with a group, or with the family

'Yes' for Multiple Myeloma Treatment

Lenalidomide (Revlimid, Celgene) plus dexamethasone was recommended in final NICE guidance as an option for previously untreated multiple myeloma in adults who were not eligible for a stem cell transplant.

Treatment could be recommended in cases where thalidomide was contraindicated for any reason or the patient could not tolerate thalidomide.

An appraisal committee said evidence suggested that the combination therapy substantially improved the length of time people lived compared with the usual bortezomib-based therapy.

Antimicrobial Guidance for Leg Ulcers

Antimicrobial prescribing guidelines for leg ulcer infections in adults were issued by NICE for consultation.

The guidance aimed to optimise antibiotic use and reduce antibiotic resistance.

It urged health professionals to be aware that there were many causes of leg ulcers, and although many ulcers are commonly colonised with bacteria, most leg ulcers would not be infected. Also, antibiotics do not promote healing if a leg ulcer is not infected.

The consultation period will end on 23rd July.

Outgoing CMO to Join Fight Against Antimicrobial Resistance

Continued overuse of antimicrobials has led to Prof Dame Sally Davies's appointment as UK special envoy on antimicrobial resistance (AMR).

The Department of Health and Social Care said that the outgoing Chief Medical Officer, who is an international expert in the field, would be "driving forward the UK's world-leading strategy" and advising the UN in her role as co-convenor for the Interagency Coordination Group on AMR.

Dame Sally said: "AMR is a complex challenge which needs local, national, and global action.

"The UK should be proud of its world-leading work on AMR. We have made tangible progress but it is essential we maintain momentum."

ViV-TAVI

The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for aortic bioprosthetic dysfunction was supported by available evidence, NICE said.

In final guidance, an appraisal committee described the procedure as "technically challenging" and said that it should only be carried out in specialised centres and by clinicians who had training and experience in complex endovascular interventions.

Parastomal Hernia

Evidence on the safety of reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia showed there were serious but well-recognised complications.

Due to limited evidence, the procedure should not be used except where special arrangements were in place, NICE said in final guidance.

'Lack of Evidence' for Heart Failure Treatment

Cardiac contractility modulation device implantation for heart failure should only be used for research purposes because of a lack of evidence on its efficacy, NICE said.

Implantation had been considered an option for people with advanced heart failure that had not responded to conventional therapy.

The treatment, in which a device similar to a pacemaker is implanted in the right or left pectoral region, raised no major safety concerns, NICE appraisers said in final interventional procedures guidance.

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